The Link Between Cultural Communication, Hospital Safety, and Desired Outcomes

The Link Between Cultural Communication, Hospital Safety, and Desired Outcomes

by James Z. Daniels & Janice Bonham West | Apr 23, 2018 | Magazine, Nursing Diversity |

A clinician sees a Somali patient with a primary complaint of back pain and, following an exam, prescribes a traditional course of western medical action. The patient, however, is reluctant to act on the medical advice because he thinks his back pain is caused by a bad relationship with his parents or guilt over something he did. “It is always good (for clinicians) to have some knowledge about their patient’s culture, to know who they are dealing with,” says Fozia Abrar, MD, of Minneapolis. “It might cost time and money, but you save more money by not getting a misdiagnosis, by improving quality of care.”

Suffering from bacterial gastritis, a Somali woman in Minnesota visits several providers but does not take the medication they prescribe. When met with a smile and a greeting in her native language by Dr. Abrar, the patient complies with the same treatment recommended by the previous ­providers—Dr. Abrar successfully ­persuaded the patient to fill a prescription and take the medication because of her ­knowledge of the patient’s culture. This situation is not new or unique—medical ­anthropologist and psychiatrist Arthur ­Kleinman, MD, has spent 30 years championing cultural issues in ­medicine. He says a great body of evidence shows culture does matter in clinical care.

Every cultural group has traditional health beliefs that shape members’ perspectives about wellness. The increasingly diverse, twenty-first-century patient population requires clear communication and practitioner awareness of patient health perspectives in order to significantly impact patient satisfaction, safety, compliance, and outcomes.
Organizational Culture, Patient Satisfaction, and Safety

Organizational culture informs every worker whether patient satisfaction is a key value. By influencing employee behavior and how ­employees are treated, ­culture drives employee effectiveness, safety, and whether employees take advantage of opportunities as they arise. Organizations that dedicate additional employee resources to patient safety signal to employees that both employee effectiveness and patient safety are high ­priority. In other words, organizational values and beliefs guide employee commitment to patient and worker satisfaction. According to the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture: 2016 User Comparative Database ­Report, patient safety improved more at hospitals where they increased employment of staff who reported ­incidents, ­compared to hospitals that did not expand the number of employees who ­reported incidents.

At Atrius Health, a Massachusetts ambulatory care provider with 36 locations, staff can report safety events while updating existing electronic health records (EHRs). This reporting mechanism has increased the number of reported events, and as many as 30% of events reported monthly come in through the EHR tool, according to Ailish Wilkie, patient safety and risk ­management ­director for Atrius Health.

In other words, employee ­accountability shapes ­workplace and organizational culture.
Patient Culture, Provider Culture

In addition to the effect workplace culture has on patient satisfaction and employee competency, two additional areas of culture impact health care effectiveness. Both a patient’s cultural background and the provider’s scientific/medical culture inform patient and provider wellness perspectives. If patient compliance with the treatment plan is the goal, providers need to understand the patient’s cultural identity.

By the same token, patients need to know that their perspectives are respected. Few health care ­observational ­studies have reported ­sufficient information to support the claim of provider bias, but a 2006 study published in the Journal of General Internal ­Medicine reported that most internal medicine residents gain cross-cultural skills through informal training, and most stated that delivery of high-quality, cross-cultural care was important but were skeptical about the expectation of learning every little detail about all cultures. Barriers to ­cross-­cultural care included lack of time, not knowing enough about the religion or ethnic group of the patient they were caring for, and/or dealing with belief systems which are ­different than their own.

A 2000 study in Social ­Science and Medicine found that physicians rated ­minority patients more negatively than White patients; the study also reported that physicians viewed minorities as non-compliant and more likely to engage in risky health behaviors. Clearly, providers need reliable resources to add to their understanding of the patient’s perspective.

A 2017 survey of 111 health care providers revealed where providers currently turn to access cultural training and information, and what types of information providers need when they are unsure/unaware of the patient’s cultural profile and its implications for treatment decisions, patient compliance, and safety outcomes. The survey found that providers want more data on their patients’ use of nontraditional medicine; their faith beliefs; and who the health care decision-makers are.
Diversity and Disparities

An increase in racial and ethnic minority health ­professionals provides greater opportunity for minority ­patients to see a practitioner who speaks their primary language or is from their own racial or ethnic background. This can improve the quality of communication, patient safety, satisfaction, compliance, and outcomes. In addition to ­increasing the diversity of practitioners, hospitals are working to improve hiring diversity, employee cultural awareness, and organizational culture.

In 2015, The Health Research & Educational Trust (HRET) commissioned a ­national survey of hospitals and health systems to quantify the actions they are ­taking to ­promote diversity in leadership and ­governance, and reduce health care ­disparities. Data for this project were ­collected through a national survey mailed to the CEOs of 6,338 U.S. registered hospitals. The response rate was 17.1%, with the sample generally ­representative of all hospitals.

Minorities represent a ­reported 32% of patients in hospitals that responded to the survey, and 37% of the U.S. population, according to other national surveys. In contrast, the HRET survey data show that minorities represent only 14% of hospital board membership, 14% of executive leadership positions, and 15% of first- and mid-level positions.

As a sign of progress, though, nearly half of hospitals surveyed had a plan to ­recruit and retain a diverse workforce matching their ­patient population. Further, 42% said they implemented a program to find diverse ­employees in the organization worthy of promotion.
Cultural Data Collection

The HRET data show that 98% of hospitals are collecting patient data on race. Additionally, other areas of data collection included ethnicity (95%) and first language (94%). But, the percentage of hospitals that correlated the impact these factors have to the delivery of care was a mere 18%. Remarkably, in 2011 only 20% of hospitals analyzed clinical quality indicators by race and ethnicity to identify patterns, whereas 14% looked at hospital readmissions, and 8% analyzed medical errors.

A serious flaw in the HRET survey was zero data collected on hospital patient national origin. The report listed myriad reasons why hospitals might be failing to meaningfully use the data, such as fearing potential liability issues after publicly acknowledging disparities in care, concerns about the public relations backlash, and a lack of knowledge in developing clinical programs that would reduce or eliminate inequalities. Plus, some hospitals noted the lack of a “diversity champion” on their staff to help lead the effort.

Hospitals seem to be making progress in educating staff on diversity, with 80% providing cultural competence training during orientation and 79% offering continuing education opportunities on cultural competency, according to the survey.
What’s Next?

Hospitals have begun to include leadership goals ­designed to reduce care disparities by implementing ­diversity initiatives such as: allocating adequate resources to ensure cultural competency/diversity initiatives are sustainable; ­incorporating diversity ­management into budget ­planning and ­implementation process; increasing hospital board diversity to reflect that of its patient population; board members demonstrating completion of diversity training; developing plans specifically to increase ethnic, racial, and cultural diversity of executive and mid-level management teams; and executive compensation tied to diversity goals.

Beyond the C-suite, hospitals are developing diversity plans with initiatives that include diversity goals in hiring manager performance expectations; implementation of programs to identify diverse, talented employees within the organization for promotion; documented plans to recruit and retain a diverse workforce that reflects the organization’s patient population; required employee attendance at ­diversity training; hospital collaboration with other health care organizations to improve health care workforce training and educational programs in the communities served; and education of all clinical staff during orientation about how to address unique cultural and linguistic factors affecting the care of diverse patients and communities.

This increased implementation of appropriate health care and adherence to effective diversity and cultural education programs at every level of health care will ultimately result in improved patient ­satisfaction, compliance, hospital safety, and patient health outcomes.


James Z. Daniels & Janice Bonham West
James Z. Daniels, MPA, MSc, is a consultant and writer who lives in Durham, North Carolina, and frequently contributes to ­Minority Nurse.

Janice Bonham West, MEd, is a writer and consultant who lives in Raleigh, North Carolina.

Transitioning wound care patients to post-acute care

Transitioning wound care patients to post-acute care
January 2018 Vol. 13 No. 1
Setting goals and meeting needs.

Takeaways:

When discharging patients from acute care facilities, consider cognitive and functional status; the home environment; family or caregiver support; access to services, medications, and transportation; and follow-up care.
Depending on the patient’s situation, the three goals of wound care are healing, maintenance, and comfort.
After discharge from an acute-care facility, patient medication management, diet, and lifestyle can help support wound healing.
Patient and family engagement and education, including their goals, preferences, and concerns, are fundamental to a successful transition.

By Armi S. Earlam, DNP, MPA, BSN, RN, CWOCN; Lisa Woods, MSN, RN-BC, CWOCN; and Kari Lind, BSN, RN

Discharge to post-acute care settings such as rehabilitation and skilled nursing facilities, long-term care hospitals, and home health depends on the patient’s overall health. Other factors that must be considered include the patient’s cognitive and functional status; the home environment; family or caregiver support; access to services, medications, and transportation; and follow-up care. In this article, we’ll focus on the needs of wound care patients who are transitioning to post-acute care.
Elements of a wound care discharge plan transition wound care patients post acute. When discharging a patient who needs wound care, acute-care clinicians (wound care nurse, discharging nurse, and case manager) should evaluate the comprehensive wound care plan, asking questions related to the goals of care, discharge setting, care provider, products and resources, patient factors that influence wound healing, and follow-up care.

What are the care goals?

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Depending on the patient’s situation, the three goals of wound care are healing, maintenance, and comfort. If the goal is wound healing, treatment should focus on wound granulation and eventual closure. However, if the wound is unlikely to heal (for example, an elderly patient with arterial wounds who is too frail for a vascular intervention), the goal is to keep the wound clean, stable, and free of infection.

For patients receiving end-of-life care, comfort is the goal. Treatment includes dressings that are changed less frequently, cause less pain, adequately absorb drainage, and control foul odor.

Keep in mind that goals may overlap and evolve, so the wound care plan should be modified as necessary.

Where will the patient go?

Wound severity and complexity may affect the choice of post-acute care setting. For example, a patient with multiple wounds requiring either negative pressure wound therapy (NPWT) or twice-daily dressing changes may be best placed in a long-term care hospital. On the other hand, someone who needs once-daily wound packing can be managed at home if the patient or family can perform dressing changes between home health nurse visits.

Additional considerations include clinician time needed to perform wound care and equipment availability. Some post-acute care settings may not have the resources for frequent dressing changes or clinician visits. The discharging facility must establish that the necessary equipment and clinical personnel are available.

Who will perform wound care?

Clinicians need to assess whether the patient is functionally and cognitively able to perform wound care. If not, other options include a home health nurse or a family member or friend. If the patient lives in a remote area and wound care will be done by a family member with only periodic visits by a home health nurse, the in-patient nurse needs to assess the caregiver’s ability to complete care tasks and provide education. The teachback method allows caregivers to demonstrate what they’ve been taught so the home health nurse can assess comprehension and ability.

If the patient is being discharged to a setting other than the home, the facility must demonstrate the availability of clinicians who have the knowledge and skills to manage the prescribed wound therapy.

What products and resources will the patient need?

Each facility and agency has its own formulary of wound care products; the brands used in the hospital may not be the same used in post-acute care. The patient’s insurer also may dictate what products will be used. For example, different manufacturers of NPWT products have contracts with different insurers, which will dictate what brand can be used at home.

Insurance companies reimburse home health agencies a set amount depending on the patient’s diagnoses. Daily dressings or costly products may not be feasible after acute-care discharge. However, an expensive product that requires twice-weekly dressing changes rather than twice-daily saves clinician time, making it a more cost-effective choice. Alternatively, substituting a less-expensive comparable product or therapy for an expensive one without loss of efficacy may facilitate a timely transition.

What patient factors should be addressed?

After a patient is discharged from an acute-care facility, medication management, diet, and lifestyle can help support wound healing. For example, patients with diabetes who have foot wounds must control their glycemic levels by following medication regimens and dietary recommendations, and patients who smoke should begin a cessation program. Patients with heart failure who have leg swelling and blistering that results in wounds must adhere to their diuretic therapy. To avoid infection that can impede wound healing, all patients must adhere to prescribed antibiotic regimens.

When treating pressure injuries, addressing the etiology is crucial. Clinicians or family members may be using the appropriate wound care products, but if the affected body part is not properly offloaded and pressure not redistributed adequately, then the wound treatment will be futile. For example, a pressure injury on the heel won’t improve if the cause of the pressure isn’t addressed by using offloading boots or pillows under the calves when the patient is resting in bed.

What are the follow-up care plans?

Discharge instructions should include detailed wound care guidelines and contact information for the provider with whom the patient should follow up. Plans for future supply procurement, conditions for revising the care plan, and access to transportation for follow-up care also should be considered.
Successful transitions

Safe and effective care transitions not only are best practices, but they’re also essential in today’s healthcare environment. Changes in reimbursement, including both incentives and penalties for certain discharge outcomes, along with a much-needed emphasis on quality, accountable care have encouraged this attention. Patient and family engagement and education, including their goals, preferences, and concerns, are fundamental to a successful transition. Nurses can help ensure that treatment goals and patient needs are met by providing support, education, and care.

The authors work at Lutheran Medical Center in Wheat Ridge, Colorado. Armi S. Earlam is the lead certified wound ostomy and continence nurse, Lisa Woods is a certified wound ostomy and continence nurse, and Kari Lind is an RN working in wound and ostomy care.
Selected references

Adkins CL. Wound care dressings and choices for care of wounds in the home. Home Healthc Nurse. 2013;31(5):259-67.

Agency for Healthcare Research and Quality. Care Transitions from Hospital to Home: IDEAL Discharge Planning: Implementation Handbook.

Alper E, O’Malley TA, Greenwald J. Hospital discharge and readmission. UpToDate®. April 3, 2017.

Dreyer T. Care transitions: Best practices and evidence-based programs. Home Healthc Nurse. 2014;32(5):309-16.

Hudson R, Comer L, Whichello, R. Transitions in a wicked environment. J Nurs Manag. 2014;22(2):201-10.

Krapfl LA, Peirce BF. General principles of wound management: Goal setting and systemic support. In: Doughty DB, McNichol LL, eds. Wound, Ostomy and Continence Nurses Society® Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016; 69-79.

Milne C. Challenges of transitioning wound patients through the continuum of care—Q & A. November 2016.

Adapting to Overnight Shifts: 5 Common Mistakes and How to Avoid Them

Adapting to Overnight Shifts: 5 Common Mistakes and How to Avoid Them

Mar 30, 2018 | Blog, Minority and Community Health

Working overnight shifts is a big change for many nurses, but it’s also extremely common. With the 24-hour demands of the bustling, modern health care system, there’s a good chance you’ll have to work the night shift at some point in your career, especially when you’re starting out. But don’t fret! There are many ways to ensure that the transition from day to night goes as smoothly as possible.

All nurses need to be on their A-game with technical medical skills and emotional resilience no matter what time of day they’re working. Night shift nurses have to shoulder even more burdens because they often work mostly or entirely alone for their shift. While there’s no one “right” way to adapt to the night shift, there are several common mistakes that you’ll want to avoid to build good habits.

Common Mistakes to Avoid When Switching to the Night Shift

Going against your circadian rhythm is no small task. However, resorting to quick fixes will only make your shifts more difficult in the long run. Avoid these five common mistakes and you’ll adapt to the swing of a night shift quickly.

1. Not getting enough rest before starting a shift.

As a nurse, it’s important to always be sharp on the job. The staff at Gurwin Jewish Nursing and Rehabilitation Center emphasize that not getting enough rest is the number one mistake that new night shift workers make, and it’s one of the most dangerous. Since shifts are often upwards of eight hours long, there’s no safe way to “power through” on too little sleep. This goes for both on-shift work and driving when sleep-deprived.

How to Avoid It:

Install blackout curtains where you sleep and get a fan or white noise generator.
Turn off your phone, get a “Do Not Disturb” sign, and inform loved ones of your schedule.
Staying up for a few hours to relax and take care of yourself may be easier for some nurses than going straight to bed at the end of a shift. You’ll figure out what works for you with time, so don’t be afraid to experiment.
Take proper care of your legs and feet while on your shift, so you won’t be troubled by pain or soreness when you’re trying to sleep.
Light soothing candles and practice stretches to relax yourself before bed.

2. Leaning on sugary foods, alcohol, or caffeine instead of proper nutrition.

It can be tempting to snack on chocolate or chug coffee to keep yourself going through your night shift. Keep in mind that, if consumed in excess, coffee can lead to jitters at first, followed by a crash. You’ll be far better off if you instead focus on getting more sleep.

How to Avoid It:

Plan and pack your meals ahead of time to avoid relying on vending machines.
Schedule your heavy meals so they won’t interfere with sleep.

3. Letting your personal life fall into disorder.

Sometimes it’s hard to keep your personal life in order while working the night shift. Errands, social gatherings, and childcare all battle for your attention when you’re not at work. This reduces your ability to get good sleep and, in turn, to focus at work.

How to Avoid It:

Yoga and meditation help you relax and leave work behind so you can be present when you’re engaging with family or friends.
Establish a schedule for sleep, chores, and activities. This will reduce the stress of missing out on things.
Plan gatherings ahead of time with friends and family to ensure you can make it to fun gatherings.

4. Not asking for help or feeling like you have to “do it all.”

Yes, there are fewer resources available overnight at the hospital. This can lead to superhero-esque thinking, where you refuse or even genuinely forget to ask for help. Being honest about needing a hand is better than dropping the ball because you’re juggling while tired.

How to Avoid It:

Get to know the others who work nights so you can trade favors.
Get to know the resources available to you during your shift.
Ensure that your roommates or family are sharing the load with you at home.
Choose sleep over chores when possible at home. Others can help you with chores, but they can’t sleep for you!

5. Missing out on workplace bonding, training, or resources due to night shifts.

It’s easy to feel forgotten when working the night shift. Try not to miss out on opportunities for bonding, continuing education, or extra support because of your schedule. It can be hard to make time or schedule changes for these opportunities, but they’re integral to your career development down the line.

How to Avoid It:

Check announcement boards and learn about opportunities available at your workplace.
Make it known to your boss and coworkers that you’re interested in additional training, support, resources or team bonding even if you work the night shift.
Ask if there are online resources available for any opportunities that you simply cannot attend.

Your job as a nurse is important. Don’t let working the night shift get in the way of providing the best care possible to your patients and yourself. Getting enough sleep is integral to your job performance and personal health, but that’s not always enough. You also need to make sure you’re practicing good self-care and focusing on your health along the way. With these great tips, you’ll adapt to the night shift in no time!

Deborah Swanson is a medical office professional with two decades of experience helping small practices and large hospitals alike improve efficiencies. She recently started consulting with allheart.com providing insight into the daily activities of medical professionals and how best to serve them.

News You Can Use: Detecting Dysphagia

Detecting dysphagia
May 2017 Vol. 12 No. 5

Author: Carel Mountain, DNP, RN, CNE; Kimberlee Golles, MS, CCC-SLP

It’s 8:00 am and time for your 83-year-old patient, Virginia Johnson*, to take her oral medication. She was admitted with a left femoral fracture following a fall. After the initial surgery, she developed a urinary tract infection, and this morning she is disoriented and confused. As Mrs. Johnson takes the first pill, you notice she takes a long time to swallow and then coughs immediately after. You recognize that Mrs. Johnson may have dysphagia and that she’s at risk for developing aspiration pneumonia.

As the population ages, hospital clinicians see more patients with dysphagia resulting from stroke, dementia, and Parkinson’s disease. (See Causes of dysphagia.) Patients with dysphagia are at high risk for developing aspiration pneumonia as a result of food, liquid, or oral bacteria going into the lungs. Other complications include dehydration, malnutrition, and airway obstruction. Through consistent patient interaction and using a simple assessment technique, nurses can recognize dysphagia early and make referrals to help prevent complications, decrease hospital stay, and contribute to the health and safety of patients.


Bedside assessment

Use the PASS acronym to determine your patient’s risk for dysphagia (See Don’t PASS up the opportunity.) Start by asking if it’s probable that the patient will have difficulty swallowing. For example, intubated patients and those with feeding tubes are at risk for dysphagia. Next, ask for an account or history of previous swallowing problems, which may indicate future problems and the need for additional or immediate intervention.

The third step is to screen your patient for observable symptoms such as drooling, coughing, or change of voice or speech. Your observation doesn’t need to be formal; simply watch the patient while he or she is eating or taking medications. However, to ensure accuracy, make the following preparations:

Ensure that the patient is seated as upright as he or she can tolerate without significant discomfort or pain.
Make sure the patient is fully awake and alert.
Note patient behaviors when eating or taking medication. For example, does the patient appear impulsive or anxious?

Any of the following signs or symptoms may indicate the need for an immediate referral to a speech-language pathologist (SLP) for dysphagia assessment:

coughing or throat clearing before, during, or after swallowing
wet, gurgling voice before, during, or after swallowing
shortness of breath after swallowing
drooling or loss of liquid from the mouth
holding food or liquid in mouth for extended time without swallowing
complaining of food or liquid feeling stuck.

Patients with risk indicators should also be referred for assessment by an SLP. Making a referral may not require input from a provider, but check your organization’s policy.
Interdisciplinary referral

Collaboration between speech pathology and nursing can help reduce complications related to poor swallowing. The SLP, after careful assessment, can adjust the patient’s diet related to the degree of swallowing difficulty. In addition, the SLP may prescribe the following exercises:

neck muscle exercises
tongue and oral exercises
coughing exercises
pursed lip breathing
effortful swallowing.

Nursing considerations

Poor oral function can lead to an increase in gram-negative anaerobic bacteria and masticated food residue in the mouth, both of which increase the patient’s risk of developing upper respiratory infections and aspiration pneumonia. And in patients with decreased mobility, compromised respiratory status, or reduced cognition, poor oral hygiene may increase the risk of bacterial infections secondary to aspiration of secretions, food, or liquid into the lungs.

To prevent these complications secondary to dysphagia, ensure good oral hygiene. Provide consistent oral care, at least three times a day, including cleaning the tongue, palate, and teeth with a brush or swab. You or the SLP also can train patients, nursing assistants, and family members to provide oral care. It’s best to choose a consistent time, such as lunch, for reminding and encouraging the patient to perform swallowing exercises prescribed by the SLP

To ensure consistency of care, document all nursing interventions, including aspiration precautions, education, and patient understanding.
Stop complications before they start

Your early and accurate detection of dysphagia helps reduce patient complications. Using the PASS bedside swallowing assessment is an easy way to identify at-risk patients, make appropriate referrals, and stop the complications of dysphagia before they start.

After recognizing Mrs. Johnson’s difficulty swallowing, you notify her physician and make a referral to the SLP, reporting your PASS observations. After completing the swallowing evaluation, the SLP informs you that Mrs. Johnson appears safe for nectar thickened liquids and requests that her pills be administered crushed in puree. By working as a team, you and the SLP adjusted Mrs. Johnson’s plan of care, thus avoiding potential complications and ensuring Mrs. Johnson an uneventful recovery.

Carel Mountain is director of nursing at Sacramento City College in Sacramento, California. Kimberlee Golles is a speech-language pathologist at Kaiser Permanente Medical Center in Walnut Creek, California.

*Name is fictitious.
Selected references

Campbell G, Carter T, Kring D. Nursing bedside dysphagia screen: is it valid? J Neurosci Nurs. 2016;48(2):75-9.

Canham M. Looking into oropharyngeal dysphagia in older adults. Nursing. 2016;46(6):36-42.

Hines S, Kynoch K, Munday J. Nursing interventions for identifying and managing acute dysphagia are effective for improving patient outcomes: a systematic review. J Neurosci Nurs. 2016;48(4):215-23.

Park Y, Oh S, Chang H, Bang, H. Effects of the evidence-based nursing care algorithm of dysphagia for nursing home residents. J Gerontol Nurs. 2015;41(11):30-9.

Seedat J, Penn C. Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting. S Afr J Comm Disorders. 2016;63(1).

Why your nursing networks matter

Why your nursing networks matter
March 2018 Vol. 13 No. 3
Networks help you advance your career, provide high-quality care, and support your colleagues.

Takeaways:

Professional networks are crucially connected to quality patient care.
Building a professional network can take two paths: a network in your immediate clinical environment or one created through an organization.
Professional networking has rules, such as adding value to others, building a professional image, and being prepared and positive.

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN, and Tanya M. Cohn, PhD, MEd, RN

nursing network matter
Maria is a direct-care nurse working on a medical/surgical unit in an acute-care hospital. She recently achieved certification and became a member of a national nursing organization for her specialty, both of which are needed to advance through the clinical ladder at work. However, Maria isn’t sure why her hospital values membership in the national organization or how it will help her career. She has a busy personal life and doesn’t have time to volunteer in her local chapter.

Maria’s lack of understanding about the value of professional networks isn’t unusual. Many nurses never make the investment of getting involved with professional associations or take the time to ensure that they have a strong network of colleagues within and outside their own organization. They wonder why they should spend what free time they have on an activity that seems so indirectly related to their work, and they fail to see how a network can enhance their professional growth or be a wise career investment.

The value of professional networks

Maria, like all direct-care nurses, is part of the profession of nursing. As a member of the profession, she has the opportunity to develop through continuing education, certification, and membership in nursing organizations. These activities will help Maria evolve from a novice to an expert nurse and open doors to professional networks. Professional networks also will provide her with mentorship, support, and teamwork opportunities. For example, if Maria’s interested in developing specific skills or advancing her education, she can use her network to identify a mentor for skill development or guidance on educational opportunities.

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Professional networks are crucially connected to quality patient care. Specifically, healthcare demands evidence-based practice, but nurses across the nation frequently are faced with variations in patient care and deep-rooted sacred cows of practice that are neither evidence-based nor current. Working in silos of individual clinical settings, nurses are left with less-than-optimal patient care and the need to develop evidence-based solutions from scratch. This is where professional networks can promote evidence-based practice through collaboration. For example, as a member of a national organization, Maria has access to networking with other medical/surgical nurses. Together they can compare and share best practices or research findings from their clinical practice, reducing the need to re-create the wheel individually. The result is consistent evidence-based, high-quality patient care.

For young nurses like Maria, a strong network can help when looking for new career opportunities. Many positions are never advertised, and workforce recruiters acknowledge that their best referrals come from professionals whose judgment they trust. Today’s healthcare environment is volatile, so building a strong network should be part of a professional insurance policy.
Steps to building a network

Building a professional network can take two paths: a network in your immediate clinical environment or one created through an organization. Both require common steps.

First, establish an understanding of your goals and who can help you achieve them. For Maria, this could include using her knowledge and experience as a certified medical/surgical nurse to establish a unit-based education program or to take part in a unit-based council to work collectively with other nurses through
evidence-based practice and nurse competencies. Maria also might be interested in tapping into the nursing organization she’s joined to seek out up-to-date practice alerts. Regardless of the professional network, after goals are set and the right people are identified, you can interact, share knowledge, and receive plans to help you achieve your goals.

If you don’t have a specific goal in mind, building a professional network might seem daunting or unclear. Start by putting yourself out there in the nursing profession. For Maria, who may not be able to commit to joining a committee within the nursing organization, she can plan to attend the organization’s annual conference. While there, she can take steps to maximize the networking experience. First, she should think about some conversational topics and introductory questions to use when interacting with other attendees. Depending on Maria’s professional goals, the topics and questions could revolve around clinical practice, leadership development, or advancing education. In addition, Maria should be professionally prepared for the conference, including wearing professional attire and taking business cards. She also should plan to attend all social events and interact with the conference vendors, who could be potential future employment opportunities or offer cutting-edge evidence-based products she can share with her clinical colleagues.
The golden rules of networking

Networking opportunities exist everywhere, including online with sites such as Facebook, LinkedIn, and Twitter. Many nursing organizations have Facebook and Twitter accounts that nurses can follow to support networking about clinical practice and professional development. LinkedIn, on the other hand, helps nurses identify mentors and colleagues with similar interests. Regardless of whether you’re networking at a conference, within an organization, or online, you’ll need to follow some rules. (See Expert advice.)nursing network matter expert advice
Networking for introverts

If you’re naturally introverted, networking may not come easily. You may even avoid networking events because they’re exhausting and force you outside your comfort zone. The hardest part can be walking through the door into a room. Fortunately, most people would rather talk than listen, so let others do the talking. You can never go wrong asking questions and establishing common ground. (See Get the conversation started.) Chances are that once you start asking questions, the conversation will flow easily. Most nurses like to be asked about their opinions and sought out for advice. You’ll be seen as a great networker because you take the time to listen.
Join the networked world

Over the course of her career, Maria will learn that building a network is one of the most powerful opportunities that membership in a professional association can provide. A good network outside her clinical setting will help her gain access to and act on new information quickly. She’ll also save time and energy by accessing other professionals who’ve overcome some of the same challenges she’s facing. Many young nurses have fast-tracked their careers by getting involved with association committees or running for office.

We live in a networked world, so developing your networking skill set is important to your career success. You never know what new opportunities you’ll encounter or who you’ll meet until you extend your hand, introduce yourself, and start asking questions.

Rose O. Sherman is a professor of nursing and director of the Nursing Leadership Institute at Christine E. Lynn College of Nursing, Florida Atlantic University in Boca Raton. You can read her blog at www.emergingrnleader.com. Tanya M. Cohn is a nurse scientist at West Kendall Baptist Hospital Nursing and Health Sciences Research in Miami, Florida.
Selected references

Cain S. Quiet: The Power of Introverts in a World That Can’t Stop Talking. New York: Broadway Paperbacks; 2012.

Henschel T. How to grow your professional network. 2018.

Jain AG, Renu G, D’Souza P, Shukri R. Personal and professional networking: A way forward in achieving quality nursing care. Int J Nurs Educ. 2011:3(1):1-3.

Mackay H. Dig Your Well Before You’re Thirsty: The Only Networking Book You’ll Ever Need. New York: Currency Press; 1997.

Maxwell JC. The 21 Irrefutable Laws of Leadership: Follow Them and People Will Follow You. Nashville, TN: Thomas Nelson; 2007.

Sherman RO. Building a professional network. Nurse Leader. 2017;15(2):80-1.