This past spring, Chenjuan Ma, PhD, and Amy Witkoski Stimpfel, PhD, RN, both assistant professors at NYU Rory Meyers College of Nursing, published a study in the Journal of Nursing Administration that examined whether working overtime can negatively influence how nurses collaborate with other nurses and physicians. In their study “The Association Between Nurse Shift Patterns and Nurse-Nurse and Nurse Physician Collaboration in Acute Care Hospital Units,” the researchers concluded that one third of all nurses work longer than they are normally scheduled, and as a result, their ability to collaborate decreases.
Drs. Ma and Stimpfel took time to talk about the study and its results.
Why did you decide to do this study in the first place?
Dr. Stimpfel: There has been increasing interest in how to manage shift work and overtime hours for nurses due to the impact of fatigue on patient safety and quality. Collaboration has been identified as being a factor that is influential in patient safety and quality as well. We know that our ability to work effectively and regulate emotions—key to collaboration—diminishes with increasing wakefulness and fatigue. We could not find literature to support the relationship between work hours/overtime and collaboration in the nursing literature, which is why we conducted this study.
It’s interesting that nurses who work regular shifts of 11.88 hours or longer regular shifts of 12.17 hours don’t have a decrease in collaboration. But if nurses working that first shift of 11.88 hours had to work a shift of 12.17 hours—which would mean overtime—they would have a decrease in collaboration. Did you discover why this happens?
Dr. Stimpfel: Our data did not detail why working overtime resulted in decreased collaboration. However, the conceptual model in our study helps guide our hypothesis about why this relationship occurs. As nurses work longer shifts, often unexpectedly, this increases wakefulness. Prolonged wakefulness can result in less ability to make decisions and regulate emotions, which may lead to greater difficulties in collaboration. As suggested by our findings, this is more likely to happen when nurses have to unexpectedly work longer than scheduled.
Does any amount of overtime cause problems with collaboration between nurses and other health care professionals?
Dr. Ma: With our current study design (i.e., observational, cross-sectional design), we were not able to detect the minimum amount required to lead to changes in collaboration. However, as the very first study of its kind, our study provided empirical evidence of a significant association between work hours/overtime and collaboration. Our current study suggested that one hour of overtime was associated with 0.17 decrease on the RN-RN scale. In other words, a 0.17 decrease from mean score of the RN-RN scale suggest that a unit’s rank on the RN-RN score would drop from 50th percentile to approximately 30th percentile.
Why is collaboration so important?
Dr. Ma: Collaboration is critical for quality care and patient safety. When working collaboratively, different parties in the patient-care team—including nurses and physicians—will share objectives, responsibility, decision making, and power to achieve patient care goals.
Previous studies have shown that patients receive superior care and have better outcomes in hospitals where nurses collaborate well with other health care providers. Without good collaboration among health care providers, quality patient care may be compromised.
Were you surprised by the results of your research?
Dr. Ma: Not really. Maybe the high number of nurses—one in three nurses—reported working longer than scheduled.
Do you have any suggestions for what should be done so that collaboration doesn’t diminish?
Dr. Ma: One highlight of our findings is the significant association between longer overtime and decreased collaboration. This finding suggests that one strategy to improve collaboration is to minimize nurse overtime as much as possible by a variety of means, better shift scheduling, and predicting and ensuring adequate staffing, etc.
Is there anything regarding this research that you think is important for readers to know?
Dr. Stimpfel: Our findings have broad implications, not just for nurses, but also for other health care providers who are at risk for shift work-related fatigue. Effective teamwork and collaboration are critical to patient outcomes, thus, managing shift work and overtime hours are important for the entire heath care team.
Of all the various facets of the nursing field, hospice, many people think, is the most emotionally difficult to work in. But Connie O’Malley, RN, a hospice nurse for the past three years at Gilchrist Hospice Inpatient Unit in Towson, Maryland, loves her work.
That’s not to say that the work isn’t challenging; it often is. But it also holds a lot of rewards.
How long have you worked in hospice? Why did you get into this area of nursing? What drew you to it?
I’ve loved hospice for more than two decades. I was a geriatric nursing assistant about 25 years ago and worked on one of the medical nursing home floors. A patient with metastatic bone cancer could no longer live at home, and there was no space on the inpatient hospice unit. His prognosis was approximately four to six weeks. He was 60 years old an army veteran and a really wonderful, beautiful human being.
When I first met him, I didn’t want to bond with him because he was dying. And so I put up a barrier around my heart and gave him good care, but was not my normal self like I was with other patients. I found this exhausting after only a week.
One day when his hospice nurse came to check on him, we spoke about this. I told her that I was holding back from getting to know him and love him because he was dying. But at the same time, I felt like maybe our paths have crossed for a reason. This hospice nurse said, “Don’t think that we don’t love our patients and grieve for them when they die. When we care for people in their homes, we are invited into their families. We sit in their favorite chairs and interact in their lives in a way that is different than any other kind of health care. We grow to love them, and when they die, we are sad. You are allowed to love him, and it is okay if you cry when he dies. You can’t have a meltdown where you need to be sent home or take a bereavement day. But if you go take a 5- or 10-minute break to cry on the patio, that is okay. You will find your own way to grieve the patients you lose—whether it is a special song you listen to on the way home or if you drive home silently. You will make your own way to grieve them and honor them. But please love your patients.”
Some people might say that working with those who are dying is depressing. Do you feel that way? Why or why not? What do you think you bring to people who are dying?
Working with dying people is an honor and completely humbling for me. I get to care for people when they are at the very end of their life, and for their families in one of the hardest parts of life’s journey. The majority of families open themselves up and allow me not only to provide my nursing expertise and care for their loved one, but also love the patient and their family.
When you care for someone for several weeks, nurses and staff become family to the patient and their loved ones. It is an honor that I am aware of every day that I work. It is much like being with a friend who is giving birth—it is a special place between this world and the next. To be able to help someone’s body be comfortable through the process and provide education and support and normalcy to their loved ones is an amazing thing.
When I first came to hospice, a dear friend told me he thought that it was such a depressing job. I don’t allow myself to focus on the fact that I lose patients. I feel the exact opposite—I get people. I get to care for people at their absolute most vulnerable state of being. I get to hold their families’ hands and help them learn how to let go. I get to give them education to make a terrifying situation less scary and a little bit easier. Every family changes my life, and I don’t feel that I lose them when they die. I feel fortunate that our paths have crossed and that I have been able to be their nurse at this time.
How do you keep your spirits up?
Being a hospice nurse is exhausting—especially in the inpatient setting. We care for people of all ages. Young people are especially tough on our hearts and minds, and sometimes when families are struggling, it wears on us.
To combat the heaviness that I carry, I make sure that when I am off work, I do things that make me happy and are relaxing. I’m a creative person. I like to crochet, and I make sure that I have projects to work on. I spend time with family and friends enjoying them. Simple things like getting coffee at a diner or spending the night at my mom’s apartment and watching movies together are priceless.
What kind of skills do nurses need to be able to work in hospice?
I came to hospice with four years of cardiac telemetry hospital experience. Despite our patients being at end of life, we use all of our nursing skills daily. We still have patients that have complicated care that needs to be given, so anyone with any kind of nursing background would do well. Very often a lot of people have the idea that everything is very low-key in hospice, but honestly there are nights that I am clinically busier than I ever was on a cardiac unit.
What are the biggest challenges of your job?
Families who fear medication interventions for comfort. Even though hospice has been around for 30 years, there is still a lot of fear around administering morphine and other comfort medications to patients. My biggest challenge is to educate families in what pain looks like and reassurance that medication does not accelerate death. The second biggest struggle is educating people about normal end-of-life occurrences—mainly the truth that everyone stops eating at end of life and that it is normal. A lot of families and visitors struggle when our patients stop eating.
What are the greatest rewards?
The greatest reward is to meet a family on their first day who is struggling with a terminal diagnosis for their loved one, and who are so resistant to any comfort measures and any education about what happens at end of life, and to watch them walk the path and see their minds and hearts change and grow in this process.
A lady was with us for 10 weeks, and all of the staff grew to love her and vice versa. When she was in her last few days, I approached her husband to ask for a good time to come say goodbye to her as I did not want to intrude on his and their daughters’ time with her at the end. He put his arm around my shoulder with tears in his eyes and said, “You come when you want to and as often as you’d like; you are family. Please tell all of the staff too. You have loved us all and become our family, and you are welcome at this time just as much as the last 10 weeks.”
If nurses would like to work in hospice, is there any specific training, certifications, or experience that they would need?
A valid nursing license in whichever state you want to work in. I would say that hospice is a field that a nurse has to be drawn to. It is intense and there is a lot of psychological and emotional weight that we carry on a daily basis. A large number of the nurses that I work with have had family members—parents especially—who have died under hospice care, and it seems that we seek out this work to repay that care that we received when our loved ones were dying.
Technology in health care is always changing and improving—this means faster, more accurate, and safer ways to do your job. Here’s the scoop on the latest and what’s coming in the not-too-distant future.
Technology has been making our lives easier throughout history. While some people are concerned that more efficient technology prevents nurses from spending time with patients, experts say that this couldn’t be further from the truth.
“There is a fear that technology takes nurses away from the patient to spend time at the computer. As interface capabilities increase, more time can be spent with the patient,” argues Nikkia Whitaker, MSN, RN, CCRN, clinical technology integration manager at Dayton Children’s Hospital. “Having systems work together to decrease multiple workflows and eliminate manual processes is what will help nurses appreciate the emergence of technology.”
Get Ready, ‘Cause Here it Comes
Remember when you were a kid and you wondered if eventually robots would take over the world? That’s not happening exactly, but robots are being implemented in health care. And don’t worry; your job is safe.
Both large and small technologies are revolutionizing the nursing practice in so many ways, says Divina Grossman, PhD, RN, FAAN, president and chief academic officer at University of St. Augustine for Health Sciences. “One example is the deployment of robots, such as those that deliver patient medications from the pharmacy to hospital units, automate the preparation of chemotherapy and other drug admixtures, take patient vital signs, deliver food to patient rooms, or transport linens throughout the hospital,” says Grossman.
Robots, though, are just a small part of what is going on technologically in health care. Grossman says that mobile technologies, used by themselves or with other technologies, can reduce clinical errors, improve quality and safety, and reduce the physical burden of care for bedside nurses. “Hand-held devices like iPhones with different apps can be used for accessing and charting patient information at the point of care; linking barcoded drugs, treatments, and patients accurately; communicating between patients and nurses across different rooms or areas; remotely detecting motion in bed of patients at risk for falls; and obtaining diagnostic test results at the bedside are a few examples,” explains Grossman. “The tasks of lifting, positioning, and moving patients—which historically have caused frequent back strain and physical injuries for nurses—can now be done using smart technology systems and can even be operated remotely.”
Cathy Turner, BSN, MBA, RN-BC, associate vice president of MEDITECH, agrees that the use of smartphones is part of an ongoing trend to help support nurses in their delivery of care. “Nurses do many different things during a shift of care, and they interact with patients in different ways. Sometimes a device such as a Workstation on Wheels is the appropriate vehicle for the workflow, but there may be times where something smaller may be less intrusive,” Turner explains. “Smartphone devices are able to deliver that flexibility. The smaller devices may be something nurses are already using for calls, secure texting, etc. Why not be able to do a quick medication administration using scanning and documentation tools fully integrated into the Electronic Health Record [EHR]? The other advantage to this type of device is that it is similar to a patient’s use of their portal from an app on their phone. This provides a nice opportunity to share what they are doing on their device on behalf of the patient and provides a teachable moment for the patient using the portal.”
But there are even more types of technology that can directly help nurses who are working with patients. “Wearable technology, telephone monitoring, and nanotechnology further expand the ability to monitor patients’ physiologic parameters—not just episodically as snapshots, but continuously for diagnostic, therapeutic, and clinical evaluation purposes,” says Grossman. For example, “with a noncompliant patient, a sensor can detect whether and when a patient took their medication and have the information transmitted electronically to a nurse through an app on a mobile device. Medication dosages can be adjusted commensurate with serum levels throughout the day; these can also be correlated with levels of blood pressure, heart rate, oxygen saturation, stress or anxiety measured by the same wearable devices,
EHR, an Oldie, but a Goodie
While EHRs aren’t exactly from the stone age, they are the most familiar and most widely used technologies in health care today. But they have also come a long way.
“[EHRs] and Point of Care documentation devices are probably among the most adopted technologies,” says Majd Alwan, PhD, senior vice president of technology at LeadingAge, as well as the executive director of the LeadingAge Center for Aging Services Technologies. “What is new: over the past couple of years, many of these technologies have undergone significant improvement through successive upgrades. They are now much more user-friendly, touch- and even voice-enabled, mobile friendly (to provide access through tablets and smart phones), and have better clinical decision support system, information exchange, and analytics capabilities.”
“Nurses typically spend more time with patients and contribute more information to the patient record than any other member on the care team. While this entails a lot of responsibility, there is also a lot of flexibility and freedom that comes from using an integrated EHR solution. An effective EHR gives nurses more meaningful time back with their patients, and results in less time on documentation,” says Turner. “While there is perception that EHRs are too complex and impede the patient/provider relationship, an EHR designed to support nursing workflows improves both the patient experience and the quality of care that the nurse can provide.”
Turner also says that nurses no longer just enter information and observations into their patients’ EHRs. In fact, EHRs actually give back to the nursing field. “[EHRs are] providing actionable data, clinical decision support, and surveillance tools that allow nurses to proactively meet the needs of their patients,” she says.
In addition, says Turner, EHRs can suggest problems to be addressed as well as the actions that can then be taken. “They can ensure that patient safety protocols are in place, allowing the nurse to focus on more of their time and energy on the patient,” she says. “Surveillance tools monitor EHR data and identify patients at risk. Nurses spend a great deal of time documenting the care a patient receives. The surveillance tools analyze that documentation along with lab results and other data, and push notifications and actionable items to the nurses, giving them that time back.”
These surveillance tools are also able to monitor many patients through watchlists and let nurses know who needs immediate attention. “Watchlists can be built around fall risk, sepsis, CLABSI, VTE, or other potential risks that may affect a patient’s health. These lists give back to nurses, saving them time and giving them the most up-to-date information needed to effectively treat their patients,” says Turner. “I remember reading a heartbreaking story of a parent who lost their child to sepsis. The words that stuck with me: the parent implored that clinicians ask: ‘What if it’s sepsis?’ Surveillance will ask. And direct, appropriate care actions can be taken.”
Learning Via Simulation
While nursing students will always work directly with actual patients before they graduate, the use of simulations beforehand enables them to practice different procedures safely and to learn about rare procedures or cases that they may not often see. “Students are able to learn in a safe environment and can pace their learning activities; not all students learn the same way,” says Nadia Sultana, DNP, MBA, RN-BC, clinical assistant professor and nursing informatics program director at NYU Rory Meyers College of Nursing. “Simulation centers have been planned to include technology that is similar to the work environment.”
Grossman gives an example of how simulation can help nurses learn without an increased risk for patients. “Nurse practitioner students can learn complex skills such as suturing or draining wounds, placing central lines, or inserting of chest tubes before they perform these procedures on live patients in real health care environments. Faculty also have the ability to create dynamic computer-based simulation scenarios to enable nursing students to learn how to adapt their clinical treatment decisions to fluctuations in the patient’s condition,” she says. “With simulation, the ‘patient’ can be of any age and racial background since human patient simulators can be infants, children, or adults and come in different skin tones and physical features. Through computer-based scenarios, simulated patients can become hypotensive, tachycardic, or hypoxemic, and nursing students can learn how to tailor or adapt clinical treatment decision accordingly.”
Students can also be acquainted with rare conditions via simulation. “They can learn how to assess those patients using simulators. For example, a student may not be able to encounter a live patient with Tetralogy of Fallot in the clinic during the semester, but he or she can auscultate, palpate, and assess the relevant findings using the Harvey cardiology simulator. This simulator can mimic 50 different cardiac conditions and also simulate any cardiac disease in a realistic way,” Grossman explains. “The ability to learn interprofessional practice and teamwork using simulated case scenarios like a post-disaster situation or an acute stroke patient in the ER with teams of students from multiple programs—nursing, medicine, PA, et cetera—is also possible with simulation. Thus, nursing and other health care students can learn how to communicate with each other and collaborate in the care management of an individual patient or groups of patients through simulation before they are assigned to care for live patients.”
An even more advanced type of simulation is coming—virtual reality—and both student nurses and experienced ones are going to be stunned with how realistic it will be.
“Virtual reality or augmented reality simulation…depart from the conventional treatment simulation with three-dimensional image data and computer software. Implementation of virtual simulation requires the ability to transfer the planned treatment geometry from the computer to the treatment room in a way which is accurate, reproducible, and efficient enough for routine use,” says Grossman. “Haptics are an example of virtual reality technology where the nursing student can do patient assessment and examination and feel the virtual patient’s skin and body, with the ability to perform clinical interventions. Using engaging and immersive technology like Google Glass or HoloLens, the student can feel being in the real-world health environment, move around freely, interact with the patient and others, carry out tests and treatments, and learn from their mistakes while in the lab or simulation center without compromising patient safety.”
Have no Fear
If the thoughts of working with some of this technology scares you, don’t worry. The facility will provide you with the training you need, and the technology will make health care safer and allow you more time with patients.
“It is easy to be afraid of change, but you must always keep in mind what is best for the patient. Put yourself in the patient’s position and imagine how much safer they must feel to know that so many systems are working to support their care,” says Whitaker. “Do not be afraid to advance. A nurse’s touch will always be valued and needed, but technology can help bring nursing care to the highest level.”
As the school year starts up again, we thought we’d share why nurses love what they do to help inspire prospective students to pursue this rewarding career. We asked each nurse why it’s great to be a nurse right now and they gave us many different reasons, but they all agree on one thing: being a nurse rocks!
Here are seven reasons prospective students should consider nursing.
“2018 is a great time to be a nurse. I’m a Clinical Nurse Educator for patients with chronic granulomatous disease, a rare disease that only 20 people in the U.S. are born with each year, and my job takes me around the country to meet with them in person—but we can connect virtually as well. I’m able to build great, personal relationships with my patients—and, having four children myself—being able to be there for patients like that means the world to me. Additionally, the resources available are incredible: connecting my patients and their caregivers with online social communities and others in the rare disease community who understand their experiences is so helpful in ensuring that they feel less alone. Witnessing this positive impact on their outlook on their condition is extremely rewarding.”
—Brian Coyle, BSN, MBA, RN MSCN, Clinical Nurse Educator at Horizon Pharma
“Nursing is future proof. A complex computer algorithm meant to replace nurse anesthetists like me for endoscopy procedures was recently pulled from the market, because robots can’t do this job. The ethical and bureaucratic hurdles have never been more challenging, so nurses feel useful and irreplaceable.”
—Nick Angelis, CRNA, MSN
“The best part about being a nurse in 2018 is having access to the best education, technology, and resources available, which allows us to pinpoint clients’ needs and help them achieve their daily goals and a better quality of life.”
—Eronmwon Balogun, RN, BSN, Skilled Home Care Nurse, BAYADA Home Health Care
“I’ve always had an overwhelming sense that I needed to help anyone I felt was in pain either physically or emotionally. I truly believe it’s within my soul—an innate gift. When I was an Army medic, I was in constant awe of my fellow soldiers—whether a medic, nurse, or MD—the camaraderie was powerful. I knew I wanted to pursue nursing as a career.
When I graduated nursing school, I began my journey in Oncology. Twenty-seven years later, I am still fortunate enough to be caring for the Oncology population. To this day, I still have that feeling in my heart and gut—the sense that has allowed me to become part of so many lives, and to help countless patients and families.”
—Kevin Flint, RN, BSN, MBA, OCN, Nurse Director, Vernon Cancer Center, Newton-Wellesley Hospital
“Today’s world is fueled by powerful women, and this is very evident in the nursing profession. You are never limited as a nurse because you can work anywhere you want—in a school, hospital, or even home setting. Nursing is an empowering profession that is in demand and can take you nearly anywhere you want to go.”
—Pamela Compagnola, RN, Clinical Manager, BAYADA Home Health Care
“In our high-tech world, as a nurse I love that I am still able to give a personal human touch to people in need of care. For me, the person-to-person connection is why I went into this field and brings me simple joy every day.”
—Lannette Cornell Bloom, BSN, RN, author of Memories in Dragonflies, Simple Lessons for Mindful Dying
“Nurses today have endless possibility and opportunity to really make a difference. We need to believe and be empowered that we do make a difference and that we are a big part of the health care system.”
—Rodilyn Glushchenko, RN, MSN, CCRN, CCNS, NE-BC, Nurse Director ICU, Hemodialysis and Cardiovascular Center, Newton-Wellesley Hospital
As increasing numbers of patients don’t speak English as their first language—or at all—the health care field is taking action. Here’s what’s happening and how you can become involved.
Imagine if you were in a hospital in a country where no one spoke English. Being in a strange hospital or other health care facility can be scary enough, but if you had no idea what was going on, it would make you more stressed—possibly making your health worse. You would feel incredibly vulnerable, as not knowing what was happening to you or if the workers could help you would be terrifying.
There was a time in the United States when that could happen. Although it shouldn’t happen, legally, anymore, as Allison Squires, PhD, RN, FAAN, explains, there is still a need for more bilingual nurses. “All health care facilities are required by law—including the Civil Rights Act and updated regulations in the Affordable Care Act—to provide patients who do not speak English with an interpreter,” says Squires, an associate professor at the New York University Rory Meyers College of Nursing. “The interpreter can be an in-person interpreter or a telephone or video interpreter to meet the requirements of the law.”
According to Squires, the increase in patients who haven’t developed English skills comes from two situations: the post-WWII legacy in which U.S. citizens came here as immigrants, and the most recent wave of immigration, which has matched or surpassed the immigration numbers of the early 20th century. “According to the Pew Research Center, one in five households in the U.S. speaks a language other than English at home. More communities are also becoming refugee resettlement cities across the U.S., which means increasing linguistic diversity in places that have historically only had English speakers,” says Squires. “The demand for nurses who speak another language is at an all-time high.”
Location, Location, Location
While all the sources whom we interviewed agree that Spanish is the most prevalent second language needed for patients, they also say that other languages are vital as well, depending on your region of the country. “Spanish is the priority language nationally. Other languages depend on where you live and who is migrating there,” says Squires. “For example, in the New York City and New England regions, there are now large numbers of Russian speakers. These individuals often come from former Soviet Union states where Russian was the official language. Other parts of the country, like Texas and Louisiana, have large numbers of Vietnamese speakers who came to the U.S. as refugees or immigrants. Other than Spanish, language demand is often specific to a local health care service area.”
“Spanish is the language in highest demand, particularly in Texas, California, Florida, and Illinois. In California, bilingual skills are needed for Spanish, Chinese, Vietnamese, and Russian,” says Terry Mort, who is manager of talent acquisition for VITAS Healthcare, the nation’s leading provider of end-of-life care. In the 14 states and the District of Columbia in which they provide care, VITAS Healthcare has also found the need for Mandarin, Cantonese, Tagalog, Hmong, Korean, and Creole.
“We constantly have to look at demographics of the communities we serve and pay attention to how they’re changing over time,” explains Mort. “Take California as an example. At one time, South Central Los Angeles was primarily an African American community, whereas today it’s predominately Hispanic. And as our services move into outlying areas of Los Angeles County, our needs change again because we encounter more families that are Filipino, Asian American, or Hispanic American.”
Currently, in South Florida, several VITAS hospice teams are solely Spanish speaking to appropriately serve their patients’ and community’s needs. “In California, a trilingual nurse—someone who speaks English, Spanish, and other language—would be in high demand,” says Mort.
Although particular languages may be needed to serve certain populations, there are also instances in which unexpected languages may also be required. For example, when there was a recent influx of patients from Puerto Rico at the University of Maryland Baltimore Washington Medical Center who needed health care after Hurricane Maria, there were more Spanish-speaking patients, says Edith Lopez Dobbins, RN. Dobbins is a JET Nurse, which stands for Just Excellent Timing and means that she is a full-time nurse who serves as supplemental staff for different nursing units throughout the hospital. As a result, she has noticed an overall increase in patients who speak Hindi and Korean as their first language.
“In the hospice profession particularly, we also have the challenge of end-stage dementia patients, who may revert to their language of origin as their disease progresses. We had a Russian patient who reverted to speaking Russian, but the family indicated he had not conversed in that language for more than 20 years. If that happens, it requires us to update our care plan so that our nurses and staff members can communicate effectively with these patients in a language they understand,” explains Karen Peterson, senior vice president and chief nursing officer for VITAS Healthcare. “The more languages our staff members can speak, the easier our job is.”
Benefits to Being Bilingual
Bilingual nurses on staff help open everyone up to another world as well as another set of patients to care for, says Vivian Carta Sanchez, DNP, ARNP, from Tenet Florida Physician Services. “Nurses who are bilingual can also serve as translators to communicate very important information from physicians who do not speak the language,” says Sanchez.
Squires says that if you work in a hospital, home care, long-term care, or rehabilitation, there are four key times when interpreters are needed—admission, patient education, consent, and discharge. “Using an interpreter during these times can help reduce your patient’s risk for readmission and complications,” explains Squires.
Having a nurse who is bilingual, rather than using a family member to translate, can be crucial. “Let’s say that I take five minutes to explain something in detail to a patient, and the family member who translates what I said to the patient takes about 30 seconds. I can tell that my patient isn’t hearing the same thing that I said—and that’s a risk to the patient, because they’re not getting complete information,” says Peterson. “It’s one of the reasons we prefer not to use family members as translators because they are part of the unit of care and also dealing with psychosocial issues associated with end of life.”
Another advantage to staffing or being a bilingual nurse is that when you are speaking the same language as a patient, the work you are doing will take the same amount of time that it does as when you are talking with an English-speaking patient, says Squires. There’s no need to be concerned about waiting for an interpreter to arrive or to have to deal with any issues that can occur when using an interpreter by phone. In addition, communicating with family members may also be easier. “That being said, as a bilingual nurse, if you are the first language nurse to work with the patient when they access health services—be they in the hospital, home care, or primary care—sometimes you spend more time with them initially because the patient is so happy to have someone who speaks their own language,” states Squires. “You find out all this other stuff that the patient held back because of the language barrier or issues with interpreter services. Another advantage of being a bilingual nurse is that you can quality check video or phone interpretation.”
Speaking to patients in their native language isn’t only about the words; it’s also about their culture. Dobbins says that while they use “language phone-lines” to keep at patients’ bedsides so that they, their families, and the health care workers can communicate—which is certainly helpful—the phones can also make talking more impersonal. “It makes patients and their families uncomfortable—possibly because it’s not just about language, it’s about culture. Most of the time, we use peers in the health care team who speak the same language as the patient for better communication and overall quality of care,” says Dobbins.
“Bilingualism is even more imperative in the hospice profession because there’s a lot of emotion and psychosocial aspects of language surrounding the dying process. Each person might have a different opinion or thought process around the issues related to dying. It’s unique in that people may have difficulty conveying their thoughts and feelings, even in the same language, simply because it’s about death,” explains Peterson. “Some patients or family members can’t even say the word ‘hospice,’ so they find a way not to say it. But when our nurses, families and patients understand each other’s language and cultural nuances, we’re more confident that patients are making the right decisions and receiving the best possible care because everyone understands each other.”
Knowing about patients’ culture has become so important that the Chamberlain University College of Nursing began offering a Hispanic concentration on its Phoenix, AZ campus in May 2016. Pam Fuller, EdD, MN, RN, the Phoenix campus president, states that this concentration doesn’t aim to attract Hispanic nurses, but rather to appeal to nurses who want to care specifically for this culturally diverse group. This concentration is offered to anyone who is enrolled in the university’s pre-licensure BSN program. Because of its ability to logistically provide clinical experiences for students who are enrolled in the Hispanic concentration, the Phoenix campus volunteered to pilot it. “The local hospitals and health care centers currently serve Hispanic patients and families every day, and Chamberlain helps provide nurses and care to these local communities,” says Fuller.
“Providing nursing care requires not just an appropriate educational degree and a license, but also crosses boundaries of human dignity and respect. Many, if not all, hospitals and care centers are challenged to communicate more effectively with their patients, regardless of cultural background. Chamberlain specifically launched the Hispanic concentration based on information from hospitals in our local markets,” explains Fuller. “When a patient is in pain or in need of health care, they tend to revert to what is comfortable to them, culturally. If you are culturally more comfortable with your own language and traditions, if there is someone who can speak—at least a little bit—the language you speak, it makes the care that much more effective and personal.”
“Chamberlain’s Hispanic concentration is not a language program. This concentration exposes students to the Hispanic language and culture and allows for 25% of their clinical experience to be placed with a Hispanic patient. This gives them real-time experience in serving the Hispanic population,” says Fuller. “Any student—regardless of their personal cultural background—may enter this concentration…The goal of the Hispanic concentration is to educate students and expose them to the culture and language of the Hispanic community to provide an improved level of care to this population.”
Attracting Appropriate Personnel
How can facilities go about recruiting bilingual nurses? Squires believes that a combination of actions could help. Nursing schools need to recognize local demand for bilingual services and restructure curricula to help ensure the success of English as a Foreign Language (EFL) students, says Squires. “Even now, EFL students have lower pass rates on the NCLEX-RN exam, and that’s not helping to meet our need for more bilingual nurses. Schools need to change how they teach and support EFL students so they have the same success rates as English speakers,” Squires says.
“Organizations should give bonuses to people who are bilingual to encourage better communication,” says Sanchez.
As for becoming bilingual, Squires says that to achieve the level of fluency to be able to effectively and safely communicate with patients about health issues, nurses would be required to undergo years of study or at least a six-month immersion in a country where the language that they want to learn is spoken. “Having just a few words or phrases can be helpful for recognizing when a patient is in pain or [has] toileting needs, but when it comes to the complex communication needs that go with admission for services, patient education, consent, and discharge, you really need to have what’s called sociolinguistic competence in a language. That’s something that your employer should help you certify or do it on your own to make yourself more marketable,” says Squires.
At the end of the day, being bilingual or having bilingual nurses on staff is all about patients’ safety and comfort. “As a nurse, many of my most rewarding moments have to do with going the extra mile to help a Spanish-speaking family during their hospital stay,” says Dobbins.