Developing diversity in the workforce

Published in Kai Tiaki: Nursing New Zealand 1410.10 (Oct 2008): p23(1).

Identifying barriers, opportunities and strategies to integrate and develop a diverse health workforce was the aim of a workshop at the recent Diversity Forum in Auckland.

“Capitalising on a diverse health workforce” was hosted by the Centre for Asian and Migrant Health Research at the Auckland University of Technology (AUT) and opened by dean of the Faculty of Health and Environmental Sciences at AUT’s North Shore campus, Max Abbott. He recounted how pivotal overseas health professionals were to his recovery during a recent hospital stay.

Nurse consultant-recruitment at North Shore Hospital, Waitemata District Health Board (DHB), Carat Frankson, identified some bottlenecks to the registration of overseas nurses, in particular passing the International English Language Testing System (IETLS) exam, getting a job offer and finding employment opportunities for spouses. Other bottlenecks included organising passports and visas, selling and buying houses, finding schools, living costs, climate, separation from family, loss of familiar surroundings, religious practices, cultural backgrounds and the financial costs of moving from one country to another. Strategies the DHB provided in order to embrace a diverse nursing workforce included:

  • coaching, support, mentorship and supervision in the work environment;
  • introduction to the New Zealand cultural context and context of nursing at the DHB;
  • education in the principles of the Treaty of Waitangi; and
  • education in the values of the Waitemata DHB: integrity, compassion, openness, respect and customer focus.

The process could be mutually beneficial, Frankson said. “It is our responsibility to introduce and support new recruits into the New Zealand way of life, offering them cultural support. Incorporating and including immigrants into our communities is a responsibility we all share.” White these health professionals benefitted our workforce, they could also benefit other areas of society, eg schools, Libraries, universities, community centres, religious centres and the legal system, she said.

Auckland DHB clinical nurse educator, Roanne Crane’s presentation on integrating overseas-trained health professionals into the DHB identified some of the issues facing overseas registered nurses, such as Language, manoeuvring through the New Zealand registration process, socialisation, cultural differences, unprincipled agents and assumptions/racism.

Reducing health inequalities

Workforce development consultant at Counties Manukau DHB, Elizabeth Ryan, discussed the increasing demand for health services. The population was ageing, with the number of people over 65 projected to more than double between 2001 to 2021; a third of deaths occurring everyday in Counties Manukau were from potentially preventable conditions; and workforce demand would outstrip supply, with shortages nationally of up to 40 percent predicted by 2021, including in South Auckland. Having an ethnically diverse workforce was a key strategy in reducing inequalities in health, she said. The workforce needed to reflect the community being served in order to deliver quality health services in a culturally-appropriate manner. Ethnic matching was associated with greater patient satisfaction and better patient-reported outcomes.

She highlighted initiatives such as increasing the number of high school students studying health courses, with an emphasis on Maori and Pacific students, increasing numbers pursuing health at mid-career level, especially males/ Maori and Pacific people, collecting accurate demographic data, developing an affirmative action policy and the pilot programme which wilt see around 50 Pacific-Island trained nurses gain registration in New Zealand annually over the next three years.

Meeting the challenge of institutionalised racism was tackled by Auckland University researcher Nicola North. Of note was the complex and subtle set of skills that international medical graduates (IMGs) and international registered nurses(IRNs) needed to acquire, eg understanding cultural differences, familiarity with the culture of the new community of practice, fluency with the nuances of professional communication, and understanding the behaviour and values expected. To meet the challenge, North suggested several factors needed to be addressed: self-reflection as a society, a focus on immigration and settlement structures and processes, even-handed behaviour from registration councils, finding employment, smoothing the process of joining the new practice community and, lastly, getting real. “We need to acknowledge we need IMGs and IRNs more than they need us,” she said.

In the final part of the workshop, the group considered the question: What would a health system that capitalised on its diversity look like? Answers included:

  • recognising skills and supporting people financially;
  • ensuring the health workforce reflects the population demographics;
  • passing on success stories to the media;
  • rewarding and acknowledging cultural competence;
  • fostering diversity at all levels, including around decision-making, to develop new ideas and treatments;
  • consolidating, streamlining and integrating information systems to free up funding for initiatives;
  • growing the inter-cultural communication capacity of the entire workforce, eg educating people about how to deriver bad news to patients;
  • including diversity at art education levels;
  • focusing on areas of under-representation and targeting them specifically; and
  • ensuring support mechanisms are developed to take into account cultural differences, eg around employee disputes.

New York author Margaret Visser argues that change and diversity are necessary to human growth and evolution: “Machines like, demand, and produce uniformity. But nature loathes it: her strength lies in multiplicity and in differences. Sameness, in biology, means fewer possibilities and, therefore, weaknesses.” (1)

Reference

(1) Visser, M. (1999) Much depends on dinner:. The extraordinary history and mythology, allure and obsessions, perils and taboos, of an ordinary meal. New York: Grove Press.

How to conquer anxiety and even enjoy giving a presentation

Published in Kai Tiaki: Nursing New Zealand 13.10 (Nov 2007): p20(2).

It is 11 years since my first conference presentation and I remember that day vividly. I had prepared carefully for the presentation; friends and family came to support me; but a tricky question at the end of my presentation took me by surprise: “Ruth, thanks for that interesting presentation. How does what you say relate to postmodemism?” I was mortified and fudged an answer. It’s a wonder that anyone presents realty! Why would you expose yourself in this way and what is the purpose of a presentation?

In this article I attempt to summarise some of my learning and share some strategies and ideas, in the hope of prompting readers to consider embracing the performance that is presenting. I am going to ask you first to think about who was the best speaker you have ever heard and what was good about them. Now, think about what presenting might have to offer you. Why should nurses think about presenting or public speaking? It is a good career move. The pay off is personal satisfaction, peer esteem and building your career. It is a good skill to develop–you might need to present research at a conference, in-house or at an interview. These experiences help you become a better presenter and increase your visibility.

Conferences, for example, provide an important arena and opportunity for people to exchange views and communicate with each other. They are also useful for linking up with the people who are most interested in your work.

What makes a good speaker?

What makes a good speaker? In my view, a good speaker begins and ends their presentation strongly; you are hooked from the first word to the last, by their brilliance, humour, wisdom, provocation and ability to entertain. They also know how to tell good stories, but they never read from their speech. They capture your attention because, not only do they know their own work, they also have a clear message.

So how does one go about speaking? I have developed as a presenter over the years from being flustered and over-prepared, to having far too much to say, to now beginning to feel natural and comfortable when I present at a conference or gathering of peers.

When I was a group therapist and facilitator, I had to speak to several people at a time and this helped me grow in confidence as a speaker. Then I was asked to facilitate a function attended by 250 people. This prompted me to do a Toastmasters course, where I learned how to recover from mistakes in a presentation. I also realised that when I was anxious, I lost my ability to be natural and humorous, but if I could manage my anxiety, then all would be well

In terms of conference presentations, I prepared by reading previous papers and began networking, so I got to know other people in my research field, which helped me realise I had something to offer.

Preparation crucial

Preparation is crucial to presenting well Three aspects need to be addressed: the purpose, structure and content of your presentation. In considering purpose, it is important to know the key messages you want to convey. It might help to start at the end and work backwards–every presentation needs a destination. Then consider what you need to say to assist the listener to get those key messages. Is there a context you need to introduce? How much can you assume your audience will know already? So to the structure. I tend to work on the basis of four parts to a presentation: the introduction, the body, the guts and the conclusion.

The purpose of the introduction is to motivate the audience, which you can do by having a warm up or a question. I also use this part to introduce myself and define the problem or issue, and set the scene. Then you can introduce the context, such as terminology and earlier work. At this point, I would also emphasise what your work contributes to the topic or area, and provide a road map of where your presentation is going. This normally takes around five minutes. The next part of the presentation outlines some big picture results or themes and why they are important. This is followed by the “guts” of what you want to say, where you present one key result, carefully and in-depth.

The conclusion is where many presenters (including myself) run out of steam. The conclusion involves rounding off your presentation neatly and linking everything you’ve said. This can be a good time to mention the weaknesses of your work, and it can help manage questions at the end. It is good to find a way to indicate the presentation is over. I do this by thanking the audience and asking if there are any questions.

Now to the content. Many people use PowerPoint presentations. Use slides like make up–sparingly and simply: common advice is don’t have too much on them; and don’t have too many. (I’m still working on this one.) Six words per bullet point and a maximum of six bullet points per slide is recommended.

The slides are merely an adjunct to your talk, so please don’t read them word for word (my pet hate). The purpose is to highlight key points for the audience and to prompt the speaker. In considering the number of slides to have, keep in mind that each slide takes about a minute and a hail or two minutes to read and fully understand?? If you have 87 slides for a 25-minute talk, like someone I was on a panel with recently, you are likely to overwhelm your audience. Take care with formatting your slides and make sure the spelling is correct. Lastly, be sure you’ve saved your presentation to two types of media. Practise your presentation, ask for a second opinion and get some feedback. Practising helps fine tune your timing.

On the day itself, make sure you are prepared and took and feet good. Ensure you take the media you are going to use and take a hard copy of the presentation to refer to. Say your presentation out loud. At the venue expect nothing to work and scope the technology. Address your anxiety. I do this by practising my presentation, going for a brisk walk and taking deep breaths. I also like to get to the venue early and mingle with those attending the conference, so I can develop some allies in the audience. Focus on being yourself and focus on giving.

Connecting with the audience

Now to the actual presentation. Make sure you project your voice to the very back of the room. It is important to know the audience and pitch your message accordingly. Make eye contact if possible–this is easier if you had time to meet people beforehand. Find a way to involve the audience and make sure you have a good opening. Use repetition to reinforce your message: tell them what you are going to tell them; tell them; then tell them what you told them, but repeat it in different ways. Make sore you are standing in the right place so you aren’t blocking your slides or other visual aids.

Remember that once you get involved in what you have to say, then the nervousness will go away. Don’t be afraid to pause, and you can pause for emphasis. If you get stuck, just move on to the next part of your presentation (others won’t notice). Be spontaneous, considerate and inclusive. I like to move around and I tend to focus on entertaining. If you can generously link in with what previous speakers have said, or affirm later speakers for continuity and reinforcement, that is all to the good. Whatever you do, don’t go over time.

Congratulations, you’ve finished. Now, let’s talk about feedback and questions. Feedback is critical to Learning how to improve your talk and for future presentations. Solicit feedback, if it isn’t freely given, but be prepared for some negative comments! Ask for written feedback, if appropriate.

Managing questions is important. Repeat the question so everyone can hear. It is important to be both prepared and polite. Keep your answers short where possible. If you get drawn into a Long discussion with a questioner, for the sake of your audience, offer to discuss the issue tater. Don’t be afraid to say that you don’t know. Find a way to turn criticism into a positive statement, eg “thanks for mentioning that, it’s given me something to think about”, rather than being defensive.

Different types of questions

In my experience there are four types of question: the genuine request; the selfish question (which is realty about the questioner saying “Look at me”); the malicious question (which is designed to expose you); and the question that has absolutely nothing to do with your presentation and makes you wonder if you and the questioner were in the same venue!

Presenting requires a delicate balance–preparation is important but so is being yourself and being spontaneous. It is important to have content and structure, but the more you have of both, the less room you have for questions and spontaneity. It is important to be inclusive, but be careful with humour and jokes or your own stories, unless you can Link them with your talk well. Lastly, be entertaining, know your material, keep it simple, be prepared, be creative and have fun!

Advice to a student nurse

My response to  a student nurse who was haunted by questions about becoming a nurse. Published in Kai Tiaki: Nursing New Zealand 13.1 (Feb 2007): p4(1).

I was pleased to see [x} letter, Questions haunt nursing student, in the December/ January 2006/2007 issue of Kai Tiaki Nursing New Zealand (p4). The questions she has reflected on indicate she is going to be an amazing nurse.

I believe nursing is both an art and a science, and our biggest tools are our heart and who we are as human beings. I was moved by her letter and thought I’d share my thoughts. The questions she posed were important because the minute we stop asking them, we risk losing what makes us compassionate and caring human beings.

Let me try to give my responses to some of the questions Lisa raised–I’ve been reflecting on them my whole career and continue to do so.

1) Can a nurse “care” too much?

Yes, when we use caring for others as a way of ignoring our own “issues”. No, when we are fully present in the moment when we are with a client.

2) Don’t patients deserve everything I can give them?

They deserve the best of your skills, compassion and knowledge. Sometimes we can’t give everything because of what is happening in our own lives, but we can do our best and remember we are part of a team, and collaborate and develop synergy with others, so we are resourced and can give our best.

3) How do I protect myself and still engage on a deeper level with the patient?

I think we have to look after our energy and maintain a balance in our personal lives, so we can do our work weft. We also need healthy boundaries so we can have therapeutic communication.

4) How do I avoid burnout?

Pace yourself, get your needs met outside work, have good colleagues and friends, find mentors who have walked the same road to support you. I’ve had breaks from nursing so I could replenish myself.

5) Why can’t I push practice boundaries, when I see there could be room for adjustment or improvement?

I think you can and should, but always find allies and justification for doing something. Sometimes you have to be a squeaky wheel

6) Isn’t it okay to feet emotionally connected to the patient?

Yes, it is okay to feel emotionally connected to the patient, but we also have to remember that this is a job and our feelings need transmutation into the ones we live with daily.

7) Don’t I need to continually ask questions, if nursing is to change, or will that just get me fired?

Yes, you do have to ask questions but it is a risky business. Things don’t change if we don’t have pioneers and change makers.

8) Finally, am I just being a laughable year-one student with hopes and dreams, and in need of a reality check?

No, your wisdom and promise are shining through already and we want more people like you. Kia Kaha!

The ‘small’ things count in caring

Editorial published in Kai Tiaki: Nursing New Zealand 8.10 (Nov 2002): p28(1).

KAI TIAKI Nursing New Zealand has recently carried narratives written by nurses discussing their experiences as recipients of health care, eg “My Journey of Pain” by Glenis McCallum (July 2002, p16). These experiences gave the nurses the opportunity to re-examine their practice and to reclaim their empathy.

Similarly, a personal experience provided the impetus to write this brief piece. I recently had the opportunity to re-evaluate my own beliefs about nursing and the importance of communication and caring when I witnessed my sister receiving care in a hospital maternity setting. What came across was the importance of the “small” things–the caring and the communication, and the importance of compassion and empathy. The sweetness of the person who opened the door to the unit and said “welcome to our world”. The rudeness, almost surliness, of the nurses who forgot to introduce themselves or tell us what was happening.

Rightly, there is much focus on nursing as a profession, yet is it possible that in this debate we have forgotten the small things that really matter to our clients -the things that make people feel safe and cared for?

This personal and professional interest was further piqued by two workshops held in Auckland recently that focused on maternal mental health issues. Both highlighted the important role nurses have to play when caring for women experiencing childbirth.

In the first workshop, organised by the education and support group, Trauma and Birth Stress (TABS), 170 consumers and health professionals gathered to explore post-traumatic stress disorder (PTSD) after childbirth. The group TABS was formed by women who had all experienced stressful and traumatic pregnancies or births that had negatively affected their lives for months or even years after the experience. One of TABS’s aims is to educate health professionals on the distinctions between PTSD and post-natal depression so the chance of misdiagnosis is lessened and correct treatment is started quickly.

Speakers at the workshop included an international nursing researcher from the United States, Cheryl Beck. A number of New Zealand women have shared their stories of PTSD with Beck and have found telling their stories and having someone understand and believe them has been very therapeutic. Other speakers included TABS member Phillida Bunkle and Auckland University of Technolgy midwifery lecturer Nimisha Waller who spoke on how mid wives can assist mothers with PTSD.

In my role at UNITEC Institute of Technology, I organised the second workshop, which also featured Beck. Entitled “Teetering on the edge: Postpartum depression–assessment and best practice”, the workshop attracted around 100 nurses, midwives, GPs and consumers. A professor in the School of Nursing at the University of Connecticut, Beck has for many years focused her efforts on developing a research programme on postpartum depression. Using both qualitative and quantitative research methods, she has extensively researched this devastating mood disorder that affects many new mothers. Based on the findings from her series of qualitative studies, she has developed the postpartum depression screening scale (PDSS). Currently Beck’s research is focused on PTSD after childbirth and she presented her work to date. In September, there were 27 participants in the study, 18 from New Zealand and the rest from the United States.

The themes of her presentation were a reminder of the dramatic negative consequences of occurrences we as health professionals deal with frequently. Emergency situations arise and we all do our job, often without a second thought as to the future impact of our actions (or inactions) on the woman and her family.

Beck also spoke at the TABS work shop. The response to both workshops was really positive. Workshops such as these, where the long-term impacts of the health care experience are discussed, can act as a reminder for anyone working with women at and around the time of childbirth to critically view their practice and that of their colleagues. Themes that feature in the research are around caring, communication and competence–the very things that were absent in my recent experience of the health system. Women in the study felt they were not shown caring, communication from health providers was poor, and they perceived their care as incompetent.

Through her research, Beck poses the question so many mothers ask: “Was it too much to ask to care for me?” As health professionals, we need to ask ourselves every day “how can I care for the needs of this client?”, because nursing is not just a profession, it is a caring profession.

* For further information on TABS http://www.tabs.org.nz/