With the recent groundswell of the MeToo movement concerning sexual harassment and power inequity, it’s no surprise that industries across the board are reevaluating their working cultures. Health care is no exception and the recent Time’s Up Healthcare movement is gaining attention.
The movement began as a response to the Time’s Up Foundation’s widespread success at promoting safe and healthy work environments and calling attention to how power plays a role in harassment people experience in the workplace.
Time’s Up Healthcare’s website states a mission “to unify national efforts to bring safety, equity, and dignity to our healthcare workplace.” The organization, in partnership with organizations such as the American Nurses Association, American College of Physicians, and the Council of Medical Specialty Societies aims to call attention to the disparities in health care workplaces and the undue burden that kind of culture can carry.
When nurses work in an environment where they are concerned about their own safety or that of their colleagues, the quality of care they can give to patients can be disrupted. The distractions caused by an environment where sexual harassment is either accepted or present but expected to be ignored are enormous. Health care workers in those situations can feel the implications of that stress physically, mentally, and socially.
Instead of being able to concentrate on giving the best care possible, health care workers must constantly weigh the risks. They are required to take the temperature of their workplace and wonder what kind of retribution might happen if they speak up. The cost of speaking up could mean losing their job or even enduring additional threats.
Workplaces like this are entirely unacceptable. Time’s Up Healthcare is shining a spotlight on what’s happening and why it needs to change. The movement is hoping to also build a support network where people who are impacted by harassment at work can go for resources and direction. They also hope to promote an awareness around the issue and exactly the kinds of situations or scenarios that might fall under this kind of problem.
With that aim, the organization hopes to help eliminate this problem. Through education and trainings, harassment and power inequity can be challenged, examined, and eliminated.
Harassment is not okay. Nurses and other healthcare workers deserve better. Their patients deserve better. Time’s Up Healthcare is taking that big leap.
If you are one of the many Americans whose savings plan has been impacted by a smaller-than-expected tax refund this year, it might be a good time to consider changing your financial planning approach.
Lots of people consider the tax return windfall they get every spring as an unofficial savings bonus. In reality, it’s a poor way to save money. The government ends up having your money until you file your taxes. That money does nothing for you while the government holds it. It’s not earning any interest, and it’s not being used to invest in any kind of growth fund.
A more sustainable plan is to make a better estimate of your tax withdrawals so you can retain control of that extra money. You can decide how to invest it so you earn money. Even if you are only earning a small amount, the funds are gaining something they otherwise would not.
Whether you are a new employee just signing up for your withholding or a long-term employee ready to make a change, it only takes filling out one form, the Employee’s Witholding Allowance Certificate or W-4, to change your withdrawal amounts. If you are unsure of how many deductions to claim, you have lots of options to learn about how to handle your money.
Organizations like the National Association of Personal Financial Advisors offer consumers resources to help find what they need. You might just need some advice on how to use your money wisely instead of getting a lump-sum tax refund. Or maybe you’d like to know your options on how to do that and also use your latest pay raise to start or add to a retirement plan. Often a fee-only advisor, who will not earn any commission on products or services, will discuss the best options for your personal situation.
The Financial Insdustry Regulatory Authority website contains valuable information about investing, understanding certain financial brokerage processes, and the difference between financial products and professionals. Websites like The Motley Fool, Kiplinger, or Bankrate give both novice and advanced consumers information they can use. Whether you need information on multiplying your savings for retirement, figuring out how much you can afford for a mortgage, or consolidating your credit card debt, you can get reliable, accurate information if you know where to look.
Once you are armed with information, you can decide if hiring a professional is your next best step. Generally a few hours with a fee-only advisor will pay for itself several times over. They can help you save thousands of dollars while also showing you how to take steps to grow your money, too.
While that boost of cash at the end of tax season is welcome, with a little planning, you can make it even better. And the more control you have over your own money, the better off you will be.
From a student nurse deciding on a career path to a seasoned nurse looking to advance into administration, each step along a nurse’s career is filled with questions. Fortunately, mentors in the nursing industry are becoming a more visible presence.
The Nurse Mentorship Program at Stanford Health Care is one such valued and valuable mentoring program. Introduced in 2004 for graduate nurses, the program now encompasses a range of nurses in different areas of their careers.
Minority Nurse spoke with associate chief nursing officer for inpatient services and magnet program director at Stanford Health Care at Stanford University Anita Girard and with Stanford’s program manager of nursing excellence Kevin Tsui about the distinct benefits of this kind of program.
Girard and Tsui say many nurses seek mentoring for varied reasons. They might seek leadership advice or they might want guidance for switching specialties. Still others may be looking for assistance with specific tasks such as writing or giving a top-notch presentation at a conference.
Any nurse can gain from a mentoring relationship, says Girard, but a specific benefit is one that will help a nurse professionally and personally. “The biggest benefit is the networking nurses have being in a mentoring program,” she says. “Mentoring opens you up to a whole new world.”
Tsui agrees and notes the satisfaction nurses reap from establishing a firm footing in their careers and having someone who can help guide them. The resulting good feelings lead to happier nurses, and the benefits stretch far. “Those mentoring connections streamline goals, build positivity and retention, and nurses feel a sense of control,” he says.
Nurses, says Girard, can feel siloed. Despite being in the same profession, nurses have varying specialties and may not have opportunities to hear from nurses in different areas. Mentoring includes both the one-on-one discussions and the larger access to others in the industry that becomes available. “Mentoring gets you out of that box,” says Girard.
So how does a mentoring relationship benefit the nurses and their organizations? According to Tsui, “It’s crucial. By sharing an organization’s mission, vision, and values, it makes transparent the format for mentoring,” he says.
Nurses in a mentoring relationship within the same organization are working within the same culture, so are able to set clear goals and create objectives that are going to be important to the nurse’s career within that organization and in the larger industry. Often, says Girard, mentors will give guidance based on what they already know about the organization. They will be able to help a nurse put priorities in order for certification, advancement, skills development, and personal improvement.
Mentors are also able to be objective about a nurse’s path, so they can help nurses align their goals and use their own knowledge to help a nurse achieve those goals, says Tsui.
A mentoring relationship is definitely a give and take, says Girard. “You really need to make an effort to understand why you want to get into a mentoring relationship in the first place,” she says. And mentees need to make a solid commitment and understand that any mentoring activity needs to be given top priority, she says.
Mentees are responsible for reaching out, setting up clear timelines, and even using tools to streamline online tasks such as emails and calendar appointments. Any communication should have an agenda with clear and succinct ideas and questions. By doing this, the mentee shows the mentor clear goals and intentions mean they have a goal for mentoring and that it will be productive.
Tsui says that sometimes mentees are not clear about the process and expect the mentor to initiate or complete tasks for them. Instead they need to keep in mind they need to be committed to change and driven to use the guidance of the mentor to advance their goals.
At Stanford Health Care, the mentoring program satisfies a magnet hospital requirement, but the benefits have been extensive. “We are driven to excellence,” says Girard. “It is a journey of innovation and inquiry and what we can do to make things better.”
There is no denying that a mental health stigma exists. People who suffer from depression, anxiety, obsessive thoughts, or even psychosis sometimes feel the pressure of that stigma so greatly, they fail to talk to anyone about it and, in effect, deny themselves treatment that can help them feel better.
Nurses have a pulse on this particular health issue that makes patients feel especially vulnerable. On May 30, everyone is invited to join a Twitter chat about mental health issues hosted by the American Foundation for Suicide Prevention. At 2 pm EDT, you can use #MHMChat to follow and participate with many top associations and organizations who are closing out Mental Health Awareness Month with the conversation.
Mental Health America is an excellent resource for nurses who want to refer their patients to ways they can take steps for better mental health or also to find ways to improve their own. Those interested in finding out steps they can take to care for their mind and body to help support mental health will find suggestions through the Fitness4Mind4Body campaign. Tips on diet and nutrition (like ensuring proper nutrition and even the importance of certain vitamins and minerals) or the role of stress in mental health can offer effective pointers.
As a nurse, you can ask questions and really listen to your patients to determine if they are struggling with mood changes or psychological struggles. Maybe they don’t admit to feeling sad, but they comment about snarling at colleagues. Or a patient who admits to having trouble sleeping and then can’t get out of bed in the morning for work or other commitments might be trying to reveal information without admitting to mental health struggles. Still others, who might feel a general unease or fear for example, might not even know they are having real problems that can be helped with treatment.
This is also a good time to take stock of your own mental health. Nurses are under enormous stress on the job and don’t always get a chance to eat well, sleep much, or exercise at all. All of those factors can contribute to compassion fatigue, anxiety, depression, and a general decline in mental health.
Luckily, as many work to reduce the stigma of mental health issues, help remains available. Even for patients who live in remote areas, help can be found online or over the phone if they have those connections. The National Institute of Mental Health offers information for getting help that can be accessed by many.
As the month comes to an end, reach out to people in your life to help them if they are struggling. If you are struggling, show yourself some compassion and get help. The results can be life changing.
Few nurses have a solid grounding in personal finance about making decisions about their own financial future. Money management can be overwhelming. But you don’t need to learn the fine points of microeconomics – just the fiscal facts that pack a wallop on your wallet.
The good news is that the economic outlook for most nurses is rosy. Employment prospects are strong, says Donna Cardillo, RN, nurse entrepreneur and inspirational/motivational speaker. “The job market for nurses is much better. The market is cyclical and always has been. The last slump lasted about seven years, but that has all changed and many employers are now offering sign-up bonuses,” she explains.
The bad news? Many nurses still struggle to lead financially empowered lives, rather than being slaves to debt or just getting by paycheck to paycheck. Here are nine ways to make powerful personal and career decisions.
Evaluate an Employer’s Salary and Benefits Package
Often nurses decide to accept a job offer based only on the hourly wage, without being aware of the entire salary structure and how it can drastically pump up your pay.
Jon Haws, RN, CCRN, nurse educator and founder of NRSNG, wrote a popular article about how he doubled his first-year earnings as a new nurse. In “How I Made Over $70,000 My First Year as a Nurse (how I learned to game the system),” he recounts his experience as a newly graduated critical care nurse at a Level I Trauma center in Dallas, Texas.
According to Haws, that article “is a bit dated and I realize the $70,000 is nothing to a California nurse, but I outline some step-by-step ways to really maximize what you can make right out of school.”
Some of his steps included grabbing the pay differential for nights and weekends, getting an automatic raise after 6 months and a year, and working overtime and bonus shifts. That strategy requires that you make yourself an expert on your HR department or union contract rules, of course, which may be difficult before you’re hired. Not every employer is transparent about its pay policies. It’s easy enough to check Payscale.com or Salary.com for comparisons. Also, be sure to consult with a tax professional about the ramifications of higher compensation—you want to be ready when the tax bill arrives.
“The benefits package is something that employees don’t always take into consideration, but it can be significant,” says Launette Woolforde, EdD, DNP, RN-BC, vice president for nursing education and professional development at Northwell Health in New Hyde Park, New York.
She encourages nurses to plan for the next step of their education and especially note those related benefits. “Some organizations offer employees some sort of tuition reimbursement plan. When you get a job and get through adapting to your new role as nurse, that’s the time to take advantage of those benefits.”
According to Woolforde, some organizations provide employees with a discounted rate or deferred payment options for a number of nursing schools. “So a $500 a credit may be reduced to $400 a credit and the student isn’t invoiced until after the class is over. By then the tuition reimbursement will have kicked in so students don’t suffer out of pocket expenses that disrupt their cashflow,” she says.
In addition, many organizations pay a stipend or differential based on a nurse’s educational achievements. “For example, let’s say the salary is $50,000 a year to start, but if a nurse has a bachelor’s degree, they may add $5,000 a year. If you’re certified they may add even more,” she explains.
Decide on Your Financial Priorities and Make Every Step a Learning Point
There may be a sunny employment outlook for nurses, but you still have to earn and save to fund your priorities. Not every nurse will have the same financial needs and not every nurse will experience life transitions in the same order. Yet, there are some goals, such as starting a family, buying a house, or early retirement, which many nurses aim to achieve and can—with some work on their inner and outer game.
“I made $35,000 or $45,000 my first years in nursing and had to figure out a way to increase income or reduce spending,” says Brittney Wilson, RN, BSN, nurse influencer at TheNerdyNurse.com. “I opened the door to those possibilities.” Wilson carried $40,000 in student debt that she now believes was avoidable, if she’d lived at home, attended a community college, worked a part-time job, etc.
As a young wife and mother, she tried many methods to economize, as she wasn’t emotionally able to work more hours at the bedside. “One example, I tried extreme couponing and was able to take our $600 grocery bill down to $100. I had to figure out a way to get diapers and formula for my baby,” she explains. Wilson started her blog a couple of years later, mainly for personal expression, but she also started getting free products and fees from brands. “People kept offering me money but initially I felt some guilt about it,” she says. “When I came to terms with it and actively decided to monetize my blog, I hung the ‘I’m available to be paid’ shingle directly, and even more offers came in.”
As Wilson felt more and more confident that she was providing a valuable service, she increased her ad and consulting rates, and focused her blog on her nursing specialty. “Earning extra income is like walking down a hospital hallway. It’s a journey. You can open each door and look around or keep going down the path. Just keep opening doors until you find the one that is right for you,” she advises other nurses.
Wilson got so good at earning and saving that she and her husband are on-track to pay off their house mortgage in a little over five years.
If you’d like to get better at the nuts and bolts of budgeting, bill paying, and tracking various financial accounts, you may want to try apps and programs like Mint.com. By corralling everything into one place, you get a better handle on your spending and saving, and can see in charts and graphs how well you’re doing with your finances.
There are also minority personal finance experts you can follow for advice from someone who figuratively speaks your language. For example, African American pros include Michelle Singletary, who writes “The Color of Money,” for The Washington Post and syndicates. Or, if you prefer podcasts, Rich Jones and Marcus Garrett host Paychecks & Balances for Millennials aiming to pay down debt
Decide When to Make Major Purchases
Even if a purchase is appropriate for your life stage, try to minimize your total household overhead. Even well-paid nurses risk fatigue from worry or overwork to manage bills and payments for one-time splurges or ongoing financial commitments.
Woolforde encourages nurses to carefully consider whether a major purchase is a sound money investment. “I see this often—the first thing a nurse graduate buys is a flashy, brand new car, as a reward for all that hard work in school. A flashy new car is nice but it’s a rapidly depreciating item as opposed maybe holding out for a down payment on a new home that appreciates for a good long-term return,” she explains.
You might decide that your next major investment will be in your own higher education or specialized training. If so, be sure to take advantage of employer-provided assistance programs before taking out large student loans. Maybe your current workplace has a tuition reimbursement plan if you’ll commit to working there after graduation, but you hesitate to limit your options. Find out how often graduates using that program decide to stay with that employer; usually the figure is high. If your circumstances and goals match theirs, you’re likely safe in taking the same route.
So many students lament how little they knew about educational loans that a free interactive game called Payback was created by a financial literacy non-profit. The makers warn: “College can help you realize your dreams, unless it leaves you with a student loan nightmare.” Students navigate an online maze of decisions: What school to attend, what major to declare, whether to focus on studies for a higher GPA or social life for more connections, etc. At the end, if a player does decide to borrow educational funds, it’s with eyes wide open.
Choose a Specialty That’s Fulfilling—And Remunerative
Whether you’re a new nurse graduate or you’ve been in the field for years, now might be a good time to switch to a specialty or workplace with better long-term prospects for pay and benefits.
Cardillo encourages nurses to explore non-traditional career options and to take risks. “Your next job may not pay as much, but may have many other advantages. When it comes to being a bedside clinical nurse in a hospital, there’s only so much you can make, even with overtime. Some other health care related industries have greater earning potential over the long run even if you have to take a pay cut in the short term,” she says.
Cardillo points to a variety of popular nurse settings and roles that pay well, such as: Nurse informatics, quality management nurse, corporate wellness nurse, insurance nurse, or nurse consultant.
You may also want to check out DiscoverNursing.com for interactive features that guide you through the process of choosing from scores of specialties. Some under-the-radar titles have surprising rewards, including high demand or ease of entry. You’ll get information on the education, training, and certification required to fill a role, as well as its average salary and employment outlook.
Decide to Cut Hours or Leave the Bedside Altogether
Reducing your hours to, say, care for a family can be a difficult choice that depends on many conditions, but it can be the right choice, if done right.
“If you opt to get out of the job market for a while, stay in touch with nursing colleagues through professional associations [and] keep up with credentials and licenses,” advises Cardillo. “Keep yourself current, marketable, and connected.” She warns that nurses who let their licenses lapse—accidentally or not—won’t be ready to jump back in when they need to or want to.
“Some nurses drop out of the workforce to take care of elderly parents, but then the parents die and they’re left with literally nothing and can’t find a job,” she warns.
Cardillo recommends that you first explore opportunities to work at home, which are more common today for nurses. If that’s not possible, check to see if your state allows for an inactive status license, rather than outright letting it lapse.
Another life stage when nurses may be tempted to let their license lapse is at retirement, but Cardillo sees downsides to that. “Nurses retire, but after so many years they get bored or financially need to work again because they don’t want a lower standard of living.”
Care for Yourself and Your Career Longevity
“Nurses are leaders—they advocate for their patients, but they struggle with advocating for themselves,” says Diane Neustadt, director of operations at New York-based Forest Hills Financial Group.
Her firm supports the National Association of Hispanic Nurses New York chapter, of which Neustadt is an active member. Because of her involvement with the chapter, she’s able to explain the importance of managing one’s own financial life in terms that nurses relate to. “I tell them it’s like being proactive about your own health. Nurses work long, unpredictable hours so self-care is so important: physically, emotionally, and spiritually. I’m a spiritual person and also know the importance of financial well-being—live one day at a time but not just for today.”
Neustadt believes in “protection first,” which means having enough insurance and the right kind. “Employer-sponsored benefits are a good thing,” she explains, “but not only may company benefits not be portable and go with you, generally those employer-provided benefits are minimum benefits and should be viewed as the base of benefits to build upon. Three areas that normally need attention are disability, additional retirement income, and long-term care.”
Make the Most of Expertise from Family, Friends, and Coworkers
Woolforde received informal money mentorship from two unexpected sources who guided her to become financially savvy. The first was her older brother, who went to college when she was in her senior year in high school and was surprised at the expenses beyond tuition that he hadn’t anticipated. “When he came home at his first break he told me frankly, ‘You’re going to have to get scholarship money if you plan on going to college.’ So, we spent countless hours in the library combing through books and catalogs looking for scholarships. That was before everything was available online.”
She was doubtful about her ability to garner scholarship funds—others will have a higher GPA, more financial need, better applications. “At first, I said, ‘there’s no way I’m going to get it’ and he said, ‘you don’t know until you try,’” she explains. After piecing together several small scholarships—$600 here and $2,000 there from various sources—Woolforde was able to fund her freshman year at a commuter college. Good grades allowed her to garner full scholarship funding for the rest of her bachelor’s degree in nursing.
Woolforde next got valuable advice from a nurse preceptor who insisted they visit the hospital credit union after one shift. “She helped me open a retirement account and set up direct deposit of part of my paycheck into that account. I was just starting my career, so retirement was the farthest thing from my mind as a 21-year-old,” she says.
Try to find a money mentor who understands your situation and connects or relates to you in that way, advises Woolforde. “My brother understood the home situation and my preceptor maybe recognized me as her younger self—she was an African American female, too. Everyone who has walked this path, grown in professionalism, grown in a nursing career, it’s our responsibility to share what we’ve learned,” she says.
Make the Most of Your Employer’s Financial Programs
Your organization may offer employee benefit education, such as having an HR representative provide short updates at staff meetings, or making a vendor available for one-on-one consultations. Take advantage of these resources if they can help you fill in the financial puzzle pieces of your life.
“My family emigrated from Armenia when I was nine years old,” says Anna Dermenchyan, RN, MSN, CCRN-K, senior clinical quality specialist in the Department of Medicine at UCLA Health and a PhD student at UCLA School of Nursing. “At the time, my parents didn’t know the language or the culture, and thus we struggled financially as a family.” When she worked at a bank as a senior in high school, she learned about financial concepts and became more proactive about managing money.
Dermenchyan now actively engages with the University of California system’s excellent financial program for employees and students, which include onsite classes as well as live webinars on financial wellness and retirement.
“I’m an early Millennial and we think about work-life balance and living in the moment, and this necessarily doesn’t help us save enough money for the future. We want to earn, spend, travel, and just enjoy life,” she explains. “However, financial health is part of achieving wellness and maximizing potential benefits for the future. Just like with Maslow’s hierarchy of needs—personal finance is at the basic level, and everything rests on it.”
Most nursing schools don’t include a financial component in the curriculum, so many workplaces fill in the gaps with seminars, consultations, and program “nudges” to encourage fiscal health. “At first, I just put in $100 a month towards retirement; that’s what I could afford after paying loans and family expenses,” says Dermenchyan. “The automatic deduction from each paycheck makes it easier, and some institutions make a matching contribution. In addition, I was advised by a financial consultant that with every salary increase, I should increase my contribution to retirement,” and she has continued to ramp up her rate of saving and investing.
Prepare for Retirement
Some nurse leaders point to numbers of disengaged older nurses who are forced to continue working because of under-funded retirement plans. They didn’t put aside enough money for the future, and early social security payouts at 64 are too small to support even modest lifestyles.
“Nurses are unlike other caring professions—police, firefighters, and teachers—because they don’t earn pensions from municipal government employers,” says Ric Edelman, a #1 New York Times bestselling author of personal finance books such as The Truth About Money and The Truth About Retirement Plans and IRAs. “That puts their financial future in jeopardy.”
Edelman is also the founder of Edelman Financial, one of the nation’s largest independent financial planning firms. His firm offers a free financial plan to nurses, waiving its customary fee for the two-meeting process—either in person or via teleconferencing—which results in recommendations for investments, insurance, estate planning, and more.
By starting the process toward financial stability and independence, you can empower yourself as an earner, saver, and investor. It is possible to experience the feeling of security that comes from having your financial life firmly in hand. This moment is the best time to take that first step.
A paper or electronic patient health care information record serves two major purposes: communicating information both within and outside the practice and creating written history in the event of later questions or challenges. Complete, accurate, and legible health care information records document all phases of medical treatment, including the care plan, laboratory and diagnostic testing, procedures performed, and medication provided.
The new Nurse Practitioner Claim Report: 4th Edition from CNA and Nurses Service Organization (NSO) analyzed 287 closed professional liability claims against nurse practitioners (claims that resulted in an indemnity payment of $10,000 or greater) over a 5-year period. The report’s analysis revealed that the majority of claims against NPs resulted from an alleged failure involving core competencies, and demonstrates that nurse practitioners are responsible for reviewing, following up on, and documenting the results of appropriate tests and consultations in a timely manner.
The following general principles of documentation can help the practice maintain a consistent, professional patient health care information record:
- Ensure that hard-copy notes are legible and written and signed in ink, and also that they include the date and time of entry.
- Avoid subjective comments about the patient or other health care providers.
- Correct errors clearly by drawing a single line through the entry to be changed.
- Sign and date the correction, as well as the notation giving the reason for the change.
- Do not erase or obliterate notes in any way. Erasing or using correction fluid or black markers on notes may suggest an attempt to purposefully conceal an error in patient care.
- Document actions and patient discussions as soon as possible after the event. If it is necessary to make a late entry, the entry should include the date and time, along with the statement, “late entry for ______” (i.e., the date the entry should have been made).
- When dictating notes, include all vital information, such as date of dictation and transcription. Sign transcriptions and write the date of approval or review.
- Never alter a record or write a late entry after a claim has been filed, as this may seriously compromise legal defense.
- Develop a list of approved abbreviations for documentation purposes. Review and revise the list as necessary and at least annually. In addition, maintain a list of error-prone abbreviations that should never be used, such as this one from the Institute for Safe Medication Practices.
- If using a form, complete every field. Do not leave any lines blank.
Furthermore, to help nurse practitioners avoid this segment of risk, nurses should ensure their practice has a written policy governing documentation issues, and all staff members are trained in proper documentation practices. The policy should address, among other issues: health care information record contents, patient confidentiality, release and retention of patient health care information records, and general documentation guidelines.
And while rare events may be difficult to prevent, nurse practitioners can glean lessons from the experiences of their colleagues to help evaluate and enhance their own patient safety and risk management practices.
Disclaimer: This article is provided for general informational purposes only and is not intended to provide individualized business, risk management or legal advice. It is not intended to be a substitute for any professional standards, guidelines or workplace policies related to the subject matter.
This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to [email protected] or call 1-800-247-1500. www.nso.com.