Category Archives: Nurse Consulting

Changes in Regulations

Many states want to make changes that will impact nurses and how they practice nursing.  Advanced practice nurses (APN’s) should stay abreast of potential changes in relevant nursing or related regulations.  Nurses already have to take continuing education courses in order to maintain their licensure.  As an APN, the basic requirements that a registered nurse has to take are not going to be sufficient for an APN.  The best way to stay current is to join an association and become a member nationally and then join the local chapter.  Being a member of a national organization will allow the APN to get current regulations that affect the entire country and the local chapter will give the information that pertains to the state where the APN practices.  The local chapters of an organization can provide opportunities as well for speaking engagements where the APN can be involved in presenting a topic that is researched to also expand upon the APN’s knowledge (DeNisco & Barker, 2012).

References

DeNisco, S. M., & Barker, A. M. (2012). Government regulation: Parallel and powerful. In Advanced practice nursing: Evolving roles for the transformation of the profession (2nd ed., pp. 231-260). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home?deepLink=true

Rosie Moore, RN, DNP

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Nursing Diversity

Nurses need to be culturally sensitive to patients, just because it is something that we do not do in our day to day lives, does not mean that someone else does not do it for religious or cultural beliefs (Alligood, 2010).  We cannot assume that because someone looks homeless that they are. If a patient is arriving by ambulance, he should be seen by someone.  It is understood that the other patients also need help, but the nurse needs to prioritize.   As a nurse, we have to observe the body language and see what the patient is feeling.

I had a friend who was an anesthesiologist and stopped at an expensive diamond store to get his wife an anniversary gift.  He was dressed down in jeans and a t-shirt and a hat nothing special said he was a doctor by his dress code.  He inquired in the most expensive jewelry and the salesperson said to him, oh let me show you this section here this may be more affordable and we can offer you payment plans.  She naturally assumed because he looked like an ordinary Joe in jeans, that he did not have the money to pay outright for his gift.  He asked for a manager and she complied, to which he stated, I am Dr. so and so head of anesthesiology at ABC hospital.  He proceeded to explain that he came in to look for a gift for his wife and was not allowed to select from the section he was looking at because his salesperson assumed that he did not have the income to afford those items.  He provided his card and stated that he would take his business elsewhere where he is not judged on his appearance. We as nurses have to be careful that we do not do the same to our patients and treat them equally the same.

References

Alligood, M. (2010). Madeleine M. Leininger: Culture Care Theory of Diversity and Universality. In Alligood Introduction to the Nursing Theory 7th ed. (pp. 417-434). Retrieved from Vital Source Bookshelf

 

Strategies on Cultural Competence

In my own nursing career as a supervisor for field case managers, I have encountered patients and staff that come from diverse cultures. Every two weeks, our entire region would participate in Grand Rounds and during those rounds, our medical director reviewed four cases that had been submitted prior to the meeting in order to evaluate them for a better plan of care to help the patient.  My team consisted of a mixture of different cultures.  I had some wonderful nurses from different Caribbean Islands, some of them had a very strong accent, but that did not stop them from providing good care.

During our grand rounds, the medical director selected two of my case managers to present their case.  The case was presented in our own team meeting and as a team, we thought it would be a great case to present.  The one case manager we will call her Ms. R. presented a case about a member that had too many cats in the home and she was having difficulty staffing the case with home health aides because no one wanted to go in the home with so many cats. The medical director gave his evaluation of the case and the case was closed with the new information for the nurse case manager to implement.

During a manager meeting with about six other managers, the topic of case presentations came up and how each team needed to submit two cases per week, even if they were not selected for grand rounds.  A manager from England, who spoke with an English accent, stated that my team presented a lot of cases all the time.  I confirmed and stated that our strategy was that in our team meeting as an exercise we would bring two every week so that everyone had a chance to comment and it helped the presenting nurse in case her member was selected for grand rounds.  The English nurse manager asked me how I even understood Ms. R. and a few other staff from the islands that I had.  I politely let her know that I did have a diverse team and every one of them was a great nurse or social worker and did their jobs quite well.  As for understanding them, I listen to what they were saying intently and I did not multitask when they were speaking so that I could capture every word they said. Her response was “I am glad that they are on your team (Clark et al., 2011).”

A week later, I resigned from that position and unfortunately for my staff four of the team went to this one manager and the other nine went to someone else.  But of the four there was one from Haiti, one from Grenada, one from Puerto Rico and the other one was African American.  I  heard from all four about the poor treatment they were receiving from this manager. I, of course, could only listen, since I was no longer working there, but this is a perfect example of how not all nurses follow the code of respect of others cultures.

With patients, it is the same thing,  as nurses, we are not always going to understand what someone is saying whether it be a language barrier, dysphagia from a stroke, or dementia, but as nurses, we need to be able to read the body language.  We need to fine-tune our ears to try and understand what the person is saying. Living in Florida I am exposed to many cultures.  I myself am of Hispanic descent and although born in the states, I understand the diverse cultures that there are here.

In integrating health teachings, many materials are available in Spanish and Creole, However for the ones that are not, the use of translation companies are available through hospitals or managed care companies to help with the teaching that we are offering the patients.

References

Clark, L., Calvillo, E., De La Cruz, F., Fongwa, M., Kools, S., Lowe, J., & Mastel-Smith, B. (2011, May-June). Cultural Competencies for Graduate Nursing Education. Journal of Professional Nursing, 27(3), 133-139.

Strategies on Cultural Competence

In my own nursing career as a supervisor for field case managers, I have encountered patients and staff that come from diverse cultures. Every two weeks, our entire region would participate in something called Grand Rounds.  During those rounds, our medical director would review four cases that had been submitted for evaluation and best treatment options.  My team consisted of different cultures.  We had some wonderful nurses from different Caribbean Islands, some of them had a very strong accent, but that did not stop them from providing good care.

During one of our grand rounds, the medical director selected two of my case managers to present their case.  This case was presented in our own team meeting and we thought it would be a great one to present.  The one case manager we will call her Ms. R. presented a case about a member that had too many cats in the home and she was having difficulty staffing the case with home health aides because no one wanted to go in the home with so many cats. The medical director gave his evaluation of the case and the case was closed with the new information for the nurse case manager to implement.

During a manager meeting with about six other managers, the topic of case presentations came up and how each team needed to submit two cases per week, even if they were not selected for grand rounds.  A manager from England, who spoke with an English accent, stated that my team presented a lot of cases all the time.  I  stated that our strategy in our team meeting was to bring two cases every week so that everyone had a chance to comment. It also served as a good practice for the nurse presenting the case if the member was selected for grand rounds.  The English nurse manager asked me how I even understood Ms. R. and a few other staff from the islands that I had.  I politely let her know that I did have a diverse team and every one of them was a great nurse and social worker and did their jobs quite well.  As for understanding them, I listened to what they were saying intently and I did not multitask when they were speaking so that I could capture every word they said. Her response was I am glad that they are on your team (Clark et al., 2011).

I did resign from this position and unfortunately, four of the team went to this one manager and the other nine went to someone else.  But of the four there was one that was from Haiti, one from Grenada, one from Puerto Rico, and the other one was African-American.  I heard from all four about the poor treatment they were receiving from this manager. Of I course could only listen since I no longer worked there, but this was a perfect example of how not all nurses follow the code of respect for other people’s cultures.

With patients, it is the same thing, as nurses,  we are not always going to understand what someone is saying whether it is a language barrier, dysphagia from a stroke, or dementia, but we need to read the body language.  We need to fine tune our ears to try to understand what the person is saying. Living in Florida I am exposed to many cultures.  I myself am of Hispanic descent and although born in the states, I understand the diverse cultures that are here.

In integrating health teachings, many materials are available in Spanish and Creole, for the ones that are not, the use of translation companies are available through hospitals or managed care companies to help with the teaching that will be offered to the patients.

References

Clark, L., Calvillo, E., De La Cruz, F., Fongwa, M., Kools, S., Lowe, J., & Mastel-Smith, B. (2011, May-June). Cultural Competencies for Graduate Nursing Education. Journal of Professional Nursing, 27(3), 133-139.

A Review of a Nurse’s Role

A nurse can play three different roles as part of an interprofessional team.  The three roles consist of a nurse, nurse leader, and nurse educator.   The inter-professionalism team consists of other healthcare workers as well, not just nurses (Sommerfeldt, 2013). However, as nurses, the roles can be at different levels depending on the patient’s condition.  At my previous job, I worked as a complex case manager.  The team consisted of registered nurses, social workers (masters prepared) behavioral health specialists, community health workers, and nutritionists.  The nurse case manager managed the patient but if there was an issue with the patient in the home setting that required community resources, the community health worker would be consulted to assist in those needs.  If the member had psychological issues or other financial issues that required the need of a social worker or behavioral health specialist this referral would be added as well.  There was collaboration on the plan of care and all participated because we all were looking at the patient as a whole, not just as the part that each discipline took care of.  If a member was not able to pay his light bill or water bill due to financial difficulties until those needs were met through resources, any teaching that the nurse would do would be in vain.  A person cannot focus on teaching for their health or anything else if their mind is on their current financial strain, not their medical condition. In this instance, the nurse is playing the role of the nurse leader.

When a patient is in the hospital a nurse can also play the role of a nurse that is doing dressing changes, medication administration, and other treatments.  The nurse’s role in the interprofessional team may consist of the doctor, physical therapist, and dietitian, this would be more medically involved because maybe the patient is recuperating from heart surgery and requires a lot of care initially.  The patient may be on a special cardiac diet, which can also be explained by the treating nurse, however in this instance, the member is starting something new, so a consult from the dietitian can help the patient understand the diet and the nurse can reinforce the teaching.

The nurse educator as part of the interdisciplinary team can be seen for example in a disease management setting.  This type of setting also has multiple specialties that can follow the patient.  In this instance, the nurse educator is educating the member on how to empower themselves and learn about managing their chronic disease by learning about taking their medications, following a diet and exercise program, learning to check their blood sugar, or blood pressure.  The nurse educator can document what the patient learned based on return demonstration in the plan of care.

All three roles bring value to the scenario that they are in because the nurse will be around the patient most of the time.  In each role, the nurse is responsible for all aspects of the patient’s care.  Regardless of which role the nurse is playing, working on an inter-professional team is a style of partnership that allows decision making to be collaborative (Sommerfeldt, 2013).  It takes many people to working together to get a patient discharged to his home.

 

References

Sommerfeldt, S. C. (2013, February 25 2013). Articulating Nursing in an Interpersonal World. Nurse Education in Practice, (13), 519. http://dx.doi.org/http://dx.doi.org/10.1016/j.nepr.2013.02.014