Compassion Comes from the Heart

As nurses, we have the ability to use compassion and genuinely want the best for our patients.  We understand our patients and want to help them find the best treatment that will help them.  There are also nurses and doctors who do not exercise cultural competence in what the patient’s beliefs and wishes are.  As nurses, we have to validate our patients’ feelings of fear of not being able to provide for their families.   Many hospitals have case managers who focus on the hospital losing money and allow patients to treat at their facility but if they do not have insurance, they are very quick to send them elsewhere.  Many times when this happens, these case managers that are gatekeepers, are not thinking of the patient’s safety.

Social workers and nurse case managers are the peacemakers in these delicate situations, involving patient advocacy.    A good nurse case manager will identify the problem right away and diffuse it so that the focus is back on the patient.   Sometimes our culture in America imposes our beliefs on others thinking that they have to accept a specific method of treatment, but the reality is patients have a choice.  If a choice is explained well to someone, they will make the right decision.  We as healthcare providers have to explain things to the patient and family to help them understand and make an informed decision.

The skill that the staff needs to learn about caring for patients from other cultures is to remember that we as healthcare providers have to be sensitive to someone’s beliefs or culture.  Just because they do things differently does not mean it is wrong, it is just different.  We as healthcare providers have to be respectful (Barr & Dowding, 2012).

Cultural expectations were seen in my previous job while I was the manager of a team of nurses and social workers.  There was a manager from England and then there was myself,  of Hispanic background.   The majority of my team was from a different culture.   There was a nurse on my team who was great, but she spoke with a thick island accent, however her patients loved her.  The other manager like myself was from England. During a case presentation, the other manager stated how hard it was to understand her and she should not present again.  I stated that was not a fair statement because she presented cases and her skills and case were valid.   The other manager did not reply to my statement verbally but she made herself known by challenging everything I said in the future.  It is instances like this that discourage people from staying in jobs.


Barr, J., & Dowding, L. (2012). What makes a leader? Leadership in healthcare (2nd ed., pp. 32-44). [Vital Source Bookshelf]. Retrieved from

Leadership and Ethics

The ethical situation that comes to mind this week is religious ethics.  This theory focuses on religion, which is depicted by the parent’s upbringing and the older family members typically.  One particular faith, Jehovah’s Witness, does not allow for blood transfusions.  This is very important when you have a baby in the NICU (Neonatal Intensive Care Unit) that is in need of the transfusion and the parent will not consent.  The treating neonatologist will need to get a court order to do the transfusions.  In an extreme emergency, if two doctors sign off that it is an emergency, then the baby will receive the transfusions while they await the court order.  As a parent of a premature baby myself, I could not imagine not doing everything I could to save my child.  But in this case, the religious code of ethics is based on the upbringing of the parent (Denisco & Barker, 2012).

The parent refusing to allow treatment of transfusions to their baby would be a hindrance to the baby’s care, while at the same time as nurses we are trying to promote a  family-centered type of care involving the caregivers in the decision making and treatment  (Meadow, Feudtner, Matheny Antommaria, Sommer, & Lantos, 2010).  When my baby was in the level 3 critical NICU, they had open rooms, because the babies were too critical to be in closed rooms.  I watched a baby in front of us get sicker by the day and hearing the nurses and the doctors speak about the need for a blood transfusion and other treatments.  By the time they gave the baby the blood transfusion, it was too late, and the baby was terminal.  You as the parent are watching and hearing this because, in this type of critical setup, there is nothing between you and the next bed except a curtain and in front of you there is not a curtain.  As a nurse I thought to myself, how can they be having this discussion right in the open this way? As a parent I thought, how can these parents watch their baby die? I thought about how those nurses felt and if I were the nurse in that situation, what would I have done?

With the use of religious ethics, we may not agree with the family, but as nurses, we need to respect the other person’s customs and beliefs as long as the baby is being taken care of and there is not a medical threat to the baby’s life. When I stop and think about the nurse manager that was supposed to be the example, all we heard from her was complaints about the parents and how ignorant they were.  A part of me agreed, however, the nurse part of me, the part that is compassionate with the parents dealing with a decision they probably hate to make came out.  I said to the manager, we are all very much entitled to our opinions and they may not be the views of our patients, but in this crisis, we just need to support the parents because the baby will receive a transfusion whether they agree or not by court order.


Denisco, S. M., & Barker, A. M. (2012). 25. Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 569-581). Retrieved from

Meadow, W., Feduter, C., & Matheny-Antomennaria, A. H. (2012, April 13, 2010). A premature infant with necrotizing enetrosoliteis. Special Articles-Ethics rounds.



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.


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


Cultural Sensitivity and In-vitro Fertilization

A nurse was referencing a situation that occurred at the office she worked at.  The topic was about in-vitro fertilization and how the treating doctor did not want to be involved in the patient’s delivery due to the fact that five embryos’ were terminated and three remained.  Would all eight embryos have survived in one pregnancy? Could the embryos’ have been frozen to be used at another time?  This brings up a different cultural competence involving religion. Many people may not think of the embryo as being alive or a baby yet.  This would make caring for the individual patient difficult. Now what happens to the nurse that is working on a GYN floor and a woman comes in with complications following an abortion?  The scenario would be the nurse is a Christian and does not believe in abortion and she is not there for an abortion at the moment, she is there for a complication as a result of the abortion.  So in thinking about cultural competence on the nurse’s specific need, will she deny taking care of this patient because she does not believe in abortions, or will she take care of her because the patient came in after the abortion done with complications?  Those are some of the questions that we as nurses need to ask ourselves because as a manager of the

Now, this makes wonder what would happen to the nurse that is working on a GYN floor and a woman comes in with complications following an abortion?  The scenario would be the nurse is a Christian and does not believe in abortion and she is not there for an abortion at the moment, but she is there for a complication as a result of the abortion.  So in thinking about cultural competence on the nurse’s specific need, will she deny taking care of this patient because she does not believe in abortions, or will she take care of her because the patient came in after the abortion was done with complications?  Those are some of the questions that we as nurses need to ask ourselves because as a manager of a team if your employee asks for special accommodation for religious beliefs, we have to review it with the employee and the human resource department.  Regardless of what the culture is, if we can find a holistic approach to treat our patients and respect their differences, we will be able to provide excellent care (DeNisco & Barker, 2013).




DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd  ed., pp. 6-17). [Vital Source Bookshelf].

Leadership Styles and Organizational Changes

The role of the professional nurse when implementing a change is to identify that there is a need for a change (Rubenfeld & Scheffer, 2014).  Once the need for a change is identified by the nurse, the next step is to implement a change in behaviors efficiently and with quality. When identifying the area specifically that needs the change, nurses need to be deliberate in stating the purpose for the change.  When speaking to the target group about making the change, it is important to keep their attention span with non-lecturing phrases.  As nurses we are not always in our comfort zone to explain why changes need to be implemented.  We should be prepared to explain why this change is needed and what improvements these changes will make.


Generally, people will always be resistant to change.  But as professional nurses, our focus is to build trust and credibility.  The goal is to acknowledge that the change is coming and that you empathize with the feelings of the upcoming change (Rubenfeld & Scheffer, 2014).

Where I used to work, they were very involved with ACHA (Agency for Healthcare Administration), because we held a state contract.  Evidenced based nursing was in a sense required as far as the patient care when our case managers were managing a case.  However on the same note, although our case managers were not performing hands on care, they were required to know about all their diagnoses and treatments.  We had social workers and nurses alike seeing the same types of members.  The issue with nurses and social workers seeing the same types of patients is that the social worker is not able to use his/her critical thinking skills in their area of expertise.   They were required to assist members who had complex medical issues for instance, on a ventilator or more complex medical problems.   A suggestion was made when I arrived at my work place to utilize the social workers in conjunction to the nurses to manage the social aspects of the patients, however the decision was denied.  It was noted that ACHA is not paying the company to rethink how cases were managed and by whom because it was not hands on care, it was case management.

There was very little nursing involved in my job role, it was primarily reports and meetings to talk about reports and how to fix these reports.  It was an ideal job for someone that had an interest in perfection of numbers and statistics.  Every other day, there was a new change that was being implemented. We often times questioned why there was a change, but what we were told was that the change was immediate and mandatory.  For the staff case managers, these changes were difficult because the staff was in the field.  They may receive an email about something that needed to be changed as soon as possible, however they may have just returned home at  5pm in the afternoon looking forward to the end of their day and they find  emails with deadlines on multiple items due.  These changes affect the staff because they have to work late hours to get the work completed timely. This kind of change caused many good nurses and social workers to resign.

As nurses or leaders we tend to fall in to the routine of lecturing due to the pressures that we are under.  However two of the six dimensions of dealing with complex dynamic changes are creativity and intuition.  As a leader we should not just teach our group something, we should implement a way to bring creativity in to the change and use intuition to know how to speak to your group.  The best way to implement a change is to get the group to commit to doing the new change and develop a smart goal with them that will allow them to measure their own goals.

The leadership theory that most resembles mine is the coaching leadership style.  The coaching leadership style allows me to work closely with the staff at different levels and  empower them to meet their goals and gain confidence of their strengths so that they can focus on them as they work on their weaknesses.  In my previous job, the leadership style could have been called a dictatorship, however for the purpose of the discussion here it will be stated as coercive.

My manager’s favorite phrase was, “I gave a directive and everyone needs to follow it, any questions (1 second wait) no, good.  It’s due by close of business.”  If questioned on how to juggle that with all the meetings and other directives, the reply was always as a manager makes it happen.  My manager always reminded me that she did not take lunch, breaks and basically had “no life” outside of work and she expected those under her to be like her. She was not a woman who read books as a matter of fact, she indicated that books were a waste of time, for fun she read the ACHA contract that was 350 plus pages because reading any other book was pointless (Barr & Dowding, 2012).



Barr, J., & Dowding, L. (2012). What makes a leader? In Leadership in healthcare (2nd ed., pp. 13-31). [Vital Source Bookshelf]. Retrieved from


Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. In Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from

Quality and Safety at Well Baby Clinics

Recently, I was speaking with a health nurse at a clinic about the increase in babies being sick due to a lack of well baby check ups and vaccinations.  In speaking with the health nurse and in review of her concerns about her well-baby clinic, one of the critical dimensions that came to mind was inquisitiveness to determine whether offering immunizations at her clinic was working or not working to get the parents to come to the clinic.  If it is a well baby care clinic, are the parents bringing in the babies for any other check ups? For instance  are they coming in when a shot is not needed?


After our conversation, the health nurse decided to seek information about the mothers that were not coming and noticed that there was a drop in the amount of people who came because they did not have public transportation available for them, due to the distance that they lived from the clinic (she is in a rural area).  I suggested that there should be some creativity on the clinic’s part to establish a new way for the immunizations to get to the parents.


Creativity and inquisitiveness were two critical thinking dimensions that I identified in this well baby clinic scenario as I was speaking to the health nurse.  The structure is the routine immunizations that they provide to the parents at the clinic.  The process is based on the age of the infant and that will determine when they come in for their routine immunizations.  The outcomes are the hopes of reducing childhood illness, for instance measles (Rubenfeld & Scheffer, 2005).

In thinking, there are a few alternative ways that I think would help the well baby clinic and also help these families. First of all, finding out where the majority of the families that were affected by the lack of transportation live.  Once that is determined, locate a school, church or shopping center that will allow once per week or once per month depending on the amount of babies that need immunization, to set up an immunization clinic for those families affected by the bus system.  The schools, church and shopping centers are places that parents will need to go to if they have school age children or if they have to buy groceries or attend a church.   Even if they don’t attend the church, if it is in the community they have easy access to bring the baby for the immunizations.

school-clinic-1 school-clinic-2

Another alternative, is working with the resources available in the community.  Perhaps the clinic can find out if the transportation available to take people to doctor’s appointments would be available to bring the parents on a specified appointment day.   If the bus can pick up the parents where they used to take the city bus and bring them in to the clinic to get the shots, then go back to the bus stop once the group was done.


When the clinic presents these alternatives to the stakeholders making the decisions on what they will pay to make the clinic a success, it is important to share the benefits for doing the immunizations.  If presented in a narrative format, explaining first, the subpopulation that uses the clinic, then the treatment and frequency that they come as well as the consequences of the parents not coming.   Presenting the stakeholders with realistic facts if the babies are not immunized and that they can get a childhood illness like the measles, and how an epidemic can spread in the community, is an eye opener.  If there are complications from the illness without having proper care to the child or even an adult who was never immunized as a child, there can be an inpatient hospital stay.  The inpatient hospital stay would cost the tax payers and stake holders more money when simpler solutions could have been implemented.

In conclusion, education and preventative care is the basis of the well-baby clinic, but when the parent does not have the means to get to the one and only clinic, then an alternative to provide the same service has to be sought to keep the community healthy and avoid unnecessary inpatient hospital stays.



Rubenfeld, M. G., & Scheffer, B. K. (2015). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from

Rapid Changing Healthcare System

In our rapid changing healthcare system, it is very important to be able to have information at the tip of our fingers so that we can best help our patients.  How great it is to have the patient’s medical records available after entering their information in the system when the patient asks a question.  My favorite thing about having the patient’s information at your fingertips, is when a patient calls me, to help me remember them I always jot down some personal information about them; for example, one patient loved to watch her Spanish soap operas, another had a pet bird named Sam.  Knowing these trivial things helps me build a relationship telephonically with the patient, this allows me to ask about it so that when it comes time to discussing their healthcare and goals, I have established a trust to build a stronger effective care plan.


Critical thinking needs to be incorporated in to the informatics process.    Through critical thinking and informatics, we are encouraged to consider our own needs, have positive feedback and think logically to assist us to make good decisions that are based on evidence rather than on emotional feelings (Rubenfeld & Schaeffer, 2014).


Rubenfeld, M. G., & Scheffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). Retrieved from

Implementing Changes

Many nurses ask themselves, how can we as nurses implement changes in our units and departments?  One way to implement change is by communicating in a narrative format; doing a synopsis of what has been happening on our unit or department.  For example, how many patients have had complications as a result of coming in with an ulcer to the unit vs. the ones that may develop them in the hospital?  Without laying blame on anyone, if this study is brought as a statistic and narrative then it may help the nurses see the importance of proper documentation on initial admission.


Everyone is always afraid of change but if presented in such a format where they are given the time to learn it, for example paid education to come to the training on an off day with different options given for the training based on the two or three shifts that a hospital or facility has.  Once the plan is implemented for training, being able to have the educators follow up with how each nurse is doing, will show the staff that the management genuinely cares.  It is important to know if the new transition towards the change is working and if not why, so that the training can be revamped.  Once the nurses see that the change is going to make their jobs easier and the patient’s quality of care will be raised to a new level, they will be more receptive.



Stevens, K. R., & Caldwell, E. (2012, August 29, 2012). Nurse leader resistance perceived as a barrier to high-quality, evidence-based patient care. The Ohio State University Research and Innovation Communications. Retrieved from

Best Practices for Informatics

The informatics that is available to nurses is amazing.  Although there is always going to be something that someone thinks of that will improve the quality and speed of how we do our jobs,  we as nurses have to be willing to have intellectual integrity that moves us beyond our own needs (Rubenfeld & Schaeffer, 2014).  I used to work remotely from home as a manager for field case managers.  Our case managers would go out in the field and see the members on our health plan. They carried a laptop so that they could document anywhere and pull up their member’s information.  Of course the security to get into the laptop was only via an ever-changing token so that they could access it. With protected health information, the nurses had to be extremely aware of technology.


Years ago, many nurses had to document on paper when they would visit a patient in their home and they carried a paper chart in their car.  Informatics has improved in leaps and bounds.


When the case manager is at the member’s home, they are able to do their assessments right in the member’s home and share the outcome from the assessments with the member.  Meetings were held via WebEx when we had them because everyone worked from home. This made training on a new process easier giving everyone the ability to receive new information at the same time.

Female doctor visits elderly woman patient in nursing home. Laptop.

We also had a patient interface after the member was enrolled in our program.  The member would get in the patient status screen and would be able to add goals to their plan of care that they wanted to work on.  When the member filled this out, the nurse on the file would receive an alert that someone updated their file.

Close-up of happy female doctor talking with senior patient at clinic.

I see many opportunities for transforming knowledge from the use of informatics.  For instance if we were able to send doctors an email right from the member’s file, and get the reply from them instantly, it would cut back on the time and phone calls to doctors to get certain forms filled out for the teams throughout.   Some nurses that did not grow up with computers may have a challenge adapting, but with some education that can be done right from WebEx, they can learn.  Computers and their programs are not going anywhere; they are the wave of the future.



Rubenfeld, M. G., & Scheffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). [P2BS-11]. Retrieved from

Culturally Competent

In today’s world, there needs to be more education of staff on diversity of cultures.  In healthcare it is very important to have all staff, not just nurses, be aware of the different cultures that come in to the hospital, nursing home, rehab centers and doctor’s offices.  Health and illness are looked at in many different ways by different cultures. Take for instance the Hispanic population; it is one of the fastest growing ethnic groups in the United States.


There are many health risk factors in the Hispanic population.  Some examples of health risk factors are smoking, uninsured under the age of 65, diabetes, diet, hypertension, obesity and low birth infants. There are also many causes of death seen in the Hispanic population for instance, heart disease, cancer, unintentional injuries, stroke, diabetes complications, chronic liver disease, homicide, influenza, pneumonia and disorders originating during pregnancy.


Hispanics are challenged on a daily basis because they have environmental and community risk factors as well.  This group has limited access to healthcare, problems with immigration status, language barriers, cultural barriers, lack of preventative care, and lack of insurance and dangerous work conditions at times.

As nurses we need to be able to provide culturally competent care to our patients. At times rather than just going through the motions of medicating patients, we need to process the information that we are receiving. There are several strategies that we as healthcare workers can use.  The first strategy in assuring culturally competent care should be evaluating the healthcare professional’s individual approach to the culture that is being worked with by asking yourself questions. Am I aware of my own biases and prejudices towards the group I am treating? Do I have the knowledge and skill to conduct the assessments that are needed in a sensitive manner?  Do I seek out to interact with other cultures other than the ones I am comfortable with?  Do I really want to be culturally competent?  (Jeffreys, 2008) Another way that nurses can become more culturally diverse is by gaining the patient and family’s trust.


Jeffreys, M. (2008, November/December). Dynamics of Diversity Becoming Better Nurses through Diversity Awareness. NSNA Imprint, 36-41. Retrieved from