According to a recent study done by the University of Michigan Comprehensive Cancer Center, researchers are now doing their best to implement safety measures for nurses when administering toxic drugs, such as chemotherapy.
Although chemotherapy can save lives, it can be dangerous to any person unintentionally exposed. Exposure to “secondhand chemo” is putting health care workers’ lives at risk and has the potential to effect the nervous system, damage the reproductive system, and increase the risk of blood cancer in the future.
Christopher R. Friese, Ph.D., R.N., A.O.C.N., along with his colleagues from the University of Michigan School of Nursing, surveyed 1,339 oncology nurses, from only one state, that work in outpatient chemotherapy. The survey measured the likelihood of self-reported exposure in relation to their working environment, nursing workloads, and safety standards. The study shows about 17% of nurses working in outpatient settings reported exposure to their skin or eyes in the past year. (All results can be found online in theBMJ Quality and Safety journal.)
According to the study, the researchers found the amount of exposure seemed to be reduced in hospitals containing more staff. Nurses with a higher workload tended to report more incidences than those with lower workloads. Exposure also appeared to decrease in hospitals where two or more nurses were required to administer the drugs. According to the findings, Friese believes it may be possible that unintentional exposure is not always reported, perhaps for fear of embarrassment.
Organizations such as the National Institute for Occupational Safety and Health have issued guidelines to decrease the number of unintentional exposures, but they have not yet been made mandatory. It is recommended that nurses use gowns and protective gear when handling chemotherapy drugs, but these guidelines may not be enforced. However, the American Society of Clinical Oncology plans to issue revised guidelines in 2012, in hopes of stressing the importance of the safety of the staff as well as the patients.
In our winter 2012 issue, we called for submissions to our first ever Take Pride Campaign, an effort to recognize those places of employment that went above and beyond regarding encouraging diversity; recruiting and retaining minorities; and creating a cooperative, inclusive work environment. We were so pleased with the response! Nurses, and even teams of nurses, recommended their places of employment to acknowledge such efforts. And the funny thing is, there is no prize. Not for our nominees nor for our nominators. Furthermore, there is no real winner. The only reward, per se, is their inclusion here. Then again, perhaps the reward is inherent—we’re just bringing it to light. We’re so glad these nurses found such inclusive places to call “home” (during their shifts, at least!). We hope the facilities continue to lead by example, and we are proud to recognize them here.
Alacare Home Health and Hospice, Muscle Shoals, Alabama
Nominated by LaConda Davenport, R.N., B.S.N., M.S.N., M.H.A.
In the five and a half years LaConda Davenport has been with Alacare Home Health and Hospice, she has traveled and worked in several of the company’s 23 offices. As she’s moved within the company, she has “witnessed cultural diversity as a top priority,” she says. “Everyone, regardless of race, age, gender, or whatever makes us unique given equal footing to achieve equal status within the company.”
The company makes its position on diversity clear not just in writing (in its diversity statement), but through diversity training, targeted staff education, and recruitment efforts aimed at minorities. Moreover, the company requires its employees to “renew their commitment to diversity” each year, Davenport says. “Alacare fosters an environment of cultural awareness amongst its employees, and everyone has equal opportunity to strive and rise to the top.”
Davenport started as an RN and went on to earn two master’s degrees and eventually became a Hospice Clinical Manager. “I couldn’t have done this without the support of the company I work for,” she says. “Diversity means that I am afforded every opportunity to grow and mature in my profession within an environment that believes in me and wants to see me strive in a positive manner that is beneficial to me and my organization. Alacare has this attitude and that’s why I believe Alacare is diversified and inclusive—they stand not behind but beside their employees.”
Bayhealth Medical Center, Dover and Milford, Delaware
Nominated by Ludmila Santiago-Rotchford, M.S.N., R.N., P.C.C.N., A.C.N.S.-B.C.
Arriving in Dover, Delaware, back in 2000 felt like going back in time to Ludmila Santiago-Rotchford. “It seemed that most people I met had rarely ventured out of the First State and many people had been here for generations,” she says. “Who knew that this state . . . just a few hours away from metropolises of Philadelphia and New York City was where the infamous Mason Dixon line that separated the North from the South was found.”
Along with a colleague, Kimberly Holmes, M.S.N., R.N., P.C.C.N., A.C.N.S.-B.C., Santiago-Rotchford hoped to promote diversity in her health care system. A simple suggestion grew into the Bayhealth Diversity Committee, a multidisciplinary group that meets bimonthly. “For the past several years we have offered Scoop on Diversity sessions where staff can learn about topics of diversity while enjoying a sundae bar,” she says. “Our annual Diversity Cruise attracts many attendees where we employees display information and samplings of food representative of cultures from around the world.”
A busy committee, they disseminate a “tip sheet” each month called Insights on Diversity and recently partnered with Delaware State University for a Celebration of Culture event. Their website includes further resources regarding diversity, as well as a way for staff to leave feedback.
“Our dream has come to fruition in large part due to the support we have received from our committee members,” Santiago-Rotchford says, citing facilitator Marianne Foard, M.S., R.N., and Chief Nurse Executive Bonnie Perratto, M.S.N., R.N., M.B.A.,N.E.A.-B.C.,F.A.C.H.E., specifically.
Frontier Nursing University, Hyden, Kentucky Nominated by Nena Harris, Ph.D., F.N.P.-B.C., C.N.M.
Nena Harris started her journey at Frontier Nursing University
10 years ago as a student, one of three minority women in her orientation session. “The nature of our program, which is distance learning, creates challenges in that there are few face-to-face interactions,” she says. “As a student, I did not engage in attempting to understand the school’s commitment to diversity, but I also did not witness any active display of this commitment in a way that students could recognize.”
Then, when Harris became a Frontier faculty member six years ago, she was the only professor of color. “Since that time, several faculty of color have been hired,” she says. “Also, I have more face-to-face interactions with students on campus and the composition of those sessions has become more colorful over the years.” In that time, Harris says she’s seen the school “develop a passion for diversity.”
A school founded to address the health care needs of the underserved, FNU is well suited to train nurses to go into those communities that continue to be marginalized—often minority communities. “The administration and faculty realize that providing care to diverse populations requires educating nurse-midwives and nurse practitioners who are committed to returning to the diverse communities in which they live and have roots,” Harris says. To that end, the school is working to recruit more diverse students and faculty, in part through its recently launched, multifaceted PRIDE (Promoting Recruitment and Retention to Increase Diversity in Nurse-Midwifery and Nurse Practitioner Education) initiative.
“FNU is a leader because it demonstrates the importance of educating a diverse workforce to meet the health care needs of an increasingly diverse population,” Harris says. “I am very proud to be associated with this institution.”
Grady Health System, Atlanta, Georgia
Nominated by Dennis Flores, B.S.N., A.C.R.N., et al.*
“Inherent in Grady Health System’s tradition of care is over a century’s worth of diverse personnel who advocate for everyone and discriminate against no one,” says Dennis Flores. “As nurses in our white scrubs, we represent a kaleidoscope of ethnic and racial backgrounds that fulfill the promise of nursing in our everyday practice.”
Many of Grady Health System’s clients come from underserved communities, and Flores says they can relate quickly to their providers, as the staff mirrors the diverse population of the Metro Atlanta region. “Nurses and patients speak the common language of a shared history and world-view, one that translates to better patient care,” he says.
Flores commends a number of things illustrating the facility’s commitment to diversity, including minorities in various leadership positions, cooperative decision making at all levels, an endorsement from the Human Rights Campaign as a Leader in LGBT Healthcare Equality, and even a multicultural Nurses Week ad campaign. “Not only is [the ad] a tacit endorsement of the variety that makes up the staff, but it wisely capitalizes on our strength: Grady’s diversity,” he says.
“The culture here allows for us to thrive and newer staff members soon become acculturated to what fierce advocacy is all about,” Flores says. “We are blessed to be working here and we take exceptional pride in representing Grady Health System.”
* Dennis Flores is joined by the following in nominating Grady Health System: Lillian Bryant, L.P.N.; Patrice Henry, L.P.N.; Luis Lopez, B.S.N., R.N.; Marie Lotin, R.N.; Andrea Mayo, R.N.; Njorge Ngaruiya, B.S.N., R.N.; Faith Works, R.N.
HCR Homecare, Rochester, New York
Nominated by Yvette Conyers, M.S.N., R.N., C.T.N.-B.
“Since I first walked through the doors of HCR Homecare, almost five years ago, I felt the culture of inclusion and diversity,” Yvette Conyers says. By meeting the need for more nurses, particularly Spanish-speaking nurses, to serve the many Hispanic patients in the area, the institution has demonstrated an ongoing commitment to diversity.
“The mission and vision of HCR Homecare supports diversity and values its employees considerably,” Conyers says. “The name HCR rings loud in a small community where everyone talks, and comments are always positive.” She cites the facility’s research into the needs of Hispanic patients, such as 2008’s Exito, which tackled reducing health care disparities through improved access and culturally competent care. HCR Homecare has also extended its efforts to improving care for African American, Russian/Ukranian, and various refugee populations. They do so, in part, through partnerships with many local agencies, such as the Rochester Housing Authority.
“Training in cultural competence, specifically transcultural care, has been implemented and is constantly being upgraded to provide better patient care and decrease hospitalizations rates, creating trustful relationships and addressing the overall disparities our nation faces,” Conyers says. Certified nurses lead training sessions and help ensure continued efforts to improve cultural competence. “The constant changes and increased number of minorities both on a national and local level support the need to have an agency that is caring, diverse, and is inclusive of the clients they serve,” Conyers says. “I take pride in my organization!”
Seton Healthcare Family, Austin, Texas
Nominated by Cindy Ford, R.N., B.S.N.
Cindy Ford can name a litany of programs that make Seton Healthcare Family an admirable force in the promotion of diversity. And with 35 years of service to the organization, she would know. “During three decades, I have witnessed Seton lead medical, nursing, and technology advancements; become nationally respected for evidence-based practices; and progress as a leader in diversity.”
The faith-based collection of facilities includes 11 hospitals and 80 other various offices, and Ford says Seton is committed to “improving the diversity and inclusion of staff…by reflecting the communities we serve.”
That started with Seton’s Diversity Leadership Initiative, which “identified the challenges in reflecting the demographic makeup of the community,” Ford says. From those efforts came the hospital system’s Office of Diversity and Inclusion, established in 2006 to meet the needs of the growing populations of African Americans, Latinos, and Asian Americans in Texas. “Programs were developed to meet leadership initiatives,” she says, including diversity/cultural competence workshops, awareness events and cultural celebrations, an interpreter program, and a recruitment team committed to diverse hiring. Seton has also adopted Cincinnati Children’s Hospital’s Project SEARCH, a hiring initiative aimed at young people with developmental disabilities.
University of Wisconsin Hospital and Clinics, Madison, Wisconsin
Nominated by Tracey L. Abitz, M.S., R.N., C.T.N.-B.
From Tracey Abitz’s description of the University of Wisconsin health care employee benefits and resources, it seems like a great place to work, regardless of whether you’re a minority or not! But those employee benefits and resources also reveal a determination to recruit and retain minorities, as well as provide culturally congruent care for diverse patients.
“There is a commitment to diversity and cultural competence to community groups and partners by reaching out to the community with the assistance of the director of community partnerships,” Abitz says. For example, the University of Wisconsin system offers a wide array of language and interpretation services, including those for the deaf or hard of hearing, as well as 32 languages through face-to-face interpreters and over 250 by phone.
Abitz describes the hospital system’s many employee resources, from child and elder care to tuition reimbursement, and the facility has also partnered with a credit union to offer free tax services to employees in a lower income bracket. “There is ongoing review of recruitment and retention data of minority groups with increased efforts to try to diversify the recruitment pool for positions at the hospital, especially leadership positions,” she says.
The nursing staff in particular has served as advocates of diversity, including their use of the Purnell Model for Cultural Competence to assess patients and family needs, Abitz says. The nurses even designed an internal diversity website with resources for clinicians.
“A new interdisciplinary resource group led by nursing has been designed to have a group of champions interested in learning more about culture and diversity with the goal of raising awareness and knowledge, allowing them to be a resource to their colleagues,” Abitz says. “There is continual reflection and commitment to always strive for improvement.”
Two kinds of hospital-acquired infections—catheter-associated urinary tract infections and surgical site infections—have been on the rise, according to a new study. The research shows that the busy schedule and heavy workload of nurses were contributing factors to the rise in these infections.
According to an NBC news report, heavy patient loads and chronic burnout have long been among the top complaints of bedside nurses. The Maslach Burnout Inventory—a well-known scale that measures factors like emotional exhaustion, depersonalization, and sense of personal accomplishment—showed more than one-third of nurses reported levels of job-related burnout.
Researchers from the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing found that for every extra patient added to a nurse’s workload, there was about one additional hospital-acquired infection per 1,000 patients.
Also, according to a study in the American Journal of Infection Control, for each 10% jump in the proportion of nurses who reported higher levels of “burnout,” about one additional catheter-associated infection and two surgical site infections were found per 1,000 patients.
The nurses in the study, on average, cared for 5.7 patients each; a number that, if reduced, could help eliminate nurse burnout, and thus cut back the number of infections. The report states that reducing nurse burnout by 30% would cut urinary tract infections by more than 4,000 and surgical site infections by more than 2,200, which would save $28–$69 million per year in estimated costs to treat those infections in patients.
Previous research also supports the conclusions reached in this most recent study. Another University of Pennsylvania study found that adding a single patient to a nurse’s workload increased the risk of dying within a week by 7%. Additionally, a 2010 study found that patient deaths in New Jersey and Pennsylvania would drop 14% each if those states adopted California‘s mandated nurse-to-patient ratio of one to five in surgical units.
The NBC News report stated that some hospitals in the United States have worked hard to address these kinds of issues. Nearly 400 hospitals have achieved so-called “magnet” status, which recognizes health care organizations that achieve structural and clinical practices that empower nurses and lead to good patient results.
Neither the American Nurses Association nor the American Hospital Association tracks statistics on nationwide patient loads, which can vary from as low as one or two patients per nurse to more than five per nurse.
At the start of a new job you hope that your co-workers will become a second family. At the very least, you certainly expect that they will like you and not tease you. And you undoubtedly hope that they won’t talk behind your back or criticize you in front of supervisors. While you may dream of a workplace utopia, a perfect working environment rarely exists.
During your career you will undoubtedly come into contact with co-workers who go for the jugular. While sometimes they will retaliate for something you inadvertently said or did, other times there will be no reason for their war against you beyond their own jealousy or ego.
So what should you do if you have an enemy in your ranks? Before you turn the other cheek or prepare to do battle, try these 10 helpful steps:
1. Rethink the situation. Did you do something to warrant their attack? If so, admit your mistake and apologize in private.
2. Laugh away a public insult with a non-defensive retort. Avoid overreacting to a public attackÑa calm response may help diffuse the situation.
3. If you are confronted during a meeting, defend yourself in a composed manner. Stand up for whatever action, idea or program is being attacked. Answer any questions and offer to explain your side of the situation further to anyone who has further questions after the meeting.
4. Kill your nemesis with kindness. Do him or her an enormous favor to upset the scales. For example, you can back up one of his or her suggestions to your department head or supervisor.
5. Get to know your adversary. Find out how he or she got their job, who their mentors are, where they worked before, and what their goals and motives are. Just showing an interest can sometimes help to mend fences. And if it doesnÕt improve the situation, knowing everything you can about your enemy can still be helpful. Knowledge is power.
6. Build up your own troops to outnumber your enemy’s. Make sure that top administrators and physicians are included in your campÑnumbers count.
7. Stand up for yourself. If you tend to have a passive personality, do the unexpected and confront your opponent. Remember, if you give respect you should expect respect.
8. Continue to work hard. Even if you’re having difficulties with your co-workers, it is extremely important that you maintain professionalism and continue to produce great work. DonÕt be afraid to contribute new ideas and donÕt be modest about sharing your accomplishments with supervisors.
9. Get rid of them. If you canÕt work it out with your co-worker, maybe you should start looking for a new jobÑfor them! Keeps your eyes and ears open; maybe you will hear of a perfect position for them at another facility. You can also recommend your foe for a promotion or lateral move to another department.
10. Develop your own networks and participate in professional associations. Do more than just joinÑget active and form relationships with your colleagues. If all else fails, find a new position where you are respected.
The distinctive nature of nursing affords us the unique ability to be able to communicate with both medical professionals as well as patients, bridging a crucial gap. We strive to address patients in a therapeutic, non-condescending manner. Yet, with added responsibilities, a harried pace, and the familiarity of day-to-day work customs, it seems we are becoming more anesthetized. Do we still notice when a patient’s dignity is impugned, and more importantly, are we being taught to do so in the first place?
Mrs. Johnson’s story
Mrs. Johnson is an 89-year-old living at home. She has been ill and her adult children take her to the hospital. The emergency room is crowded with crying children, buzzing television sets, random conversations, and the extraordinary hustle and bustle of working health care professionals. She remembers the days of being a busy worker herself, as well as a soccer mom, an active churchgoer, and a vital member of her family. But time has moved on. She now feels like a burden—a nobody—to so many.
Though feeling weak, Mrs. Johnson manages a meek smile as the ER nurse approaches. This nurse is going to talk to me, see me, and care for me, Mrs. Johnson thinks. But the nurse turns to the family member that brought her to the emergency room, asking her about Mrs. Johnson’s condition. Talk to me! Mrs. Johnson wants to say. I’m a person! Don’t you see me?
Mrs. Johnson is then taken in to see a doctor who hurries through an examination; she is subsequently admitted to a unit. The transport staff rolls her down the hall, engaged in small talk with one another. Mrs. Johnson again feels invisible.
In the unit, the bedside nurse assesses Mrs. Johnson, saying very little, and certainly not describing what she is checking or why. The nurse leaves, but not long after, Mrs. Johnson feels the urge to use the bathroom. She buzzes for assistance getting out of bed. One minute, three minutes, five minutes go by. Still alone, Mrs. Johnson eventually feels ashamed at her incontinence. She waits another five or 10 minutes until another nurse and aide to come in, wearing the unmistakable look of disgust on their faces as they eventually begin to clean her. I want nothing more than to be able to clean myself, she thinks, feeling depressed and guilty.
While in the midst of cleaning her, the nurse and aide hear a knock at the door. Mrs. Johnson is shocked when the aide opens the door, exposing her backside to the hallway, to let in a respiratory therapist. Give me my dignity, please, Mrs. Johnson thinks. I am a somebody, not a used-to-be.
This fictional anecdote, written in accordance with HIPAA guidelines and inspired by true events, is meant to remind nurses that we must preserve our patients’ dignity as well as their physical health. An appreciation for human dignity must be cultivated, as it can get lost when most nurses train using SIMS mannequins.
While in school for our prospective medical careers, we are so excited to see procedures and learn about diagnoses. Students may forget that the patient they are gawking at is a person and not just a piece in the lab. This behavior transcends into our professional careers; as we begin in our practice, procedures become routine and mundane. Indeed, our typical workday might be a patient’s worst day.
What can we do?
Sensitivity training is essential and should include role-playing, personal reflection, and discussion. If required to analyze their own actions, nursing students (or practicing nurses) might see the need to change their approach to patient care.
Foundations in education could also include emphasizing the “holistic” elements of patient care, such as discussions of humility. I know of one particular nursing instructor who was mortified at how she perceived some long-term care facilities conducted patient ADLs. She described residents heading in to the shower as “looking like herding cattle off to the slaughter house.” In horror, she observed residents being rolled down the hall undressed and wrapped in sheets. Often these patients’ bottoms were exposed for all to see, she said.
I have heard of professors, in an attempt to teach future nurses a lesson in dignity, who required students to walk around the long-term care facility with a sanitary napkin taped to the front of their uniforms. Another instructor who noticed a disregard for patient dignity required students to be placed on a bedpan (fully dressed, of course); the students were then left alone in the room with no access to a call light. One could say there is nothing sensitive about these training exercises; they would be correct, but a little lesson in humbleness may go a long way in one’s future practice.
Communication is paramount when speaking of patient dignity as well. It’s not hard to understand why a patient may feel a sense of loss and grief when placed in a medical setting. And who wants to be in a room full of people, yet ignored? Or, even worse, spoken at? Creating a therapeutic rapport is a skill that requires compassion and practice.
Through nursing, we are able to care for people when they’re most vulnerable, during their most frightened moments, at times they may never forget.
All patients are deserving of the standard of care we would show our mothers and fathers, our grandmothers and grandfathers, our own Mrs. Johnsons. In many ways, we should feel honored to play this part in patients’ lives. The calling to participate in nursing is not an inconsequential one. Nursing is widely considered as the most trustworthy profession, an art and a science. A nurse’s objective should be providing a safe—and dignified—place for patients to receive care.