Cross-Training for Workforce Resiliency

Cross-Training for Workforce Resiliency

There’s a nursing shortage that is not only affecting the United States, but the entire world. And research is showing that it could to get worse.

That’s why it’s crucial for nurses to stay happy and not completely burnout. And it’s not only up to them to stay that way, but for their employers to keep them pleased and working as well.

Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse of Health Learning, Research & Practice at Wolters Kluwer, an acute care/critical care nurse practitioner at Penn Medicine, Chester County Hospital; a clinical adjunct faculty member in the graduate nursing program at Drexel University, and author of COVID-19: Transforming the Nursing Workforce in the New Paradigm of Care took the time to answer our questions.

What could the current nursing shortage mean for hospital care quality?   

The nursing shortage is actually a global issue. According to the latest research, it is estimated that the world will need an additional 13 million nurses by 2030; in the U.S., the need is projected to be 1.1 million (International Council of Nurses). There are several reasons for the nursing shortage. As the population of the world increases and Baby Boomers continue to age, the need for care will increase. This is compounded by the fact that nursing schools around the country are struggling to meet the rising demand for nursing education due to limited faculty, resources, and clinical sites; they turn away an estimated 80,000 qualified applicants each year in the U.S. due to this supply and demand issue (American Association of Colleges of Nursing). A large portion of the nursing workforce was set to retire in the next 10 years. However, the pandemic has accelerated this event, and nurses are leaving sooner than expected due to widespread burnout and exhaustion.

If nursing staff are feeling overworked and undervalued, they will more readily leave their institution, and perhaps the nursing profession altogether. This, in turn, increases the current nurse shortage, and the problem continues to worsen. Hospital care quality suffers if nurses are burnt out and overwhelmed, just as it suffers if nurses are missing. Patient wait times increase, and bedside care suffers. For hospital care quality to improve, there needs to be a concentrated effort to fix the supply and demand issue in nursing education, and there needs to be a concentrated effort on workforce well-being and fostering resilience—that is the bottom line.

What can hospitals/medical centers do to increase resilience among their existing nursing staff, while making sure that they don’t burnout and leave?

To foster resilience among the workforce, organizations need to acknowledge there is an issue and focus on workforce well-being. This means providing a safe environment in which to practice and provide patient care. Providing adequate staffing based on acuity/severity of illness and competency not just on numbers is the first step. Building up float pools that are cross-trained to work across adjacent specialties and move from one area to another is essential. While nurses do not like to float outside of their units, in an emergency or disaster situation, having the staff cross-trained to work in adjacent specialties helps to create an agile, efficient workforce.

Health care institutions need to invest in their workforce. Providing adequate breaks, healthy meals, self-scheduling, shorter shifts, and being able to take time off is crucial to preventing burnout. Nurses want to feel valued—providing continuing professional development activities and having the ability to meet career goals with lateral or vertical moves can make the difference between keeping the talent and losing it.

Health care systems must recognize when burnout and moral distress are occurring. That means having trained personnel up on the units evaluating what is really happening and then providing mental health support through employee assistance programs. Often nurses are worried about their families; health care institutions need to provide alternative child or family care or even financial planning.  Burnout can be prevented or at least minimized if health care institutions are actively on the lookout for it, address the issues that cause it and invest in their workforce well-being.

How can nurses prevent their own burnout? Especially when hospitals, etc. are understaffed?   

Preventing burnout is no small task, but nurses can certainly take steps to reduce their stress and prioritize self-care when they feel overwhelmed in the workplace. It’s important for nurses to know how to evaluate their own well-being, recognize their limitations, and be able to advocate for themselves when something is beyond their bandwidth.

Learn to be comfortable with saying, “No.”

Saying no is one of the hardest things for nurses to do; we are a caring profession and we often sacrifice our own self-care to care for others. We need to understand that if we don’t care for ourselves and find our own inner peace, there will be no one left to care for others.

Personally, I recharge by finding my inner peace and joy by reading, enjoying the outdoors, and sitting by water. Reclaiming “me time” within my day to recharge allows me to show up fully ready for my next day of work.

What are some proven strategies for creating a more agile workforce that both addresses the nursing shortage as well as avoids reliance on traveling or temp nurses?  

The agile care model is based on patient acuity, competency of the workforce, and alternative care delivery models. It provides agility that allows hospitals to move their nursing workforce when and where they are needed and uses other members of the health care team to support patient care such as unlicensed assistive personnel, licensed practical nurses, and others. It also switches the care delivery model from a primary nurse model to a hybrid team model of care as needed.

The backbone of this model is cross-training the float pool to work across adjacent specialty areas and as a backup, having the full-time staff cross-trained to work across adjacent specialties in an emergency situation. This interdisciplinary team-based approach facilitates the rapid deployment of staff to areas most in need in a crisis, such as what we’ve experienced with COVID-19, and provides better care for a greater number of patients.

This addresses the nursing shortage by improving the quality-of-life nurses experience at their workplaces. With more nurses trained to work in adjacent areas, staff will be able to take time off and recharge. When nurses feel practice-ready, confident, and able, they are less likely to burn out because they will experience less overall stress at work. Health care institutions must also be on the lookout for early signs of burnout and encourage their nurses to take time off when it is needed.

What are the biggest mistakes that hospitals/medical centers can make with their current staff that could lead faster to burnout and them leaving?   

Health care organizations need to understand that their biggest asset is their workforce. Without nurses and other medical professionals, hospitals and medical centers cease to function. Nurses need to be recognized for their value—their workplaces should support them by looking out for signs of burnout, offering mental health support, offering family/childcare support, and encouraging a healthy work-life integration. Without these basic acknowledgements, it is no surprise the burnout and shortage levels are what we are seeing today.

Nurses’ mental health matters! Nurses need to talk to their organization and be vocal about how they can better support their nursing teams. Whether that is more frequent review of their workforce policies, more transparency in the workplace, or more vacation time, nurses shouldn’t be afraid to speak up and stand up for themselves and for their fellow nurses.

How to Handle the Pandemic-Related Hospital Staffing Crisis

How to Handle the Pandemic-Related Hospital Staffing Crisis

Staffing shortages in hospitals have been a concern for some time, owing to the country’s aging population—but COVID-19 has only worsened the situation. In reaction to the pandemic, many of these institutions spent months stockpiling medical equipment and protective clothing, but the supplies are useless without staff. So, how do we handle the hospital staffing crisis?

Despite recent decreases in coronavirus infections across the country, many hospitals are still facing staffing shortages, and may continue to do so in the coming months. Healthcare workers are still under a lot of pressure, experiencing deplorable working conditions. Many of them are unable to take much-needed breaks due to severe personnel shortages, and suffer burnout as a result. The stress levels are so high that some are even considering leaving their professions entirely.

Adequate staffing levels in healthcare institutions ensure a safe work environment for healthcare workers and quality care for patients. Hospitals must be ready for potential personnel deficits and must have contingency plans and workforce management tools in place to deal with them.

COVID-19’s Impact on Healthcare Staffing

In 1999, the state of California enacted and implemented the first and only comprehensive U.S. legislation limiting the number of patients that nurses may care for at a time. Although several studies show how better staffing leads to improved patient outcomes, no other states have adopted this type of legislation.

There are many reasons why efforts to pass legislation governing hospital nurse staffing fail to get universal support from influential groups. The first impediment is a lack of local and timely evidence to support such laws. Another is the misconception that the country lacks nurses. Meanwhile, registered nurse graduations have more than doubled in the last 15 years.

The COVID-19 pandemic served as a stark reminder of the significance of adequately staffed health systems in delivering high-quality patient care, as well as the toll that under-resourced facilities have on workers’ well-being. The rising patient demand and diseases among healthcare professionals, particularly those of ethnic minorities, significantly impacted staffing in healthcare, worsening the staffing crisis even further.

Many hospitals responded to the surge in patient demand by canceling elective treatments and shutting down non-essential outpatient clinics, but dealing with the shortage of personnel was more difficult. Healthcare workers were repurposed, and students were onboarded at the worst-affected hospitals. Some states provided temporary allowances that permitted nurses licensed in one jurisdiction to practice in another during the heat of the crisis. Nurses were allowed to work across state borders and in areas with severe shortages.

What Can be Done About the Recent Healthcare Staffing Crisis?

While no one has the one-size-fits-all solution to staffing shortages, it’s fair to presume that healthcare providers would benefit from being more proactive than reactive in their staffing strategies.

Flexible scheduling

The absence of flexible workforce management is now the most common cause for nurses leaving their first year of employment. Clinicians must sign up for shifts eight weeks in advance, and there is little leeway to readjust the schedule once it has been completed. Shift allocation is inefficient and largely reliant on manual systems, which undoubtedly isn’t suited to any last-minute changes.

Multidisciplinary training 

Nurses and other clinicians prefer to specialize, but with further training and development, nurses may cover shifts in various departments and situations. While tenure in a department is frequently used to determine a schedule, this strategy results in nurses concentrating in one specialty and limits multidisciplinary training. It’s possible that tenure isn’t an excellent criterion for scheduling.

Pipelines for candidates

Though the number of registered nurses graduating yearly is at an all-time high, there is room for more. Other healthcare fields are still producing fewer professionals than there are jobs available. To recruit future healthcare workers, healthcare companies must be future-focused in their workforce planning, building stronger relationships with high schools, colleges, and training centers.

Infection Prevention

One of the most effective methods to guarantee that patients receive the treatment they require is to lower the likelihood of healthcare workers being sick. Infection prevention teams must make a concerted effort to offer timely and complete information to employees so that they can protect themselves.

Hospital executives must also change their workplace culture by encouraging employees and managers to speak out when they observe colleagues missing a chance to improve safety. It’s critical to reinforce the idea that everyone has the right to contribute to a workplace that is safer for other employees and patients.

Employing Digital Tools

One of the numerous advantages of telehealth adoption is that nurses, doctors, and other hospital personnel may care for patients online, while quarantined or recuperating from sickness. Furthermore, hospitals may centrally control all elements of their treatment operations thanks to digital health care delivery.

Staff can also use digital technologies to communicate between hospitals, e.g. during surges, to lend support at all levels. Critical care teams, in particular, can cross-cover patient spikes.

Conclusion

The staffing crisis in healthcare may continue for some time due to the ongoing COVID-19 pandemic, poor workforce management, and low adoption of digital transformation in the sector. The government also has a role to play in enacting legislation that regulates patient-to-health worker ratios. With adequate adjustments, the deficits can be filled and care delivery optimized.

4 Key Work Benefits Modern Healthcare Workers Should Demand

4 Key Work Benefits Modern Healthcare Workers Should Demand

If the throes of recent health emergencies have taught the healthcare industry anything, it’s that healthcare workers deserve better. According to a recently published Shift Work Report, 96% of workers, including healthcare workers, agree that shift workers deserve more respect. Whether working on the frontlines, in emergency departments, or attending to patients in a family care clinic, nurses deserve more.

As a modern healthcare worker, you should fight for the benefits that you deserve. And as an employer, you should know what your employees want and need in a workplace in order to reduce turnover. Continue reading for four key work benefits that nurses should demand.

In Demand: The Current Climate of Nursing

Although nurses are indispensable, they are often unsupported. Unfortunately, the issue of undervaluation for nurses is worse for women and, even more so, women of color. Nearly 1.7 million female healthcare workers live below the poverty line with their children.

Many nurses continue to make minimum wage, even though their jobs require a high skill set and at least some education. This is not the only problem that nurses face today. With employers discouraging unionization, non-unionized nurses are missing out on an extra $128 per week.

In addition, nurses experience dangerous working conditions with little protection. Exposure to chemicals and illnesses due to a lack of Personal Protection Equipment (PPE) causes millions of healthcare workers to get sick or injured on the job.

Other than pay and safety, hospital healthcare workers endure inflexible schedules and long working hours that lead to quick burnout, whereas nurses that don’t work in emergency departments are facing job insecurity due to COVID-19.

The culmination of these issues have made one thing especially clear: it is time for a change in the way that nurses are treated.

On-Demand: 4 Value Drivers for Nurses

Beyond the bare minimum of a livable wage and accommodating work arrangements, it’s important that administrators implement key changes to incentivize productivity and loyalty.

Here are four value drivers for nurses, and how employers can implement better practices.

1.    Moral Support and Job Security

Many say that nursing is a great career to go into because there are always jobs available. The U.S. Bureau of Labor Statistics has projected 175,900 nursing jobs to open each year. However, according to the report cited in the intro of this article, 69% of shift workers—including healthcare workers—are concerned about job security even with high growth projections.

With so much insecurity in the healthcare industry, employers should work hard to ensure that their nursing staff feel supported. Here are ways in which employers can do this:

  • Empower staff by allowing them to swap shifts.
  • Provide clear expectations about hours and job tasks.
  • Make hours visible to staff so that they know what to expect on payday.

Although employers can’t control job security industry-wide, they can control whether or not they are morally supporting their nurses.

2.    A Safe and Healthy Workplace: Fair Working Conditions

COVID-19 has brought about new concerns in healthcare workplace safety. Nurses are forced to take the brunt of health hazards as they care for the most vulnerable patients, with or without proper PPE. Although it may seem hopeless, nurses can fight for stronger ethics and workplace safety.

Here are ways that employers can make a safer environment for nurses:

  • Double-checking employee health through temperature screenings and symptom logs.
  • Use videos to share new safety protocols.
  • Implement touchless clock-in features, such as apps or keycards.
  • Ensure that employees know about fair working regulations.

It’s important for nurses to follow CDC and WHO recommendations. More importantly, employers should optimize PPE according to CDC guidelines, so that nurses don’t have to work without it.

3.    Flexible Schedules

Many nurses love shift work, with 66% of workers seeing flexible scheduling as the top benefit of their job. There are some types of nursing that offer more flexibility than others. For example, telehealth nursing offers excellent schedule flexibility due to the work-from-home aspect.

Schedule flexibility is especially important to mothers and caregivers. In fact, 40% of nurses are mothers with children under the age of 18. Without schedule flexibility, nurses may have a difficult time securing childcare or working around school schedules.

4.    Communication and Care

Above all, employers need to prioritize communication with their nurses and working towards their benefit. Healthcare shift workers should feel comfortable talking with their employers about issues like safety, pay, scheduling and benefits. Here is how employers can develop soft skills and make nurses a priority:

  • Build schedules based on employee needs.
  • Ensure that payroll is accurate and on time.
  • Connect with your team to encourage a more friendly work atmosphere.
  • Provide opportunities for promotions and raises.

Essential Workers Deserve More

Nursing and healthcare facility staff have quite literally saved the day in the past year. Their tireless efforts have mitigated major risks and helped families through a global pandemic. Many of them had more to do than ever before which caused more stress at work and at home too.

It’s now more important than ever to care for nurses as employees. It will result in higher productivity, low turnover and burnout rates, an overall higher degree of job satisfaction and, in the end, better patient outcomes. All it takes is a few changes in the workplace to make this happen.

Navigating a Toxic Work Environment as a Nurse

Navigating a Toxic Work Environment as a Nurse

There’s no questioning the difficulty of a career as a nurse. You may have to work long hours, deal with a variety of patients each day, and spend most of the time on your feet. You also have to deal with the risk of things like patient violence or the general sadness that comes from losing a patient you’ve been working with. But, nursing can be an incredibly rewarding career when you’re in the right work environment. A toxic work environment, however, is a different story. It can make getting your job done feel nearly impossible. If you come home each day feeling absolutely drained, and perhaps even frustrated or helpless, you might be dealing with a harmful environment at work.

So, how can you know what a toxic work environment looks like? What are your rights, as a nurse, to a healthy environment, and what can you do to make sure those rights are upheld?

What Does a Toxic Work Environment Look Like?

As a nurse, you probably already understand the importance of being able to adapt to different work cultures. If you’re not sure how to learn more about a specific culture or atmosphere within a workplace, there are a few things you can do to get a feel for it quickly, including:

  • Watching and learning from others
  • Asking questions
  • Staying transparent

The more you observe and the more questions you ask, the easier it can become to see if you’re dealing with an unhealthy work environment. Bear in mind that if you don’t like your job or you’re not satisfied with your work, that doesn’t automatically mean you’re in a toxic environment. You may need to try a different career path. But, toxicity in the workplace is very different. You can recognize it through some of the following signs:

  • There is an overall lack of communication
  • There are cliques, exclusions, or groups
  • The workers aren’t motivated to do their jobs
  • Growth is discouraged
  • Everyone is burnt out

Finally, there’s nothing wrong with going with your gut. If you get a “bad” feeling about your workplace, even if you can’t quite put your finger on it, don’t ignore those feelings.

How Can It Affect You?

A toxic work environment is more than just an inconvenience. It’s more than just something to “trudge through”. In fact, an unhealthy work environment can contribute to a variety of physical and mental health issues. Some of the most common problems include:

  • Fatigue
  • Upset stomach
  • Heart issues
  • Muscle aches
  • High blood pressure

The toll on your mental health is nothing to take lightly, either. You might find yourself constantly feeling stressed and overwhelmed at work. It doesn’t take much for that to carry into your home life if you can’t let the feelings of the day go when you walk in the door. That constant feeling of stress can lead to mental health conditions like anxiety, or even depression. As that continues, you may end up needing to get extra help just to deal with those conditions.

Working every day in a toxic environment can wear you down. So much so, that it can even weaken your immune system, making it easier to get sick. As a nurse, you know the importance of taking care of your mind and body. If you don’t make self-care a priority, it could impact your personal life in a negative way. Your work environment shouldn’t be the thing that compromises your health.

How to Find a Healthier Environment in Your Field

If you find yourself in a toxic work environment, the best thing you can do is leave. An environment that large isn’t likely to change, even if you address the issues. You need to prioritize your needs when it comes to your career and your overall well-being. But, leaving a job isn’t always easy if you need the income.

Waiting to leave until you have another job lined up is always a safer option. Or, you might consider going a more nontraditional route with a remote job. Remote jobs allow you to work from home (or anywhere!), eliminating everything from toxic employees to negative patient interactions. Working remotely can help to reduce your stress levels and offer more flexibility.

Obviously, not all nursing jobs are able to be done remotely, but there are some that will allow you to work from home while still caring for others, including:

  • Clinical appeals nurse
  • Health informatics
  • Nursing instructor
  • Nurse auditor
  • Telephone triage nurse

Some larger hospitals and even national health care groups are always looking for nurses who can work remotely and fulfill these needs. These particular jobs might be different from what you’re used to, but that could be exactly what you need to break free from a toxic environment. In doing so, you can learn to enjoy your work again, and find fulfillment in helping patients while taking care of yourself, too.

Who Nurses the Nurse?

Who Nurses the Nurse?

The contributions of a nurse in today’s crisis – stricken society are countless, especially in the midst of this pandemic. For that reason, thorough explanation of the nurses’ role is imperative for greater appreciation. Nurses have well known responsibilities including but not limited to recording medical history, vital signs and symptoms, patient advocacy, monitoring patient health and administering medications and/or treatments. Nurses collaborate with members of the interdisciplinary team for better patient outcomes and educate patients and their families about the management of illnesses. In academic settings, we educate aspiring nurses and propel them to achieve their goals in the midst of challenging life circumstances. As they say, nurses wear many hats, and as a result, nurses are burning out.

A nurse must advocate for patients beyond the health care environment while utilizing a holistic care approach; a patient may be admitted to a hospital or other health care setting for a particular ailment. However, the nurse must question this patient’s ability to care for themselves on their own, and if incapable, ensure that adequate support is in place upon discharge. Nurses also care for patients’ families. Often times, difficult conversations must occur and nurses are challenged to interact with those on the receiving end. Nurses are usually the first to notice irregularities due to the first phase of the nursing process – assessment. Nurses are the punching bags for the frustration of others on a daily basis. While nurses ought to possess qualities of resiliency, they are also human, and if empathic in nature, easily carry the stress of others on their shoulders. Hence, while taking work load, work environment, and coping mechanisms into consideration, nurses are at increased risk for burnout.

Burnout is defined as a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands. It has many physiological effects. In a recent study conducted by Salvagioni et al (2017), burnout was a significant predictor of the following physical consequences: hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries and mortality below the age of 45 years. Specific to nurses, in a 2019 study, 14.4% were found to be unengaged with their work, 41% of those respondents reporting feelings of burnout. Due to the physical and emotional demands of the job, nurses ought to be cognizant of the warning signs of burnout (anxiousness, chronic fatigue, insomnia, and frequent illness) because they are putting their health in jeopardy. Please take into account that these statistics are not reflective of the impact COVID-19 has had in the nursing industry. Therefore, in 2019 – 2020, these statistical figures are presumed to be more alarming.

In September 2018, I recall being transported by an ambulance from a clinical setting to the hospital. Runs of atrial fibrillation and ventricular tachycardia flooded the heart monitor as I struggled to maintain my strength, oxygenation and my life. “Look! You can show these rhythms to your students!” said the EMT as life threatening rhythms printed from the monitor. My usually jovial self immediately thought, “Did he really have to say that and could this get any worse?”

At the time, I was a nursing education supervisor for a technical school. The program grew exponentially and I was expected to supervise both day and evening programs. This not only meant overseeing and executing the curriculum’s development and application, but also subbing for instructors as necessary, which was quite often. I was a single mother in need of more support. My divorce was recently finalized. Ageism and racism were also my contenders in the work environment. I was challenged when giving direction to a group of women, my staff, who were older and looked different from me. I was expected to provide hope for my students who had lost hope in themselves due to extenuating life circumstances. Inadvertently, I experienced the warning signs of burnout such as anxiousness and chronic fatigue, but ignored them, leading to my experience in September 2018.

In the year of 2019, I went on a quest to find a work environment that was more holistic and welcoming. The familiar saying, “Nurses eat their young” resonated within me. My mental health suffered as I experienced feelings of being unappreciated and belittled. Nonetheless, in the midst of all of this rain, the sun did shine again. I decided to return to my home district as a school nurse, which gave me an opportunity to give back to my community and encouraged healing for my broken soul.

As a survivor of burnout and the consequences that came with it, I feel the need to bring awareness to the fact that nurses need to be nursed. So, who nurses the nurse? If possible, nurses must nurse themselves by doing the following:

Evaluate Your Own Personal Life.

Ask yourself, have I recently experienced life changing events and have I taken enough time to ride life’s emotional rollercoaster? Trying to balance work and these emotions can lead to a very bumpy ride (burnout). One may need to request time off from work or even take a leave of absence. Taking these actions does not mean that you are weak. It just means that you are taking a step closer to healing.

Identify Sources of Support.

As John Donne said,No man is an island. No man stands alone.” It is impossible to navigate through these difficult times in solitude, so finding a trusted confidant is important. It may be a family member or a close friend. For some, it may involve getting help from a licensed therapist. Once having adequate support systems, you will come to the realization that you are not alone. This notion generates healing thoughts and behaviors.

Ask For Help.

Nurses have a tendency to practice autonomy and often forget about asking for help. We always give but do not want to receive.

Diet and Exercise.

You are what you eat, therefore in order to promote feelings of wellness, we need to eat foods and participate in activities that support wellness. Overall, one should base their diet on whole grains, increase fruit and vegetable consumption, and reduce fat, salt, and sugar intake. We should also aim for 30 minutes of moderate physical activity daily.

Watch Your Water Intake.

Men and women need approximately 3 liters of fluid daily, however water requirements vary depending on weight. As it pertains to burnout, water can help maximize physical performance. Water also significantly affects energy levels and brain function.

Make Time For Hobbies.

Do not forget about your interests. Make time for these activities. It could be as simple as listening to music or watching an interesting TV show. I’ve always loved dancing. Since my experience in 2018, I joined a ballroom dancing/social community.

Practice Mindfulness Meditation.

This is the practice of actually being present in the moment which in turn trains you to become more mindful throughout the day, particularly during stressful situations. There are an abundance of mindfulness meditation exercises that can be found on the internet. I do these exercises daily.

Get Enough Sleep.

We need at least seven to nine hours of sleep daily to function at our best. If you are having a hard time achieving this, talk to your doctor. You can consider non-pharmacological methods such as teas and lavender oils. According to the National Sleep Foundation, obtaining healthy sleep is important for both physical and mental health, improving productivity, and overall quality of life.

Watch Your Appearance.

If you think you look good, chances are you will feel good too. Participate in practices that enhance positive feelings about personal appearance. Do a facial. Get your eyebrows waxed and your hair done. Do you!

The above recommendations highlight the importance of self-care. I urge each and every nurse to take part in such practices before it is too late. The disease processes that result from lack of self-care are probable, but preventable. So before you become dependent on a caretaker due to illness, remain independent by being your own best nurse.


Special Thanks: Desmond & Lillieth Gayle; The Wong Family; Nayomi Walton, PhD, RN; Therelza Ellington, RN; Anisa Cole, LCSW; Bloomfield Public Schools

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