On Tuesday, Massachusetts voters will face a ballot question on mandating nurse-to-patient ratios.
Nurse staffing ratios are one of the most hotly debated issues within the nursing profession. Those in favor say the limits improve patient safety and care. Those against them say ratios don't account for patient acuity and would create a financial burden on hospitals and healthcare systems.
Now the public gets to weigh in on the issue. On Nov. 6, Massachusetts voters will face ballotQuestion 1, which would implement nurse to patient ratios in hospitals and other healthcare settings. The ratios vary according to the type of unit and level of care provided.
The Massachusetts Nurses Association supports the law, while hospitals, health systems and some other nursing professional organizations oppose it.
Both sides have pumped millions of dollars into the debate.
Voters seem to be split on the issue as well.
According to an October 25 to 28 WBUR poll, 58% of voters say they are against Question 1. This is a change from September when respondents to a previous WBUR poll were more evenly split with 44% in favor, 44% against, and 12% undecided.
Massachusetts is not completely unfamiliar with nurse-patient staffing ratios. In 2014, Massachusetts passed a law requiring 1-to-1 or 2-to-1 patient-to-nurse staffing ratios in intensive care units, as guided by a tool that accounts for patient acuity and anticipated care intensity.
Should the law pass, Massachusetts will join California as the only other state to require this level of mandatory ratios. In California, the law supporting ratios was passed in 1999 and was then rolled out in a staggered fashion until it was in full-effect in 2004.
Will mandatory ratios become a reality for those in the Baystate? That will be known, most-likely, in just a few short days.
Nursing students who were exposed to more Adverse Childhood Experiences have higher rates of burnout and depression.
Adverse Childhood Experiences, which include abuse, neglect, and family/household challenges, are common. Two-thirds of over 17,000 participants in the Kaiser-CDC ACE study, one of the largest studies on childhood neglect and abuse and later-life health and well-being, reported experiencing at least one ACE, and one in five reported experiencing three or more ACEs. Adverse Childhood Experiences are known to increase sensitivity to stress and negative physical and mental health outcomes.
The study included over 200 UTEP junior students enrolled in the first semester of upper division courses in the Bachelor of Science in Nursing program during the fall of 2016 and the spring and summer of 2017.
Participants completed the ACE questionnaire, the Maslach Burnout Inventory, and the PHQ-9 depression questionnaire.
Of the 211 respondents, 179 completed the ACE questionnaire. 72% reported at least one ACE, and 23% reported an ACE score of four or greater.
The most frequent ACEs reported were:
Divorced parents (32.7%)
Substance abuse within the household (31.3%)
Physical abuse (24.6%).
Of the 159 respondents who completed the MBI questionnaire:
22% reported moderate to high-level burnout on subscale A, which measures exhaustion
24% of participants scored moderate to high-level burnout on subscale B, which measures depersonalization
37% scored moderate to high level burnout under subscale C, which measures personal achievement
Of the 164 respondents who completed the PHQ-9 questionnaire:
62% reported no symptoms of depression
25% reported minimal depression
8% reported minor depression
3% reported major-moderate depression
2% major severe depression
Based on the study's results, nursing faculty should be educated on the frequency and range of ACEs experienced by students, and that these past experiences can influence students' present and future health and well-being, write the authors.
Seeing as these students will someday be present in the workforce, the influence ACEs may have on their ability to process stress and their risk for burnout is something nurse leaders should consider.
Both nursing faculty and nurse leaders can help students and nurses by intentionally educating them about available support services and making those services easily accessible.
Another intervention leaders can provide is educating students and staff on risks for and signs of depression and burnout.
Providing resources and formal training on building resilience is another tactic nurse leaders can take to combat burnout.
Nurse demographics such as generation, shift, and role influence development of resilience and burnout.
Burnout is hot topic in healthcare. But despite all the talk about it, burnout rates among nurses remain high. According to a 2017 Kronos survey of RNs employed in hospitals, up 63% report experiencing burnout.
Perhaps this is because burnout is a complex concept, and to make progress reducing it, healthcare leaders must delve into its many layers to find solutions that work for their specific organizations and nurses.
By analyzing engagement data to measure the key components of nurse resilience, the researchers found resilience varies according to nurse demographics such as generation, role, and shift.
Nurse leaders can use the findings to better understand who is at risk for burnout and to choose appropriate interventions for various groups of nurses at their organizations.
Activation and Decompression
Press Ganey developed and validated an eight-item tool for measuring resilience within its employee engagement surveys.
The tool has two separate subscales that:
Measure the degree of respondents' engagement with work (activation)
Measure respondents' ability to disconnect from work (decompression)
With the tool, Press Ganey researchers reviewed the activation and decompression scores of 17,483 nurses from 145 hospitals who completed the Nursing Excellence module of their organization's 2017 Press Ganey Employee engagement survey. Results were categorized according to generation (millennial, 1980 to 2000; Generation X 1965 to 1979; baby boomer 1946 to 1964) day or night shift, and manager status.
The activation subscale is based on the respondents' level of agreement with these statements:
1. I care for all patients equally even when it is difficult.
2. I see every patient as an individual with specific needs.
3. The work I do makes a real difference.
4. My work is meaningful.
The decompression subscale is based on respondents' level of agreement with these statements:
1. I can enjoy my personal time without focusing on work matters.
2. I rarely lose sleep over work issues.
3. I am able to free my mind from work when I am away from it.
4. I am able to disconnect from work communications during my free time.
Activation and decompression were also assessed using 2017 NDNQI RN survey results from 161,451 nurses (643 hospitals). The following statements were proxies for activation and decompression.
"I have what I need in my job so I can make a contribution that gives meaning to my life." (activation)
"Overtime hours in my last shift" (decompression)
These results were categorized by nurse role (charge nurse, nurse manager, staff nurse) and generation.
Differences Among Nursing Groups
The researchers found generational differences in activation and decompression among nurses. Additionally, activation and decompression varied by nurse manager status, nurse tenure, and shift.
Among the report's key findings:
Millennial nurses have the lowest levels of activation
Millennial nurses working the night shift have an even further activation disadvantage
Nurse managers have better activation than non-managers
Non-managers have a greater ability to decompress than managers
Both nurse managers' and non-managers' ability to decompress highly correlates with their perception of stress and the organization's support of work–life balance
Across all generations, activation and decompression are highly correlated with nurses' intention to stay in their jobs
Drivers of activation and decompression vary by generation and manager status
For example, nurse managers may report higher levels of activation because they have a greater level of autonomy than do staff nurses. Conversely, they may have lower levels of decompression because of the added responsibilities that come with a managerial role, the researchers write.
Promoting Resilience
To promote activation and decompression, it is important for leaders to help nurses feel joy in their jobs, feel valued, and to provide the tools and support needed for healthy work–life balance.
The researchers suggest the following interventions to promote resilience.
Meaningful recognition
Interventions that meet the varying needs of different nursing groups like night shift nurses, millennials, and nurse managers.
Nurse leaders share their expertise on everything from advocacy to the nursing shortage to things a new CNO should know.
Not much has changed in 20 years when it comes to nurses being interviewed by the news media as expert sources.
According to a replication of the original "Woodhull Study on Nursing and the Media," nurses are only used as sources in 2% of health news coverage (in 1997 it was less than 1%) and are only mentioned in 13% of health news coverage overall.
Yet there are nearly 3.4 million registered nurses in the United States according to the Kaiser Family Foundation. So why do journalists overlook such a plentiful, and expert, resource? According to the study, journalists do not understand the range of nurses' roles and often put "rock-star doctors" at the top of their source lists.
Here are five expert nurses who share their wisdom, knowledge, and vision for the nursing profession with HealthLeaders, and they remind us that nurses' expertise is important and needs to be heard.
Pamela F. Cipriano, current ANA president, has held positions spanning the bedside, the boardroom, and beyond, working as a healthcare consultant, a nursing faculty member, a chief nursing officer, and a chief clinical officer.
Nurses bring more to the table than clinical skills, says Cipriano—their knowledge and experiences put them in prime positions to advocate for both patients and the profession.
"I think the message is nurses are really your secret weapon—whether it's in the home, whether it's in the community, whether it's in the hospital—and we are underutilizing their expertise. It's important to recognize this from a patient outcome [standpoint and an economic one]," Cipriano says.
"The care that nurses provide is both what is obvious and a whole lot more that is not apparent," she says.
In January 2019, Ernest Grant, PhD, RN, FAAN, will take the reins from current President Pamela F. Cipriano and become the first man to be president of the ANA. The bulk of Grant's career has been spent at the North Carolina Jaycee Burn Center at UNC Health in Chapel Hill, where he oversees the center's nationally renowned Burn Prevention Program.
"I still want to see [the ANA] move forward. My top priorities are to advance the nursing profession in healthcare through fostering higher standards. [I want to encourage nurses to] advocate for issues that impact nursing in public health by being involved at the legislative level, both state and national level. That means actively volunteering to serve on committees: maybe for someone's campaign or serving as experts for a legislator on a healthcare-related issue, and understanding how decisions made in Washington or in state capitals may affect the profession itself. And then, of course, getting young nurses to be more involved within nursing and the ANA as well. They are the future of nursing," says Grant.
With years of experience as a registered nurse and a former senior adviser to the U.S. Department of Health and Human Services under President Barack Obama, Lauren Underwood, RN, is seeking to unseat Rep. Randy Hultgren in Illinois' 14th congressional district in the November election.
"I'm a registered nurse, and my career is at the intersection of clinical and policymaking, working to help transform our healthcare system. We know there are real challenges, the ACA created some and helped some, but we will need to have another serious effort around health reform. It is critical to have the voice of patients and providers at this table. And I am excited to partner [with] providers, plans, patients, and even hospital CFOs in order to get this done," Underwood says.
"I think that we need to have these critical voices at the table because healthcare is not theoretical. So many people who have had the pen for too long see healthcare through a theoretical lens, and as a result, we have a system that is broken and fragmented and inefficient, and it's time we fix that," she says.
"The shortage will not hit all areas the same. In some states, it is very regional, and some states are projected to have worse shortages than others. Some states are predicted to have a glut of nurses so there will be no shortages there at all. [Based on] the latest data, the big predictions for the shortage in the next 10 years are California, Texas, surprisingly New Jersey, and South Carolina. They are really the top at the moment for predicted shortages. We are still bracing for shortages here in Arizona, but we are now hearing that it may not be as bad as we thought it was originally predicted to be," Sanborn says.
"Better is better than perfect," is a guiding principle for Erin LaCross, DNP, RN, CMSRN, CENP, CNO at Parkview Regional Medical Center and Affiliates in Fort Wayne, Indiana.
"It's about having a mindset of continuous improvement," she says. "It just puts you in the frame of mind of always looking at being better than you are today, … and always learning and always forgiving yourself. If you did something today that you don't want to do again, then don't do it again. But you've reconciled that with yourself, and you don't have to be stressed about it."
This philosophy can help everyone from bedside nurses to CNOs learn and move forward.
"I think where we can get hung up is we want things to be perfect before we implement any changes," LaCross observes. "And then, in the meantime, while we're waiting for perfection, how many patients could have had better care?"
Correction: A previous version of this story misstated the number of registered nurses there are in the United States. There are about 3.4 million, not billion.
New RNs with bachelor’s degrees feel better prepared in safety and quality measures than those with ADNs.
While quality and safety measures are key to delivering excellent nursing care, new graduate nurses are not always adequately prepared in these areas, reports a new study by researchers at NYU Rory Meyers College of Nursing.
Educational preparation appears to be tied quality and safety competencies. The study found there is a growing gap in preparedness in quality and safety competencies between new nurses with associate and bachelor's degrees. Nurses with BSN degrees report they are "very prepared" in more quality and safety measures than their ADN peers.
"Understanding the mechanisms influencing the association between educational level of nurses and patient outcomes is important because it provides an opportunity to intervene through changes in accreditation, licensing, and curriculum," Maja Djukic, PhD, RN, associate professor at NYU Meyers and the study's lead author, says in a news release.
Nurses With BSNs More Prepared
For the study, the researchers examined quality and safety preparedness in two groups of new nurses who graduated with either associate or bachelor’s degrees in 2007 to 2008 and 2014 to 2015. They surveyed more than a thousand new nurses (324 graduated between 2007 to 2008 and 803 graduated between 2014 to 2015).
The nurses were asked how prepared they felt about different quality improvement and safety topics. The responses of nurses with ADNs and BSNs were analyzed for differences.
There were significant improvements across key quality and safety competencies for new nurses from 2007 to 2015, however, the number of preparedness gaps between BSN and ADN graduates more than doubled during this time.
In the 2007 to 2008 cohort, nurses with BSNs reported being significantly better prepared than those with ADNs five of 16 topics:
Evidence-based practice
Data analysis
Use of quality improvement data analysis and project monitoring tools
Measuring resulting changes from implemented improvements
Repeating four quality improvement steps until the desired outcome is achieved
Of the 2014 to 2015 graduates, those with BSNs reported being significantly better prepared than those with ADNs in 12 of 16 topics:
The same five topics as the earlier cohort
Data collection
Flowcharting
Project implementation
Measuring current performance
Assessing gaps in current practice
Applying tools and methods to improve performance
Monitoring sustainability of changes
How to Affect Change
"The evidence linking better outcomes to a higher percentage of baccalaureate-prepared nurses has been growing. However, our data reveal a potential underlying mechanism—the quality and safety education gap—which might be influencing the relationship between more education and better care," Djukic, says.
Laws and organizational policies encouraging or requiring bachelor’s degrees for all nurses could close quality and safety education gaps, note the researchers.
New York was recently the first state to pass a law, often called the BSN in 10, requiring new nurses to obtain their bachelor's degree within 10 years of initial licensure.
Additionally, nurse leaders and employers can affect change by:
Preferentially hiring nurses with BSNs
Requiring a percentage of the nurse workforce to have BSNs
Requiring nurses with ADNs to obtain a bachelor’s degree within a certain timeframe as a condition of maintaining employment
When nurse leaders discuss the nursing workforce, they often say that there's more to be concerned about than whether there are enough nurses to fill open positions. They understand that nurses' professional knowledge is of prime importance in delivering quality patient care and finding RNs with specialty nursing experience is becoming more difficult.
To help address this issue, Hartford HealthCare launched a system-wide operating room nursing fellowship for student nurses last year. The goal of the program is to drive interest in the perioperative specialty and foster professional development of future operating room RNs.
Here Tackett shares the three steps used to create a fellowship program for a perioperative nursing pipeline at the healthcare organization.
1) Establish Fellowship Program Fundamentals
Hartford HealthCare has experience offering fellowships, including the Susan D. Flynn oncology nursing development program, and a homegrown orthopedics fellowship. Hartford Hospital Vice President of Patient Services, Cheryl Ficara, RN, MS, NEA-BC, was an advocate for starting an OR fellowship to cultivate the next generation of perioperative nurses.
"It was really a directive from Cheryl, who was realizing OR nursing was difficult to [recruit for] and we needed to contribute to its ongoing interest," Tackett says. "We were also finding—and I think this is happening around the country—that the undergraduate curriculum, because of the demands that [nursing schools] have, they can't offer a lot of OR nursing experience."
Tackett and nurse leaders in the perioperative department at Hartford Hospital worked together to develop the program for nursing students entering their senior year of nursing school.
The program was designed to give the fellows an understanding of the role of the OR nurse through didactic and practical learning experiences, including direct observation of patient care and exposure to intraoperative nursing responsibilities.
The fundamentals of OR nursing were covered through a formalized, instructor-facilitated course of study. By working with the nurse educator and perioperative services and OR nurse preceptors, students learned about:
The foundations of perioperative nursing practice
The professional role of perioperative nurse practice
Assessment in the perioperative setting
Ethics related to nursing practice and patient care in the perioperative setting
Certification, professional association memberships, and continuing education
Patient education
Quality, safety and risk management
Methods and practices to control and prevent infection in the perioperative setting.
The leadership team wanted to ensure the fellows had an experience that showed them OR nursing is more than technical skills.
Tackett gives the example of a patient going to a well-pregnancy check at an obstetrics office and finding out there are pregnancy complications.
"She is emergently brought here. She has safety issues and the course has changed for this family. We need someone who can provide oversight not only for safety, but to support the family, and understand the physical and emotional complexities they're going through," she says. "We look to our OR nursing professional to do that. So that was another piece of this fellowship: we want these highly knowledgeable and skilled people to be the frontline of safety for us in caring for patients."
Additionally, the fellows completed research projects during their experience. One group focused on fires in the OR while another tackled recycling measures in the OR.
2) Pick the Cream of the Crop
In fall 2017, the team at Hartford Healthcare sent a request for applicants to its partner nursing schools. Junior students who would be entering their senior year, who were in good academic standing, and had at least a 3.2 GPA were able to apply.
After a round of interviews, the applicants were notified of their acceptance into the program before spring break 2018. Ten fellows were placed at five of Hartford Healthcare's various campuses. Hartford Hospital had six fellows; it had 23 applicants for those six spots.
What set candidates apart from the rest of the pack?
"A sincere interest in operating room nursing. Some of the people we interviewed came and said, 'I worked with somebody, or I had somebody in my family who was an operating room nurse, and she was inspiring,'" Tackett says. "We were also impressed by people who had some idea that this was way more than tasks and skills—that it was about advocating for the patient, applying nursing knowledge to maintain safety, keeping the patient safe from infection, and being able to respond to emergencies. There were students who could speak to that. So those [groups of] people were of greater interest to us."
3) Create Cost Effective Mentoring
The fellows worked 40 hours a week for eight weeks and were paid about $7,500 each during that time. The cost of purchasing a curriculum was about $200 per person.
Tackett says, "This was not expensive for us to run. The expense, if you will, is making sure that the nurse educator has the time dedicated for the coordination," she says. "We really do have to free up or balance the educators' time or staff time to make it work. So, there is that cost, but overall it didn't break us."
Through the experience the nurse educator was the fellows' mentor. She worked collaboratively across the healthcare system to have a similar curriculum.
"Another way to look at it is almost as if you had a group of orientees. It's kind of determining what the department can handle," Tackett says. "You have to balance what the service can bear and how many staff you have. But we didn't get complaints of people feeling overburdened because they had this young person with them."
The biggest challenge, says Tackett, was identifying what the fellows could do in the OR. For example, they could assist with positioning under direction but could not push IV meds.
"It was just going through a big list of [responsibilities] to make sure everybody was comfortable," she says.
Multiple Successes
Tackett says the fellowship was successful on many fronts.
"It was energizing for the team. You have these wonderful young people [and the team was] inspired by their energy and interest," she says. "They're very bright, they can navigate information well, and we were impressed with their research projects, so it was a positive thing. We didn't get any feedback from them or the staff that this was a burden, but we did prepare the staff that we're all in this to develop and support our future."
As for the fellows, they are now back at school completing their senior year. Tackett says there have been discussions about them returning for their capstone experience.
"We're certainly keeping in touch with them," she says. "We're maintaining that relationship with the hope that they will come back in May when they graduate."
Another OR fellowship cohort is planned for the summer of 2019.
Journalists consistently overlook nurses as sources in health news stories. It's been that way for decades, even as nurses increasingly reach higher levels of education.
Dr. Oz. Sanjay Gupta. Atul Gawande. These physicians have gained national notoriety via various media outlets. But who is the nurse equivalent? There isn't one. In fact, a replication study of the 1997 "Woodhull Study on Nursing and the Media" finds journalists routinely overlook nurses as sources in health news stories.
The original study analyzed 20,000 articles published in 16 U.S. newspapers, magazines, and health trade publications in September 1997. The researchers found that less than 1% of the articles in U.S. News & World Report, Time, Newsweek, and Business Week referenced a nurse. And nurses were referenced in less than 4% of the 2,101 newspaper health articles from seven newspapers across the country.
The current research team used the same publications as the original study and examined a randomly selected sample of 365 health news stories published in September 2017 to determine:
The type and subject of the article
The profession and gender of speakers
The number of times nurses were referenced without being quoted
They found:
Nurses were identified as sources in 2% of health news coverage
Nurses were mentioned in 13% health news coverage overall
"The lack of progress in nurses' representation in health news stories over the past 20 years was stunning, particularly since the 2010 Institute of Medicine report on 'The Future of Nursing' noted that we can't transform health care and promote the health of the public without recognizing and tapping into the special expertise of nurses," Diana J. Mason, PhD, RN, FAAN, principal investigator of the GW study and senior policy service professor for GW's Center for Health Policy and Media Engagement, says in a news release.
Researchers also conducted one-on-one telephone interviews with health journalists to better understand the barriers and facilitators to using nurses as sources in news stories. The interviews revealed themes of biases among journalists, editors, public relations staff, and healthcare organizations.
For example, participants said preconceptions exist in health news about positions of authority, placing "rock-star doctors" at the top of source lists. They also said newsroom cultures affect their selection of sources, and they have had to defend using a nurse as a source.
"Journalists and the media play an important role in educating the public about issues affecting health and healthcare, but their biases about who are credible experts is limiting the richness of their reporting,"Jean Johnson, PhD, RN, FAAN, executive director of the Center for Health Policy and Media Engagement, says in a news release. "If journalists aren't interviewing nurses, they may be missing the best part of the story."
The interviews also uncovered additional themes, including:
Health journalists not understanding the range of nurses' roles
The nursing profession not routinely engaging journalists
The researchers note that journalists and nurses can both do more to ensure the public benefits from the knowledge and insight nurses can provide
Additionally, a companion study found that biases in newsrooms about women, nurses, and positions of authority in healthcare can impede a journalist's use of nurses as sources in health news stories, despite unique perspectives that could enrich a story.
Despite occupational growth projections for nurses, their salaries appear to be stagnant, according to a new survey of RNs and LPNs.
Nursing ranks third on the Bureau of Labor Statistics' list of occupations with the most job growth. While employment of RNs is projected to grow by 15% between 2016 and 2026, their salaries are not increasing at the same booming rate.
In fact, Medscape's newly released "RN/LPN Compensation Report 2018" finds that salaries for both RNs and licensed practical nurses have remained flat for two years. The study was conducted in 2018 and 5,011 RN and 2,002 LPN respondents reported their 2017 salaries.
In addition to salary, the survey looked at factors that influence compensation including practice setting, gender, unionization, and geography.
For 2017, full-time RNs' average annual earnings were $81,000, up slightly from $80,000 in 2016. Full-time LPNs earned $46,000 in 2017 and saw no change from 2016.
The study's authors point out that if they had adjusted for inflation, both groups of nurses would have seen a decrease in wages.
Interestingly, RNs' acute care hospital wages did not rise from 2016 to 2017, but wages of RNs working in other settings did see an increase.
The average hourly wage of a full-time RN in 2017 was $37 and $38 for part-time RNs. Full-time LPNs were paid an average of $22 per hour, and part-time LPNs earned $23 per hour.
RNs and LPNs paid on a salaried basis had greater gross annual incomes than their hourly counterparts. Salaried RNs made 8% more than RNs paid an hourly wage while LPNs made 13% more.
Additionally, RNs who were salaried saw an increase in their gross annual wages from 2016 to 2017 ($82,000 to $84,000) while those who were paid hourly did not.
Though the healthcare industry continues its march toward preventive, outpatient, and community-based care, hospitals are still the main employers of RNs.
39% of RNs reported working in hospital-based inpatient care
13% of RNs reported working in a hospital-based outpatient setting or clinic
Skilled nursing facilities or another type of long-term care setting were the primary employers of LPNs (24%).
The majority of RNs (75%) and LPNs (81%) reported working full-time in 2017. Still, compared to 2016, this is a 5% drop in the number of RNs working full-time and a 1% decrease for LPNs. The decrease in full-time RNs corresponded to an increase in part-time or per-diem RNs.
A pilot program gives nurses the support to change their health habits, so they can better care for patients.
Nurses are often the ones delivering health promotion education to patients. However, when it comes to their own health habits, they may not take their own advice.
A 2011 study by researchers at the University of Maryland School of Nursing found that 55% of the 2,103 female nurses surveyed were overweight or obese. And, in a recent survey of nurses at the Medical University of South Carolina, 75% of the MUSC Health nurses reported putting their own health, safety, and wellness behind that of their patients.
At MUSC, this manifested in nurses struggling with healthful eating, including eating less than the recommend daily amounts of fruits and vegetables. But a nutrition pilot project has helped the organization's 2,700 nurses markedly improve their eating habits. Over the course of 60 days, they tripled their daily consumption of fruits and vegetables
Not only does this have the potential to improve the health of the RN workforce, but the health of patients.Researchhas found patients find preventative recommendations from healthcare providers who engage in healthy behaviors to be more credible and motivating.
Eat Your Veggies
Prior to the start of the program in June 2018:
Almost half of the MUSC Health nurses said they ate at fast food restaurants one to two times a week
31% ate at fast food restaurants three to four times a week
The majority of nurses said they ate only two to three servings of fruits, vegetables, and whole grains per day
After the pilot:
17% of MUSC Health nurses reported eating five servings of fruit and vegetables per day
72% said they eat three or more servings of fruit and vegetables a day
As part of the nutrition pilot, fresh, seasonal, and local food items were available for MUSC Health nurses to quickly pick-up at three MUSC locations. Each was labeled with the number of servings of fruits or vegetables it contained.
Additionally, the Sodexo's dietitians and chefs created new, healthier food options based on information shared by MUSC Health nurses.
"MUSC Health nurses' willingness to participate in the pilot and also engage in the planning phase by sharing details about their nutritional habits is the sole reason it was a success," Bonnie Clipper, DNP, RN, MA, MBA, CENP, FACHE, vice president of Innovation at ANA, says in a news release. "Pilots like this one and other innovative programs that target the nursing workforce are necessary to help create healthy nurses and – ultimately – a healthy nation."
Healthcare executives must be intentional about including diversity, inclusion, and equity in their strategic plans to achieve the outcomes inherent in a value-based environment.
When compared to other industries, healthcare organizations have lagged behind in incorporating diversity and inclusion into their strategic vision.
"At our company, we had our first Global Diversity and Inclusion Council in 1993. That's 25 years ago," says John Hesselmann, national head of specialized industries for Bank of America. "We have things that we have to work on, but I’d say at our company specifically, diversity and inclusion have been embedded in our culture longer than in the healthcare industry."
Bank of America sponsored the HealthLeaders Media Executive Roundtable panel discussion, "The Role Diversity and Inclusion Plays in Achieving Strategic Goals," held in Chicago in May.
Brenda Battle, RN, BSN, MBA, vice president of the Urban Health Initiative and chief diversity, inclusion, and equity officer at UChicago Medicine, agrees with that assessment.
"Healthcare has got some catching up to do. I've started up diversity and inclusion efforts now in two academic healthcare systems, both in St. Louis in 2006 and Chicago in 2012. I was one of the early pioneers with a few others who started in healthcare before me," she says."I can’t say I know anyone in healthcare that has been doing diversity and inclusion since 1993. I started in 2006. In healthcare this represents a lot of experience in the space of diversity and inclusion."
Diversity and inclusion—the time is now
But as healthcare becomes more consumer-focused, more attention is being paid to the importance of diversity and inclusion.
"Coming from the for-profit world, diversity and inclusion was a business decision because you go after who your consumer is. I think that consumerism model is going to impact hospitals and healthcare systems and push them to understand that there’s an approach and opportunity that they may be missing," says Erickajoy Daniels, senior vice president of diversity and inclusion at Aurora Health Care in Milwaukee. "Healthcare is always going to be necessary, but it needs to attend to the individuals who are growing in our communities, so there’s got to be a shift. I don’t know that there was much of a press or urgency to do so before."
Some of that urgency is tied to the industry's move toward value-based reimbursement.
"The system is moving toward value-based reimbursement and population health management with hospitals being paid for value—outcomes at the appropriate cost without sacrificing quality. Value-based reimbursement requires the hospital to be responsible for patient outcomes regardless of where care happens," Battle says. "Now hospitals and healthcare systems have to pay more attention to what really improves outcomes for populations. It requires hospitals to understand populations from a cultural perspective, a lifestyle perspective, a socialization perspective, and to consider the influence of social determinants of health on populations."
This understanding can elevate an organization's status as a healthcare provider.
"There are things that we want in healthcare. We want to be the provider of choice. Are you the provider of choice across all communities? How are people choosing you? Is it because they feel like they’re fully accepted, they’re acknowledged, and they’re valued? Is it because you understand and address their needs?" Daniels says. "Think about growth and where you want to expand your services. Know who’s living in the communities you're serving and what they are looking for."
Equity is the goal
Understanding and reflecting the needs of customers and communities is key to achieving an organization's mission.
"Our customers and the communities we do business in are diverse," Hesselmann says. "We talk about our purpose a lot. It's to make financial lives better through the power of every connection. Well, if you’re really going to practice on the purpose, think about all the words, then ask, "What are we doing in communities throughout the U.S. business to support diversity and inclusion?”
Diversity and inclusion work should ultimately be about achieving equity of care delivery.
"Equity is creating opportunities for individuals based on their specific needs. It’s not the same as equality because I don’t need what you need; I need what I need. Equity is how a healthcare system delivers care to patients in a way that meets the needs of those individuals based upon their background, their psychosocial disposition, what their needs are, and the resources they have in their environment," Battle says. "To me, the end goal of diversity and inclusion has to be equity for the individuals in the workforce, for healthcare [delivery], patient outcomes and experience, and the various metrics that healthcare organizations are tied to around improving health."
