In early December 2021, I was seeing a physical therapist for a shoulder injury. During one of my visits, the therapist was alternating between me and another patient on an adjacent bed, who had a knee replacement. While the therapist worked on the other patient’s leg, stretching it and bending the knee, I eavesdropped on their conversation.
The patient was in pain, anxious to complete the hard part of the therapy. The therapist was encouraging him to keep working. At one point the patient expressed a desire to quit. The therapist responded “Te queda una semanita más.” This translates to “You have a short week left.” The patient agreed to continue.
By adding the suffix “ita” to the word “semana,” – or week – the therapist offered the patient a perspective on how much therapy remained in a way that sounded shorter, even though it was still a full week.
This ability to minimize or exaggerate a situation by simply adding a suffix is one feature of the Spanish language that could contribute to a striking resilience in health that researchers have documented in Hispanic populations in the United States, called the “Hispanic Paradox.”
As a Hispanic quantitative psychologist, I have been involved in research on stress and cardiovascular health at the University of Miami since 1988. More recently, I joined the Hispanic Community Health Study/Study of Latinos as an investigator. This observational study of over 16,000 adults documents the health of Hispanics of various backgrounds in four urban communities in the U.S.
Stress also contributes to heart disease. How people react to that stress is important, too. The extent to which our language facilitates how we process our emotions in response to stress may therefore be important in heart disease. For that reason, the Spanish language may offer an advantage. Having lived a bilingual life, I believe this to be true.
Family ties alone can’t explain the Hispanic Paradox
I became intrigued by this phenomenon when I joined the Hispanic Community Health Study in 2008. My first attempt at finding an explanation for the Hispanic Paradox led me to investigate whether the family unit might offer some protection against early life stress.
In that work, I estimated the prevalence of adverse childhood experiences in Hispanics in the U.S. If the family was a source of resilience, I expected to find low rates of experiences of abuse, neglect or family dysfunction. But to my surprise, the prevalence of these adverse events was actually quite high in those populations. In fact, 77% of the target population reported experiencing at least one adverse childhood event, and about 29% reported experiencing four or more before the age of 18.
That led me to the realization that the source of the resilience seen in the Hispanic Paradox did not necessarily come from the safety net of family.
Exploring how culture could contribute
I next turned my attention to other cultural resources such as social support and optimism, factors that may buffer the impact of stress.
Is the Hispanic culture more optimistic than the American culture? Having an optimistic view can help people think about stress as being temporary and manageable. Optimism can make a person feel they can cope with stress.
I came across a paper on the positivity of human language. The researchers had developed a “happy index” that they applied to measure the number of positive words in a variety of sources from several different languages. They analyzed books, newspapers, music lyrics and tweets, for instance.
A figure in the paper showed the distribution of the happy index across sources and languages. The result was startling. The sources with the highest happy index ratings were those in Spanish!
In other words, the rich and positive emotion lexicon of the Spanish language may not only influence culture over time, but also influence our emotional reaction to stress.
The contribution of verbs
However, it may not only be the positive words that are contributing to better cardiovascular health in Hispanic populations. There are other features of the language that facilitate emotional expression.
Take, for example, the two forms of the verb “to be.” In English, we simply “are.” But in Spanish, we can be a certain way temporarily – “estar” – or more permanently, “ser.” This comes in handy when considering negative situations. In English I could be overweight. In Spanish I can be permanently overweight, which translates to “ser gorda,” or I could be temporarily overweight, or “estar gorda.” The latter is transient and entertains the possibility of change, which can itself encourage motivation towards change.
Spanish is one romance language that makes use of the subjunctive form of verbs. The subjunctive expresses hypothetical situations, wishes and possibilities. For instance, consider the “magical realism” of the Colombian author Gabriel García Márquez. His use of the subjunctive facilitated the possibility of alternative realities.
The Spanish language’s ability to minimize and exaggerate by the simple addition of a suffix also increases the range of emotions and perceptions. This is how the therapist in the example helped his patient persevere through a difficult phase of therapy.
While English is the language of science – precise and succinct – my hunch is that the flowery nature of Spanish contributes to a culture that supports emotional expression. In doing so, it can help its speakers manage the responses to stress.
During Oncology Nursing Month, oncology nurses and the specialty they work in are honored and highlighted. Oncology nurses work with patients who have dealt with a cancer diagnosis–whether years ago or more recent. No matter when a patient hears they have cancer, the words are startling and set in motion treatment and care plans, family discussions, and life adjustments, while also triggering some powerful emotional responses.
Typically, a nurse cares for the health of a patient with cancer, but also understands that the patient’s diagnosis touches many lives especially that of family and friends. Oncology nurses understand their very special role and help their patients process varied health issues, have hope for the future, and have compassion for the often grueling road of cancer treatment.
While many oncology nurses work in centers and offices devoted to cancer treatment and care, there are also other important and challenging roles they can explore on different career platforms.
An oncology nurse may work with cancer treatments such as radiation and chemotherapy as they monitor and care for patients on treatment days. Nurses in this role will continually assess the patient’s response to the treatment, notice and track changes, answer questions and provide relevant information, and be a calm and strong presence for patients. Nurses may choose to treat different ages of patients–from the youngest infants with cancer to the very oldest patients. Oncology nurses have a special ability to be compassionate and empathetic as they are driven to understand the journey each patient faces and help make that journey easier by providing support. Oncology nurses may also find they are drawn to helping cancer patients with hospice care to make them as comfortable as they can.
A clinical research nurse works within a research team to advance cancer treatment, prevention, and eradication. Clinical research nurses may take a variety of roles, each of which may touch a different aspect of the research project. Nurses can act as educators, provide clinical care to research participants, and provide nursing leadership for the research facility, among other responsibilities. With so many cancer trials happening, nurses can make a direct and immediate impact in areas that are of particular interest to them or in which they have special expertise.
Oncology nurses who have worked in cancer care and treatment have much-needed expertise to share with nursing students, colleagues, the public, and government officials. Oncology nurses may teach at the undergraduate or graduate levels to inspire the next generation of nurses to work in the field, and they may chair panels and seminars at conferences. They may give talks for younger students in high school who may not know about what oncology nurses do but are interested in a nursing career and want to help people who have cancer. Oncology nurses may help lobby and inform the state and federal government to increase cancer research funding or to influence the direct impact the government can have on helping people and families affected by cancer.
Oncology nurses may advance their careers and nursing specialty by joining professional organizations like the Oncology Nursing Society. They can network with other oncology nurses to exchange information about the latest developments in cancer care, to compare nursing processes, to take advantage of targeted professional development for oncology nurses, and to act as part of a larger body of advocates for the field and the patients they care for. Nurses who join professional organizations can take on leadership roles to guide projects and advocacy and reevaluate standards in the public and private sector.
Nurses who find a good fit in this field are generally fascinated by brain science and all the different implications that brain health and brain injury have on a person’s daily life. Neuroscience nurses help patients who may have a brain disease, like Alzheimer’s or Parkinson’s, or who may have brain injuries resulting from a car accident or a fall or from an aneurism or infection. Neuroscience nurses also work with patients who have had a stroke or have multiple sclerosis.
Neuroscience nurses work with patients to help them stabilize if they have had a brain injury and to manage the everyday impacts of brain injury and disease. They may work in recovery and rehabilitation to monitor progression and to encourage patients and families as they take the journey to recovery or, in some cases, to manage a progressive disease. They may also work in an inpatient or outpatient facility or in the OR. Frequently, nurses in this role develop long relationships with patients and their families. As people recover from or progress through the impacts and symptoms of brain injury or brain disease, these nurses are a sounding board, a resource, and a champion of their patients.
Because the human brain is incredibly complex and any brain injury can have a major impact on the way the body functions, a career in neuroscience nursing is challenging. Nurses in this specialty must remain current in all the latest research in brain science and in the rapidly advancing technology that helps patients with brain injury or diseases. While patient care is generally the primary focus in the career, nurses who are fascinated by brain science can also choose to lead research, may hold leadership and teaching roles in academia, and may advocate for the patients and nurses who are impacted by brain health.
The American Association of Neuroscience Nurses (AANN) is the professional organization for nurses in this specialty and is an excellent resource for both novice and veteran neuroscience nurses. Nurses can connect with others in their field, learn about educational opportunities, find out about conferences, and have access to job openings. Because neuroscience nurses have a complex specialty, the network of nurses in the field can act as a nationwide resource for puzzling cases or to hear about groundbreaking research being done around the globe. Nurses might also reference the World Federation of Neuroscience Nurses to see what’s happening in the field worldwide.
Neuroscience nurses know that brain health can change everything from a patient’s physical health to their psychological health and so they must be able to adapt to changing conditions rapidly and calmly. As they gain experience in the field they develop valuable knowledge and capabilities that positively impact the patient and the larger health team. While the challenges are constant, so are the rewards.
To be a nurse, one must possess many different skills, with clinical judgment –the ability to think critically and make quick decisions that impact patient outcomes – being one of the most important. Another increasingly important skill is technology literacy, or the ability to use, understand and manage technology. Elsevier’s recent Clinician of the Future report found that 53% of U.S. nurses believe that technology literacy will become their most valuable capability over the next ten years, ranking higher than clinical knowledge.
The report also found that 54% of U.S. nurses predict they will draw on tools utilizing artificial intelligence to inform most of their clinical decisions. However, 69% of U.S.-based nurses report being overwhelmed with the current volume of data available and 84% of nurses in the U.S. predict the widespread use of digital health technologies will represent an even more challenging burden in the future. Despite these concerns, 59% of nurses in the U.S. still agree that the widespread use of digital health technology will enable a positive transformation of healthcare.
While use of technology in the healthcare setting is not without challenges, I believe it has a net positive benefit, particularly providing nurses with tools and information to enable rapid critical thinking and sound clinical judgment in patient care. I propose three ways higher-education institutions and health systems can maximize technology throughout a nurse’s career.
Utilize Education Technology (EdTech) Solutions
A nurse’s career journey begins in the classroom, and it’s during this time they develop the foundation for clinical judgment and critical thinking they will use throughout their careers. New and emerging forms of educational technology solutions, such as simulation-based and virtual-reality (VR) scenarios are providing students with an immersive way to learn skills in a safe and standardized environment. In these realistic patient scenarios that integrate the latest evidence-based research and education content, nurses can build confidence through practice on digital patients in a virtual environment that encourages exploration, adaptation and the development of critical reasoning skills.
Shadow Health, a suite of simulation learning products, features a diverse patient set representing various backgrounds with different health concerns. This conversation-based solution allows students to respond to many patient scenarios, while developing clinical judgment skills and practicing therapeutic communication. These innovative forms of education technology are already having a profound impact on how students absorb information. A recent study on the efficiency of patient care skills for nursing students in programs that use Shadow Health found that 82% of learners showed an increase in overall efficiency and 68% were better equipped to identify the number of correct care plan components.
Make the Transition to Practice Easier
As nurses make the transition from nursing school to practice, they are entering an increasingly demanding and complex environment. In addition to patient care responsibilities and keeping up with evolving care guidelines, nurses must also update electronic health records (EHRs) and handle time-consuming administrative work. These stressors can result in high turnover rates, with some hospitals seeing novice nurse turnover as high as 35%.
Learning how to balance these responsibilities can be overwhelming and may be contributing to more patient-related errors for new nurses. According to research from the National Library of Medicine and The Online Journal of Issues in Nursing, 40% of new graduate nurses reported making medication errors, and 50% reported missing signs of life-threatening conditions. The industry can better support nurses and ensure they are always practice-ready by providing technology solutions.
Providing novice nurses in a hospital setting with simple-to-use tech-based reference and communication tools enables safe, practice-based development of their patient care competency. Nurses can rely on these resources when they have questions or are unsure of procedures, supporting the ongoing development of their critical thinking skills and reducing patient care errors.
Provide Continued Professional Development on Digital Health Technology
While a nurse’s journey begins in the classroom, ongoing education remains critical throughout their career. The Clinician of the Future report found that 79% of U.S. nurses believe that training and ongoing education needs to be overhauled so they can keep pace with technological advancements. While resident nurses may have been exposed to emerging forms of technology during nursing school and are more comfortable with digital solutions, nurses who have been in-practice for decades may not be as comfortable using unfamiliar technologies.
Healthcare leaders must identify where nurses need the most support and provide continued professional development to ensure nurses at all levels are comfortable using digital health technologies. Hospitals, health systems and nursing organizations can provide solutions for nurses throughout their careers to enable technological proficiency and support critical thinking during patient care. These resources ensure nurses have access to the latest guidelines and evidence-based treatment pathways, empowering them to make more informed, confident decisions and driving better patient results.
At the same time, it is crucial for leaders to be thoughtful about the technologies they are considering deploying and to take the time to understand the benefits of any solution under consideration. A study published in the Western Journal of Nursing Research found that the use of telehealth to manage certain diseases, such as Type 2 diabetes and hypertension actually worsened nurses’ workloads and led to twice as many activities completed by nurses. To gauge the impact new technologies will have on nurses, administrators may want to consider issuing employee surveys or informally gathering feedback, which is also a great way to show nurses that their voices matter in choices being made by the organization.
The last few years have shown us that nurses are invaluable to the healthcare industry, and it’s imperative that we provide them with tools for success throughout their entire career. Technology is going to continue to play a major role in healthcare. Healthcare leaders and educational institutions can use technology to their advantage, but they must provide current and future nurses with development opportunities to enhance their technology skills.
Diversity, equity, and inclusion (DEI) are hot topics in the healthcare world, but including a DEI module in our yearly education isn’t enough to address these issues. Policy is a valuable tool, but actual change needs to come from a more personal level, from each and every staff member.
Before we can have a meaningful conversation about DEI that might lead us toward significant change, we need to understand the meaning of diversity, equity, and inclusion and why it is important in healthcare.
First, the issues often relate to our biases, especially those so deeply ingrained in our life circumstances that we aren’t aware of them. We can’t advocate for what we don’t understand, and if we don’t advocate for change, we will stay in our “safe” silos, which only strengthens the idea that we are separate and different.
Understanding that we are separate and different and what that means is the first step in making diversity, equity, and inclusion a part of our workspace and nurse recruitment.
Diversity is simply including people with different backgrounds. For example, when healthcare systems conduct nurse staffing while considering different cultural, gender, religious, sexual orientation, and socioeconomic backgrounds, the staff benefits from exposure to differences among coworkers, and patients feel more comfortable knowing they aren’t alone.
Our healthcare system has been lacking in diversity from the beginning, and although we’ve seen a lot of progress since the days when only white males could practice medicine, we are far from diverse.
In one study, over 56% of physicians identified as White and 64% as male, according to the Association of American Medical Colleges (AAMC). According to Minority Nurse, about 75% of RNs identify as White, and 91% are female. So if most doctors and nurses are white, most doctors are male, and most nurses are female, who are we really serving?
When we don’t have a common background, it’s easy to make the mistake of seeing the patient through our own lens instead of their reality. Our lenses place them where we want them to be—fully able and capable of taking the steps we want them to take for their health. The outcomes we desire assume the tools, processes, and understanding are within their reach and that they have the same goals we do.
Textbook knowledge can never make up for the lack of diversity in our own lives. And our lack of understanding of our patients’ reality can lead to misunderstanding or errors in care, creating inequity. Hiring a diverse workforce promotes understanding and creates a more comfortable environment for patients and coworkers alike.
Equity is a concept that often gets confused with equality. In healthcare, equality means giving everybody the same resource or opportunity to achieve their health goals. Equity is recognizing that each person has different circumstances and honoring that by allocating opportunities and resources to allow them to reach an equal outcome.
Simply giving someone an opportunity isn’t enough if they don’t have the means to use it. Equity can only be achieved when nobody is allowed to be disadvantaged due to age, race, ethnicity, nationality, gender identity, sexual orientation, geographical background, or socioeconomic status.
Access to life-saving medication is an example of inequity we see every day. A medication that costs hundreds of dollars every month may not be out of reach for someone with superb insurance coverage and a large bank account. For someone whose job doesn’t offer prescription coverage or who doesn’t make a living wage, that life-saving medication is technically available but far out of their reach. Far too many patients fail to fill the prescriptions they need for this reason.
Healthcare policy can promote equity, but we can also change how we treat and educate patients. In our medication example, we could address a patient’s ability to obtain a prescription before they leave the office or hospital. No patient should walk out the door with a prescription they can’t fill.
Inclusion is about deliberately creating a respectful and safe environment for all staff and patients. Inclusion means giving patients and staff a voice in giving and receiving care and encouraging diversity. Healthcare isn’t the place for a one-size-fits-all approach. We must all strive to embrace diversity and promote equity.
Nurses Are Uniquely Positioned to Champion DEI
Nurses may have little say in enacting policy within their healthcare systems but are very likely the first and last staff member a patient sees and the role they interact with most frequently. That close relationship with our patients makes nurses the most important role to champion diversity, equity, and inclusion with our patients, in nursing education, and within our own workspaces.
One of the most essential directives we learned in nursing school may have been to meet patients where they’re at. Let’s add and coworkers to that and, together, we can create a more effective healthcare system that serves all people.
Today’s healthcare landscape has been riddled with hardship and systemic shifts. Large-scale downward trends were highlighted by the COVID-19 crisis, but originated beforehand and will require massive effort to reverse.
Unfortunately, the brunt of these inefficiencies and problems falls disproportionately on certain portions of the medical professional family. One primary example of this is the way problems in healthcare affect nurses. The rising stresses and demands on nursing professionals have initiated a drastic nurse staffing crisis, emptying the nursing ranks across the country, and creating significant employment shortages.
According to the Bureau of Labor Statistics, vacant nursing positions across the United States hover at almost 200,000 openings each year. A number of problems are contributing to this reality and need to be resolved.
1. Nurses Are Often Unreasonably Responsible for the Weight of Patient Advocacy
Historically, nurses have often taken the lion’s share of responsibility for patient advocacy. This can refer to calling for fair and adequate treatment, helping other medical professionals understand the particulars of patient cases and needs, mediating and safeguarding for vulnerable patients, and more.
However, this burden can cause a significant amount of stress, especially when a nurse feels that they are advocating for patients’ needs in the face of apathy or even resistance from fellow medical professionals who might have differing priorities.
2. COVID-19 Requirements Drove Many Nurses Out the Door
COVID-19 requirements and vaccine mandates created huge turbulence for nurses across the medical landscape. Many that disagreed with requirements or how they were put into effect left the workforce. This created another large drain on an already depleted nursing population.
3. Workplace Stress is Compounded for Nurses – It Comes from Both Sides
Nurses often liaise between patients (and their friends or families) and fellow medical staff. When tensions rise; stressful or difficult situations bring out the worst in people; or priorities differ between stakeholders in a patient’s care, nurses can find themselves caught in the middle.
They often have to diffuse the stress exuded by patients, family, partners, and friends as well as helping navigate the stress and difficulties their fellow medical personnel experience. It’s an incredibly difficult job.
5. Current Inefficiencies of Healthcare System Fall More Heavily on Nurses
The nature of nursing roles means that when the medical field experiences turbulence or systemic problems, that uncertainty or strain inordinately affects nurses.
6. The Problem is Self-Propelling: Nurse Shortages Beget More Nursing Shortages
Burnout and the long-term stress of overwork is one of the most critical problems affecting the nursing population. When some nurses quit their jobs or leave a medical facility, or when open positions remain vacant for long periods of time, the existing workload falls on the nurses that remain.
This compounds the stress, overwork, and impossible expectations that remaining nurses experience, making it more likely that those remaining nurses will succumb to the stress as well and leave the workforce.
7. Pandemic’s Effects on Medical Training
COVID-19 created staggering difficulties for medical trainees across the board. Many nursing students that were in school during the height of the pandemic would have lost out on valuable class time or training weren’t able to complete parts of their coursework, or were called up early into the workforce to cover drastic needs and shortages. Many of these new nurses entered employment feeling unprepared and more susceptible to intense stress and burnout, thus ending up more likely to leave the field.
8. Average Nursing Age Looms Over Staffing Projections
The average age of nurses across the country was 50 years old in 2018. The current number of new nurses entering the workforce will not replace the large number of nursing professionals quickly reaching retirement age. If these trends do not change, projections are dire for how nursing shortages will increase over the next decade.
How to Correct These Issues
These large-scale realities are significant and systemic. It will take significant, intentional action to correct course and make the nursing profession more accessible and sustainable. If the healthcare system can take corrective action to lessen the stresses that fall on nurses, make their jobs more secure, and help spread the responsibilities nurses currently hold more collaboratively amongst other medical professionals, we can reverse these trends.