The Supreme Court of the United States recently ruled to strike the Patient Protection and ACA’s requirement for health insurance plans to cover the total costs of contraception. The American Nurses Association (ANA) released a statement about their disappointment in this ruling.
We interviewed Cheryl Peterson, MSN, RN, the ANA Vice President of Nursing Practice and Work Environment about ANA’s stance and what this ruling means for the nation.
Why is ANA disappointed in the recent ruling of the Supreme Court to strike down the Patient Protection and ACA’s requirement for health insurance plans to cover the total costs of contraception?
ANA firmly believes all people have the right to determine how and in what form they receive health care. This recent decision from the Supreme Court affects millions of women and health care consumers who have depended on this mandate to offset some of the costs of reproductive health care. For some people, contraception can be a considerable expense. During this COVID-19 pandemic, many people are furloughed or receiving a limited income. Therefore, they may have no choice but to go without contraception health services.
Why is ANA taking a stand on this?
The American Nurses Association (ANA) has advocated for not only nurses, but for quality health care of all people—for decades. With regard to the recent SCOTUS decision on the ACA contraception mandate, we must ensure that all women and health care consumers are provided equal access to quality health care and are provided the proper counseling. All patients have a right to make their own decision about their medical care and treatment.
What do you think is going to happen to the women who counted on this coverage? Why? Do you think this may result in more unplanned pregnancies?
Unfortunately, many women are already facing tough economic challenges due to the COVID-19 pandemic. These women might have to compromise other necessities to obtain contraception coverage or may even have to sacrifice their own reproductive health because they simply don’t have the financial means to obtain these health services. The latter scenario could possibly lead to unplanned pregnancies.
What can be done to help them? What can nurses do in their proverbial “own back yards” to help these women?
Nurses can use their voices to educate women on what their best options are for affordable, quality reproductive health care, which includes contraception and contraception counseling. Nurses can also provide insights and advice on types of contraception for women with particular health needs and concerns.
What kind of challenges is the Supreme Court’s ruling going to cause?
Decisions regarding reproductive health and family planning are inherently personal. The outcome of this ruling jeopardizes a women’s ability to collaborate with her trusted primary health care provider or see the same practitioner for follow-up visits. In addition, this could result in reduced access to crucial and medically necessary health care services and the further exacerbation of health disparities.
Are there any other places that may cover the cost that remains for contraception?
Title X family planning programs have a decades long history of bridging gaps and providing comprehensive family planning and preventive health services to individuals needing access to these services.
Milestones are a big deal, and they are often times of celebration. Throughout July, that’s exactly what the Board of Certification for Emergency Nursing (BCEN) has done. This month marks the 40th of the Certified Emergency Nurse (CEN) as well as of the emergency nursing specialty certification. What makes this all even more significant is that the CEN was the first emergency nursing specialty certification offered anywhere in the world.
“As emergency medicine was becoming recognized as a specialty, emergency nurses formed the Emergency Department Nurses Association (today’s Emergency Nurses Association) and in the mid- to late-1970s recognized the need for a certification program for emergency nurses. Thanks to the forethought and efforts of the association and some extraordinary nurse-pioneers, the Board of Certification for Emergency Nursing (BCEN) came into being and several years after its creation was purposefully separated from the professional association to become a fully independent certification body,” explains Janie Schumaker, MBA, BSN, RN, CEN, CENP, CPHA, FABC, the Executive Director of BCEN, which is based in Oak Brook, Illinois.
Taking that first CEN exam was much different than it is today. “During BCEN’s first full year of operations in 1980, the very first emergency certification exam was offered on July 19 at over 30 sites around the country, including Alaska,” says Schumaker. “More than 1,400 RNs took the four-hour, 250-item, pencil-and-paper exam. After waiting several weeks for notification by mail, 1,274 nurses received the news that they had passed and became the first RNs to earn the Certified Emergency Nurse (CEN) credential.
“While BCEN has operated independently from ENA for many decades, we support each other and strongly believe professional membership and board certification are both important for RN success and to advance nursing excellence across every nursing specialty.”
Two years later, in 1982, that number of nurses who held the CEN had increased to 6,000. By 2005, 23,000 nurses held a CEN. By the end of 2020, BCEN expects to have 40,000 CENs.
“As the years went by and emergency nursing knowledge and patient care needs evolved, for instance with the introduction of medevac flights and taking into the consideration the unique physiology of pediatric patients, BCEN developed and introduced certification programs for flight nurses, the Certified Flight Registered Nurse (CFRN®) in 1993, the Certified Transport Registered Nurse (CTRN®) in 2006 for critical care ground transport nurses, and the Certified Pediatric Registered Nurse (CPEN®) in 2009. BCEN’s newest certification, introduced a little over 4 years ago (in 2016) is the Trauma Certified Registered Nurse (TCRN®) for nurses who practice across the trauma continuum from prehospital care to rehabilitation and including injury prevention. This is our fastest growing certification program, which is not surprising given that trauma is a major public health issue affecting people of all ages,” says Schumaker.
And BCEN keeps making sure that nurses can learn more. This past May, it began offering its first certificate program BCEN EDvantage.
Schumaker, a certified nurse, says that she is sure the skills she learned through becoming certified saved lives. “Once the connection between my knowledge, the care I was providing, and the correlation to studying for the Certified Emergency Nurses exam was clear to me, I became a lifelong certification advocate. I have since become certified in other areas of practice that have been a part of my career. Certification has helped ensure I have the knowledge and expertise to do the best possible job in my given role,” says Schumaker. “To me that is huge because I want to be a strong contributor and make a difference.”
In 2001, Noriyuki Matsuda, CEO of Sourcenext, realized a need—people wanted to be able to understand others when they didn’t speak the same language. He wanted to create a mechanism that could do this. But at the time, the hardware and software to make this happen didn’t exist. What he envisioned would eventually be known as Pocketalk.
By early 2020, Pocketalk launched their latest device. When COVID-19 hit the United States, the company started a relief program that donated 850 Pocketalk devices to first responders and health care providers on the front lines.
Matsuda talked with us about their relief program and how Pocketalk has helped so many across the country during this stressful time.
Why did Pocketalk feel it was needed to come up with a relief program?
Creating connections and enabling conversations is at the heart of why I founded Pocketalk. Before coming to the U.S., I saw people firsthand in Japan using Pocketalk to hold conversations in different languages and break down cultural barriers, reaffirming our need to take Pocketalk to the rest of the world.
Japan was one of the first countries affected by COVID-19. I started to think about the true mission of Pocketalk, after witnessing the impact the pandemic was having on our communities. And then, I saw the Diamond Princess cruise ship quarantined at Yokohoma, where Pocketalk helped staff members provide information and updates to concerned passengers quickly and accurately.
I wanted to—we had to—do more to help others during this time of need, and that is what led to the creation of our relief program.
We initiated the Relief Program in the U.S. in March because we knew we had the resources to be helpful for hospitals and first responders, and we wanted to give back during this global health crisis by providing translation services to those in most need. We set out to donate 600 Pocketalk Classic units to qualifying medical facilities, first responders, testing sites, and those in need of translation services. Units were given out on a first-come, first-served basis to those that applied through our website, with a maximum of three units per organization.
Over the course of just three weeks, the Pocketalk Relief Program saw widespread interest from all corners of the U.S. and officially donated more than 850 Pocketalks to qualifying applicants in 41 states to aid in the fight. We hope to be able to continue to give back to the medical community, especially during this time of great need.
Explain to our readers what Pocketalk is. How does it work? How many languages can it translate?
Pocketalk is a multi-sensory, two-way translation device. With a large touchscreen, noise-cancelling microphones and a text-to-translate camera, Pocketalk is able to create connections across 74 different languages. It’s equipped with high-quality, noise-cancelling microphones and two powerful speakers so it’s easy to have full conversations, even in noisy environments. The camera instantly recognizes and translates text, the written word, and signs. A large touch screen provides a text translation for additional clarity.
It seems that Pocketalk was initially designed for businesses/companies. Has it been used by health care workers from the start or did that come about because of the COVID-19 outbreak?
While we appeal to a variety of businesses and individuals who travel for both work and leisure, we knew we also have the technologies capable of helping many people in important industries to perform crucial day-to-day tasks. This includes teachers in our education system who work with students and parents who may not speak English as a first language, medical professionals and first responders who need quick, accurate translations on the job, and flight attendants who require translation services when assisting passengers.
Over the last few months as our world has changed, the need to share Pocketalk with health care professionals and first responders, as well as other industries, has grown immensely. Prior to COVID-19, Pocketalk was already in use at hospitals across Japan—including at the National Cancer Research Center and Ehime University General Hospital—to handle the influx of hospital visits by foreigners.
Pocketalk has also been increasingly used in the classroom by teachers and by volunteers in Minneapolis helping on the ground during recent protests and cleanup efforts. As these opportunities became more apparent, we wanted to do our part to give back to those making differences in their communities.
How has Pocketalk been helpful to first responders and medical professionals?
There are many beneficial features and aspects of Pocketalk offering critical value to medical professionals during the coronavirus outbreak. Our handheld translator is designed for accurate two-way communication at the touch of a button, reducing the time needed to communicate with patients. With the ability to translate 74 languages addressing 90% of the world’s population, Pocketalk also ensures that medical professionals can communicate with most, if not all, potential patients that come to their facilities in an emergency. While Pocketalk is able to support translation in emergencies, it can also be used by medical professionals to help with daily tasks, such as talking with family members of patients and communicating with patients who need assistance throughout the day, such as the need for an extra pillow or a meal.
Most importantly, Pocketalk eliminates the need for a human translator, reducing any human translators’ risk of exposure to COVID-19 and other contagious diseases. By dedicating ourselves to developing a product that is accurate, quick, and efficient in high-risk situations like those in the medical industry, we are trying to do our part to keep people safe and well-equipped to handle any translation challenges.
Do you have any anecdotes you can share about how they’ve made a difference?
After conducting our relief program, we did hear back from a number of members in the medical community about how Pocketalk has made a difference on the job after only a few weeks.
One respondent, an advanced emergency medical technician, told us that he was able to use Pocketalk to attend to and triage three different patients—who were native Vietnamese speakers and the other a native Spanish speaker. “What typically took 30 minutes, only took five minutes,” said the respondent.
An emergency medical specialist has spoken about Pocketalk’s immediate impact in the ER, noting how much easier it is now to talk with patients for quick reassessments and during critical moments without having to call a human translator. They said, “It’s in my whitecoat pocket on every shift.”
Is there anything else about Pocketalk or your relief program that you think is important for our readers to know?
As our world continues to tackle COVID-19, we are identifying other ways in which we can help other communities in other industries. Translation services are in higher demand right now not just within the medical community, but within other industries. Translators without Borders recently gave community organizations open access to their services, after receiving multiple requests from local organizations and nonprofits that need to translate information for their non-English speaking community members.
In addition to medical professionals, Pocketalk relief units were also given to members within other industries to help with translation needs. While most units were given to doctors and nurses in hospitals, a number of units were also given to workers in fire departments, law enforcement and pharmacies.
This is a time for us to come together as one voice made of many languages to help each other through the power of connection.
Starting now, medical professionals and first responders can purchase a Pocketalk Classic for $129 ($70 discount) using the special code MinorityNurse70 at discount–while supplies last.
Black Lives Matter. These three words have been used countless times in protests and in the media. As a result of the protests, more people are talking about racism and how it affects people who are BIPOC (Black, Indigenous, and People of Color).
Many nurses have experienced it. We interviewed three Black nurses to listen to their experiences with racism, learn how to begin conversations about it, and how allies can help.
Shantay Carter, BSN, RN, founder of Women of Integrity and best-selling author of Destined for Greatness, and nurse of more than 20 years, encountered racism back in nursing school. She recalls that some instructors would “try to wean students of color out of the program.” “I had instructors accuse me of cheating on tests or tell me that I would never become a nurse,” says Carter. Early in her career, she says, “I had patients say that they didn’t want a colored nurse taking care of them…I have had patients call me the N-word or threaten to hit me….I also experienced medical providers speaking down to me because they assumed that I am dumb.” Carter also got asked, “Are you the nurse?”
Bianca Austin, RN, BSN, CCRN, has been a nurse for 19 years. She works at an inner-city Level I Trauma Center as an intensive care nurse and is also a Major in the Army Nurse Corps, U.S. Army Reserves. Austin recalls an instance in which she and three other nurses, all dressed alike in navy scrubs, were waiting for their assigned rooms. The pod leader made the assignments based on having three nurses on duty. She had to be told that Austin was a nurse, even though she was dressed like the other nurses and wore a badge with her credentials.
Glenda Hargrove, BSN, RN, owner of Pill Apparel, has been a nurse for 11 years. She says that once a patient didn’t want her as their nurse because she is Black. Another instance occurred when she was the only Black nurse working on a unit and also the only nurse who was never invited to after-work staff outings. “At first, I tried to brush it off—until even the new nurses were invited, and I was not,” she says.
We asked all three nurses to weigh in on their experiences with racism and how to start the conversation.
If nurses experience racism, what would you suggest they do? How should they react?
Carter: “In situations where the patient is being really disrespectful, I have asked another nurse to care for that patient. As a nurse, I don’t have to be subjected to or tolerate someone’s ignorance. I also make sure to know the policy when it comes to escalating a situation to management. Knowing my rights as a nurse and employee of the institution that I work in is very important. If you encounter racism, I strongly recommend that you make your manager aware and HR if necessary. Racism and any other forms of discrimination should not be tolerated at any institution.”
Austin: “Use it as a teaching moment. Always be gracious.”
Hargrove: “There is really no easy way to answer this question. Racism has different types—it can be overt or covert. As the nurse, we have to always remain professional because like Michelle Obama said, ‘When they go low, we go higher.’ In some medical spaces, there is no one else who looks like you or even believes racism is occurring. As nurses, we are taught to advocate for our patients, but when experiencing racism, you have to essentially advocate for yourself and your right to practice in a racist-free clinical setting.”
How can nurses start the conversation about racism—and this may be different with patients, coworkers, and facility management? What steps should they take to make sure that if racism occurs, it doesn’t continue.
Carter: “As nurses, we have the power to create change. In order to have a discussion about racism, the hospital, community, and country has to be willing to talk about implicit bias, and system oppression. Joining an employee resource group or (BERG) is a great way, to encourage employees and leadership to come together to address the issues that are affecting their employees and finding solutions to make the workplace a better, more diverse, and safer environment for all. There also have to be policies in place to address those issues and have training on Diversity & Inclusion as well as on Implicit Bias. The culture and tone have to be set by the hospital leadership. Racism is something that can’t be tolerated or accepted.”
Austin: “The steps to take to make sure that racism is stopped is to not let an opportunity pass by to educate someone. Kindly let the person know the offense and explain why you were offended. They would tell us if we said something to offend them.”
Hargrove: “Nurses must start the conversation about racism by acknowledging the African-American nursing pioneers. Every nursing student learns about Florence Nightingale, but the majority have no idea who Mary Mahoney is. She was the first African-American Nurse to work professionally in the United States in 1879. When I started the brand, Pill Apparel, the mission has been to educate and acknowledge Mary Mahoney and her historic contribution to our profession.
“If racism occurs the only way to make sure it doesn’t continue is to NOT ignore it. Don’t let racism be the ‘elephant in the room’ but acknowledge it in order to learn from it and prevent it in the future.”
How can the community at large be an ally or offer support to BIPOC nurses in these situations?
Carter: “The community at large can be our allies by calling people out on their racist behavior towards others and standing with them in solidarity. BIPOC nurses would appreciate their friends and colleagues to stand up for them. We have to come together as one in the face of adversity. Just because you are not a BIPOC nurse, doesn’t mean you can’t fight against what’s morally and ethically wrong.”
Austin: “The facility I work for makes annual statements that they encourage diversity. It is a major player in the community with many business alliances. I would like to see more recruitment of BIPOC nurses, starting in high school. I believe the University and the hospital could improve enrollment and employment of BIPOC nurses if they start at that level, and the community could offer resources such as money, opportunities for shadowing, and help with preparation for nursing school.”
Hargrove: “We all know the difference between right and wrong. Martin Luther King Jr. said it best, ‘The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.’”
Travel nurses are in great demand right now, as they are helping to relieve frontline workers during COVID-19. While health care facilities are doing everything they can to make environments safe, there are still specific risks that travel nurses are dealing with during this pandemic.
Georgia Reiner, Senior Risk Specialist, Nurses Service Organization (NSO), gave us the latest information about what’s happening with travel nurses, what the risks are, and what they can do to protect themselves.
Are hospitals throughout the country calling on travel nurses to relieve frontline workers? Is the main purpose to alleviate burnout of the frontline workers?
Travel nurses are in high-demand across the United States as hospitals work to treat surges of coronavirus (COVID-19) patients. This crisis arrived at a time when nurse staffing was already a concern due to a multitude of factors, including the growing health care demands of an aging population and nurses aging out of the workforce. Therefore, the demand for travel nurses seems to be primarily driven by a need to build up hospital capacity to handle the influx of COVID-19 patients.
Data from different staffing platforms show that throughout the pandemic, travel nurses are in highest demand in areas most impacted by the coronavirus, like New York and Washington State, and certain nursing specialties like ICU/Critical Care, ER/Trauma, and Med/Surg.
Certainly, as the pandemic continues, the sense of burnout among health care workers will intensify, and travel nurses will likely play an important role in helping to alleviate burnout.
This is a different situation for travel nurses. One risk is checking licensing in different states. What can travel nurses do to be sure that their license transfers? If it doesn’t, but frontline workers are still needed, are exceptions being made?
Before deciding to accept a job, nurses need to ensure that their licenses will allow them to practice in that state/jurisdiction. Multi-state licenses are available for nurses who meet the requirements, which include elements like background checks and education criteria. Temporary licenses are also an option—these are generally reserved for travel nurses who have accepted a job in another state and are awaiting their permanent license.
During the nationwide public health emergency due to COVID-19, some statutes and regulations regarding licensure portability may be relaxed or waived, so it is important for nurses to be aware of what the requirements are both during and following the emergency period. The National Council of State Boards of Nursing (NCSBN) has compiled information about the nurse licensure compact and emergency action taken by states, which is a great starting place for information.
When travel nurses are thrust into an unknown situation in a hospital/medical center that isn’t familiar to them, and they are working with systems they’re not familiar with, what’s the best way for them to cope? How can they avoid burnout themselves? Please explain.
Working in a new environment is inherently stressful. Getting used to new processes, technologies, hospitals layouts, and new people can be overwhelming under normal circumstances, and can be amplified during a crisis like COVID-19. Travel nurses should make sure to take time for self-care to preserve their mental health. This is a stressful time for everyone, so don’t be afraid to reach out to colleagues with questions and for support. Failing to make an effort to cope with these rapid changes can have a negative impact on personal wellness and patient care.
What about a nurse’s scope of practice? what can nurses do to make sure that they are acting in the scope of practice? What if the facility allows them to do more than their own state? Does their scope of practice relate to the state they’re in or the one they’re licensed in, or both?
As the COVID-19 crisis rapidly evolves, travel nurses may be given patient assignments outside of their typical practice areas and locations. When faced with situations that exceed the scope of practice for the state in which they are practicing, or the skills or knowledge required to care for patients, travel nurses, like all other nurses, should develop and implement proactive strategies to alleviate unsafe patient assignments. Nurses need to advocate for patient safety and for their nursing license by speaking up if an assignment does not fall under their scope of practice.
When the assignment is within a nurse’s scope of practice, but not within their realm of experience or training, saying “no” to the assignment could lead to dismissal. At the same time, if the nurse does not feel they are equipped to handle the assignment, they could potentially put patient safety at risk. In these scenarios, nurses should tell their supervisor that they have very limited experience in that area and should not be left in charge. The nurse should describe the task or assignment they don’t feel equipped to handle, the reason for their feelings, and the training they would need to be more confident and better prepared.
What changes have occurred during COVID-19 regarding travel nurses and the risks they face that you think should be permanent either for the near future or forever?
Currently, there are certain state and federal regulations, declarations, and orders that extend liability immunity in the fight against COVID-19. What’s not clear at this time is the breadth and scope of these regulations and orders.
For example, it is not clear if these orders and declarations extend to all providers in all areas of service or if such immunity will be limited and specific to certain types of health care providers. Since there is lack of clarity in terms of immunity, it is prudent for nurses to not presume they have any immunity.
Further, plaintiff’s counsel can file a lawsuit, immunity or no immunity, if the plaintiff’s counsel believes the client was injured and that injury was the direct result of the nurse or other health care professional providing or failing to provide professional services. In the best-case scenario, the suit brought against the nurse will be deemed baseless and their malpractice insurer will work to get the suit dropped/dismissed.
Is there any other information that is important for our readers to know?
The COVID-19 pandemic is still evolving, and there is much we still do not know about the virus. All nurses should continue to follow the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) for updates and guidance to help prevent the spread of the virus and protect themselves and their patients.