Nursing Notes

August 23, 2012

We’re moving!

Filed under: Uncategorized — Shirley @ 12:46 pm

I am moving this blog to my own hosted site, The Nursing Notes.  As you can see, I have not been blogging regularly here in anticipation of moving to this new site.

I hope you will visit me at the new home where you will find the same value.  I will continue to post articles about nursing that are current and newsworthy along with my own editorials.  I will also post articles I write about nursing as well as blog posts about me and my work as a psychiatric nurse.

Please join me at our new home, won’t you?  Click on The Nursing Notes to be taken to the new site now.

June 7, 2012

Patient location, gloves, worker type predict hand hygiene compliance

Filed under: Nursing — Shirley @ 5:33 am
Tags: , , , ,

Here’s another article on the ever growing battle about handwashing in the hospital.  It is true that strict adherence to handwashing policy will save lives and money, but for some reason we have trouble following this simple policy.  Why is that?  Maybe there is not enough time in a shift to do all the handwashing called for?   I don’t have any answers, but would love to hear your take on this growing concern.

This article is from FierceHealthcare, which is a source I like very much.  I find many interesting articles about medicine and nursing here and you will, too.


Patients who receive care in a hallway bed are the most likely victims of healthcare workers not washing their hands, according to researchers from Boston’s Brigham and Women’s Hospital in a study to be published in the November Infection Control and Hospital Epidemiology.

In the largest hand hygiene study with more than 5,800 patient encounters in the emergency department (ED), researchers found that bed location, the type of healthcare worker providing the care, and whether the provider used gloves all were predictors of poor hand hygiene in the ED.

“We found that receiving care in a hallway bed was the strongest predictor of your healthcare providers not washing their hands,” said study author Dr. Arjun Venkatesh, an emergency medicine resident at Brigham and Women’s Hospital, in a Society of Healthcare Epidemiology of America press release yesterday.

In addition, researchers found that workers transporting patients were less likely to wash their hands because they likely do not receive as much hand hygiene training as others, according to the press release. They also said that providers using gloves was not a substitute for handwashing in controlling infections.

However, in most cases (90 percent of time), ED workers do wash their hands.

Handwashing could save up to $33 billion, according to a UPI article. In a Health Affairs study, infection control interventions such as handwashing resulted in patients leaving two days earlier and reduced mortality rates by 2 percentage points. Hospital costs also were $12,000 less, according to the article.

For more information:
– read the press release
– here’s the study abstract
– read the UPI article

Related Articles:
Hospital workers comply with hand hygiene signs about patients, not themselves
CDC: Physician offices too lax about infection control
Handwashing more common in public restrooms than in hospitals
Doctors, nurses don’t want patients to bug them about handwashing
Is 100 percent compliance on handwashing possible?

Read more: Patient location, gloves, worker type predict hand hygiene compliance – FierceHealthcare

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April 17, 2012

Mental illness means higher risk of physical problems

Filed under: Nursing — Shirley @ 1:08 pm
Tags: , ,

Here’s an article from that talks about a study showing a correlation between mental health and physical health.  As a psychiatric nurse, I have always know that my patients have a higher risk of certain physical diseases.  It’s amazing to me that it has taken so long for others to notice and try to figure it out.

Asthama, diabetes, hypertension, and even strokes are common Axis III diagnoses for inpatient mental health patients of all ages.  There has to be a reason for this correlation.  Maybe now there will be more studies to try to figure out the connections.  I can only hope so.

Please read this excerpt of the article and click over to to read the rest.  It’s worth your time and effort to do so.  While there, check out some of the other articles they have about current nursing issues.


Adults who had a mental illness in the past year have higher rates of certain physical illnesses than those not
experiencing mental illness, according to a report by the Substance Abuse and Mental Health Services
For example, 21.9% of adults in a SAMHSA national survey who experienced any mental illness (based on
diagnostic criteria specified in DSM-iv) in the past year had hypertension. Meanwhile, 18.3% of those without any
mental illness had hypertension.
And 15.7% of adults who had any mental illness in the past year also had asthma, while 10.6% of those without
mental illness had the condition.
Adults who had a serious mental illness (a mental illness causing serious functional impairment that
substantially interferes with one or more major life activities) in the past year also showed higher rates of
hypertension, asthma, diabetes, heart disease and stroke than did people who did not experience serious mental
Adults experiencing major depressive episodes (periods of depression lasting two weeks or more including
significant problems with every-day aspects of life such as sleep, eating, feelings of self-worth, etc.) had higher
rates of the following physical illnesses than those without major depressive episodes in the past year:
hypertension (24.1% vs. 19.8%), asthma (17% vs. 11.4%), diabetes (8.9% vs. 7.1%), heart disease (6.5% vs.
4.6%) and stroke (2.5% vs. 1.1%).
The report also shows significant differences in ED use and hospitalization rates in the past year between adults
with mental illness in the past year and those without. For example, 47.6% of adults with serious mental illness
in the past year used EDs, as opposed to 30.5% of those without past-year serious mental illness. Adults with
past-year serious mental illness were more likely to have been hospitalized than those without (20.4% versus
11.6% respectively).
“Behavioral health is essential to health. This is a key SAMHSA message…[read more]

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March 22, 2012

Millions of Patients Are Coming. Can Nurses Care For Them?

Filed under: Uncategorized — Shirley @ 2:28 pm

Here is an interesting article I found at Hospitals and Health Networks Daily.  This article talks about the need for more and better educated nurses to fill the need in the near future.  Won’t you read this article and leave me a comment?  I’d love to hear what your thoughts are on this topic.


By Haydn Bush
H&HN Senior Online Editor



March 22, 2012
Nursing advocates call for increasing the role of RNs in primary care.

CHICAGO — With a wave of new patients expected to access primary care services when insurance provisions of the Affordable Care Act kick in starting in a little over 20 months, hospitals and other providers are bracing for a major shock to their already stretched delivery systems. And a growing chorus of health care leaders is calling for nurses to lead the way in filling expected gaps in primary care.

I heard two of those voices Wednesday at the American College of Healthcare Executives’ 2012 Congress, as Harvard Public Health Professor Jack Rowe and Tami Minnier, R.N., chief quality officer at the University of Pittsburgh Medical Center, discussed the implications and reactions from the field to the landmark 2010 Institute of Medicine report on the issue, Leading Change, Advancing Health. The report’s big-picture takeaways include more responsibilities for nurses, increased educational opportunities and the removal of scope of practice barriers — issues that writer Whitney L. J. Howellexplores in depth in this month’s H&HN.

Rowe — who served on the Robert Wood Johnson Foundation Committee of Nursing that helped draft the report, noted that as global payments and accountable care organizations loom, nurses with increased responsibilities and better qualifications are going to be critically important.

“The more highly educated nurses have lower readmission rates, high quality outcomes and better coordination,” Rowe said.

Getting there isn’t easy, of course — while the report calls for doubling the number of nurses with doctoral degrees by 2020, Rowe noted that 40,000 qualified applicants are turned away from nursing school each year because of a lack of capacity. And calls to increase the number of nurses in the U.S. aren’t exactly new, he added.

“These are the exact same words as [another] blue ribbon panel 20 years ago, but they wanted it by 2010.”

Nursing advocates also have to contend with existing barriers around scope of practice arrangements in order to allow advanced practice nurses and BSNs to deliver more primary care services. Still, providers in 48 states have implemented some of the report’s recommendations, and Minnier explored how the report has informed a new nursing care model at UPMC that emphasizes the importance of responsiveness to patient needs.

“[Hospitals] get complaints like ‘They didn’t take me to the bathroom, they didn’t answer the bell,'” Minnier said. “In reality, that is the core of why they’re in the hospital. They need meds and treatments, but they also need the basics.”

The changes have led to an 85 percent reduction in call bell response time and a 70 percent increase in compliance with turning and repositioning patients.

“It’s a new nursing care model. Same work, same money, same space, and… a 60 percent increase in some of the outcomes.”

I had a chance to interview Minnier after her presentation for a future H&HN Daily videocast — look for it this April.

Email your thoughts on the role of nurses in health care’s ongoing transformation

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

February 29, 2012

Nurses Get Pushed Around, Again

Filed under: Uncategorized — Shirley @ 12:02 am

I recently read this article about the Kennedy baby and the struggle with these nurses.  Upon first reading, I was confused as to what really happened.  Having been in a hospital with a Code pink is called, I can tell you that hospitals take infant safety extremely seriously.  This entire incident reeks of special interest being upset because they had to follow the rules like every other person in that hospital.

I hope the hospital is prepared to back up these nurses who were simply doing their job and protecting their very young and very vulnerable patients from harm.  Read this article from HealthLeadersMedia


Alexandra Wilson Pecci, for HealthLeaders Media , February 28, 2012

Aggression involving nurses is at the center of a he-said-she-said dispute that pits Douglas Kennedy, son of the late Robert Kennedy, against the nurses caring for his newborn son. It seems that a misunderstanding between the two parties somehow escalated into a physical confrontation that’s gained national attention.

Kennedy was was arrested on misdemeanor charges of child endangerment and harassment after a Jan. 7 struggle with two nurses at Northern Westchester Hospital in Mount Kisco, NY. According to media reports, the nurses allege that Kennedy twisted one of their wrists and kicked the other when they tried to stop him from taking his newborn son outside for some “fresh air.”

In a statement provided to HealthLeaders Media, the hospital said:
“On January 7th, 2012 an incident occurred involving a patient’s family member and NWH staff members. At Northern Westchester Hospital, patient safety is our priority and we completely support the actions of our nursing staff in this case as they were clearly acting out of concern for the safety of a newborn baby. Out of respect to all parties involved, we are not elaborating on the details of this incident or providing any additional comments.”

Yet the folks in Kennedy’s corner have come out swinging hard against the nurses, saying that they tried to grab at his baby. He calls the allegations against him “absurd” and “sickening,” and says anything he did was simply an attempt to protect his son.

An emergency department doctor and family friend of Kennedy who witnessed the incident, calls the nurses the “only aggressors.” And Kennedy’s lawyer is accusing the nurses of trying to “cash in” on the events, according to media reports.

Surveillance camera footage of the incident shows the nurses trying to block Kennedy from leaving via the elevator and then the stairs. It also shows one of the nurses falling to the floor. The nurses said they called code pink, indicating child abduction.

Kennedy’s attorney, Robert Gottlieb, said in an ABC News interview that his client was only trying to protect his baby. “One of the nurses actually goes to grab the baby. How dare she?”

It’s hard to glean many details about the incident from the choppy security footage. But it seems even harder to imagine why any nurse would want to be an “aggressor” against a new dad.

In contrast, it is easy to imagine why a nurse would do everything she could to protect a newborn and comply with rules that aim to prevent infant abduction.

Although data from the National Center for Missing & Exploited Children shows that infant abductions from hospitals are relatively rare—there were only 128 cases of completed infant abductions from healthcare facilities between 1983 and 2010—hospitals obviously take the threat of abductions very seriously.

Maternity wards are often locked, and the comings and goings of visitors and family are heavily monitored. Hospitals also tightly control babies’ whereabouts; in some hospitals, babies wear security bracelets that trigger an alarm if they’re carried beyond designated boundaries.

Penalties for lax security can be hefty: Last year, Santa Barbara Cottage…(read more)

January 8, 2012

Most in-hospital adverse events unreported: OIG

Here is an article from  that addresses the failure to report events causing patient

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harm.  The article goes on to point out reasons for such a failure and the reasoning does make sense.  However, I feel quite strongly that if nurses had the time to make reports and if those reports were simple and easy, there would be quite a few made.  As it is, nurses are drowning in patient loads, paperwork, and have little to no time to eat or use the restroom, so forgive me if we sometimes don’t stay after our shift to enter cumbersome reports into the computer about events that really did not cause harm but could have.

Please read this article and I would love to hear your take on this topic.


By Maureen McKinney

Posted: January 6, 2012 – 4:00 pm ET
Read more: Most in-hospital adverse events unreported: OIG – Healthcare business news and research | Modern Healthcare

The vast majority of in-hospital adverse events go unreported by staff, according to a report from HHS’ inspector general’s office (PDF).

Using a month of survey data from a sample of 189 hospitals, the inspector general’s office found that hospitals’ voluntary incident reporting systems captured only about 14% of events that cause patient harm, such as medication errors. Federal investigators attributed low reporting rates, at least in part, to poor knowledge among hospital staff about what patient harm actually means.

“For example, staff reported only one of 17 sample events related to catheter usage (e.g., infection and urinary retention), a common cause of harm to Medicare beneficiaries,” according to the report.Other types of events that went unreported included cases of excessive bleeding related to misuse of blood thinning medications, and hospital-acquired infections.Incident reporting systems are a requirement for participation in Medicare, but a lack of uniform requirements—such as lists staff can use to identify patient harms—can damage the systems’ reliability, according to the report.“Because hospitals rely on incident reporting systems to track and analyze events, improving the usefulness of these systems is critical to hospitals’ efforts to improve patient safety,” the report said.

The report urged the CMS and HHS’ Agency for Healthcare Research and Quality to develop a list of adverse events for hospitals to use. Additionally, the office said, the CMS should reassess its methods for judging hospital compliance with the reporting-system requirement.

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January 1, 2012

To all my nursing friends everywhere….

Filed under: Uncategorized — Shirley @ 3:16 pm

December 30, 2011

Goodby, Don Berwick

Here’s an article from the Austin American Statesman written by my fellow nurse, Toni Ingles at Seton English: This is an image of Donald Berwick, w...Healthcare.  I’ve posted her articles before about the Texas whistleblower nurses and the trial.  This article is about the loss of Don Berwick.  Whether you liked him or not, this is a very good article and deserves to be read.  Enjoy the article.

Congress chewed him up and spit him out. Marilyn Tavenner will be a
good replacement for him. She is a nurse, has terrific experience and
is greatly admired by Don Berwick (and by me). Berwick’s immense
respect and confidence in her are demonstrated by his having tapped
her as his top deputy.


For the past 17 months I’ve watched through my fingers as Congress has
slowly eviscerated a gentle, brilliant, apolitical pediatrician and
Harvard professor — Don Berwick. It’s been painful, gut-wrenching and
depressing. Congress will finish him off today, when his resignation
as administrator of the Centers for Medicare & Medicaid Services takes

The words “missed opportunity” understate.

The visionary Berwick, champion for patients, was picked for the job
because his “triple aim” (his words) at health care was the same as
President Barack Obama’s reform goals: improving the patient
experience, improving population health and reducing costs — and
because Berwick had decades of experience successfully achieving those
goals in this country and worldwide.

Through the organization he founded in the early 1990s, the Institute
for Healthcare Improvement, care has been redesigned and hospitals
trained to prevent thousands of injuries and deaths.

How has Berwick achieved these changes? Intractable problems in health
care are identified, and IHI, often in partnership with the Robert
Wood Johnson Foundation, take aim at them.

In the hospital system where I work, we know about Berwick, and we’ve
worked with people from the IHI and the RWJ foundation. In 2003, we
were chosen as one of 13 pilot sites to transform care at the bedside
in medical-surgical units.

Direct-care, front-line nurses were challenged and given full license
and encouragement to develop and test methods to improve care. And
that we did. Many of the innovations Seton nurses designed are
practiced in thousands of hospitals worldwide.

In the eight years since the project began, physicians, patients and
families have become engaged in care; bedsores, patient falls,
infection and birth trauma have been drastically reduced;
communication during shift report has improved; multidisciplinary
rounds are made to enhance discharge planning, teamwork and safety;
patients are checked on hourly; response teams rush to a patient in
crisis before it’s too late; and patient and nurse/doctor satisfaction
and retention have dramatically improved. Hospital readmissions have

Through the transforming care project, in the perinatal area, birth
trauma has effectively been eliminated. Clinicians developed a bundle
of best practices for obstetricians.

This safety initiative has saved the government a bundle of money. In
2003, Seton billed Medicaid $500,000 for birth trauma; in 2009, zero.

Berwick has promoted understanding of this concept as a way to curb
government spending on health care. As part of the Affordable Care
Act, Berwick implemented financial incentives for doctors and
hospitals to coordinate care and improve patient outcomes.

Stunningly, Congress refused to confirm the nomination of this proven,
accomplished and promising leader. Eager to demonstrate contempt for
the Affordable Care Act, Republican demagogues seized on Berwick as an
irresistible target.

They dubbed him Dr. Death Panel. Why? Because he — and the Affordable
Care Act — encourage end-of-life discussions between doctor and
patient/family when medicine can do no more.

In addition, they exploited his remarks as an academic praising
Britain’s health care system for covering all its people and reining
in costs while improving outcomes.

Taking his remarks out of context, Republicans portrayed him as an
advocate of rationed care and socialized medicine. This, despite
Berwick’s insistence all along that the British system cannot be
copied here and that America’s system, having evolved around
insurance, needs its own solution.

If you repeat “Dr. Death Panel” and “rationing care” enough times, you
begin to brand and unfairly define Berwick and the health care reform

Marilyn Tavenner, a nurse and his top deputy, will succeed him. Let’s
hope that she will be able to execute his goals. Congress will be more
comfortable with her, as she is more manager than visionary.

Back to his triple aim. Has his work improved the patient experience?
Yes. Has it improved population health? Yes. Has it reduced costs?

Have we missed an opportunity? Oh, and how.

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December 26, 2011

Please thank your nurse this Christmas

Filed under: Nursing — Shirley @ 11:41 am
Tags: , , , ,

Here’s an article that I found on CNN that I hope you will enjoy.  Christmas is one time of the year when nurses have to sacrifice time with family to care for patients.  It’s nice to see in print that someone, somewhere notices. 


Anthony Youn, M.D., is a plastic surgeon in Metro Detroit. He is the author of “In Stitches,” a humorous memoir about growing up Asian American and becoming a doctor.

You can guarantee that three places will be open on Christmas day: Chinese restaurants, Denny’s and hospitals.

I spent part of last Christmas in the hospital visiting my mother-in-law who was recovering from open heart surgery.  I felt depressed walking into the building that morning.  My mother-in-law treasures the holidays more than anyone else in my family.  Lying in a hospital bed was the absolute last way she wanted to spend Christmas.

But during the time I spent at her bedside, my depression lifted, replaced by an overwhelming sense of gratitude for her doctors, nurses, and medical technicians.  I never felt for one second that her care suffered because her medical team was working on Christmas.  The nurses and support staff were cheerful, accommodating and responsive. One male nurse even wore a Santa’s cap and greeted my mother-in-law with “Merry Christmas” and “Ho-ho-ho” before he took her blood pressure.

Most physicians who work on Christmas – with some exceptions like ER docs – round on patients in the morning so they can get back home in time for Christmas dinner.  Not so for nurses and other hospital employees.  They put in full or extended shifts on Christmas to make sure that all the patients are cared for.  Thankfully, hospitals never close; medical care never takes days off.

Each Christmas, nurses and hospital support staff juggle their work schedules and sacrifice their time, giving up their own Christmases to accommodate the needs of patients.  As I sat by my mother-in-law’s bedside and looked forward to my own Christmas dinner, I thought about the dedicated caregivers who would spend their day changing catheters and cleaning wounds while the rest of us enjoyed being with our families in the warmth of our homes.

Some nurses go way beyond the call of duty.  A few years ago I went to the hospital on Christmas morning to see a patient who had undergone reconstructive surgery.  Her nurse, Sara, smiled as she worked.  Even so, I thought she looked a little tired.  I asked her how she was doing.  She told me she was working her second twelve-hour shift in two days.  She was covering for a nurse who had called in sick.  You would never know it. Sara was professional, caring and attentive to my patient, as well as to the five other patients assigned to her.  I was in awe of Sara.

Operating on almost no sleep, she was spending Christmas working in the hospital, instead of with her small children, and she was going about her job cheerfully without complaint and with consummate professionalism…[read more]

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December 24, 2011


Filed under: Uncategorized — Shirley @ 9:56 pm

May you know peace and great joy this season.  May you receive gifts of good cheer from all you meet.

Merry Christmas!

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