Nursing Notes

April 30, 2010

Survey: Nurses spending up to one quarter of time on indirect patient care

NEW YORK - OCTOBER 06: Nurse Melody McKever (L...
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We nurses have always known that there was much we did that took us away from our patients.  We all have been complaining for years that there is too much paperwork and not enough time!  Now, finally, there has been a research study to see exactly what nurses do during a 12 hour shift and to quantify how much of that 12 hours is actually patient oriented.  The findings below support what we nurses have been saying for the last 20 years.

I wonder why it has taken so long for someone to take us seriously.  Our patients have been neglected for all this time because of legal red-tape and government requirements as well as insurance requirements.  All nurses really want to do is take care of patients.  Why is that so hard to hear?

Please click over to read the entire article because this is really interesting information and we need to stay up with the current research on our field.  Let me know what you think, won’t you?


Survey: Nurses spending up to one quarter of time on indirect patient care

Next time your nursing staff members complain about having too much paperwork and not enough time at the patient’s bedside, you can tell them their feelings are echoed by nurses nationwide, as shown by a recent survey.

The survey, conducted by Jackson Healthcare, an Alpharetta, GA–based healthcare staffing and management company, found that between 73% and 75% of nurses spend one-quarter of a 12-hour shift on indirect patient care services. The top reasons for being pulled away from patient care include:

  • Documenting information in multiple locations
  • Completing logs, checklists, and other unnecessary paperwork/data collection
  • Filling out regulatory documentation
  • Entering/reviewing orders
  • Walking to equipment/supply areas, utility rooms, etc.

“Nurses are being taken away from the patient’s bedside by non-patient activities,” Bob Schlotman, chief marketing officer at Jackson Healthcare, said in a press release. “Unfortunately, due to the regulatory nature of healthcare, we know that some of these redundancies won’t go away. However, the good news is methodology, in the form of process improvements, and adaptive technology now exists to help minimize and manage these frustrations for our nurses.”

More than 1,600 hospital-based nurses were part of the online survey………read the rest of the article

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April 28, 2010

Bill Boyne: Telemedicine can make big advances in health care

Filed under: Nursing — Shirley @ 9:06 pm
Tags: , , , , , ,

I am not sure what I think about the advent of telemedicine, but I know it is a change that is inevitable.  With all the technological  advances being made daily, there is simply no way that medicine via computer is not going to happen.

I fear that we will lose something in the transfer, hopefully we won’t lose the humanity.  There is a nursing shortage.  That is a fact.  There is a physician shortage.  That is another fact.  If technology can allow more people to be cared for with fewer doctors and nurses, then it will happen.  What I worry about is the actual hands on care that will be left up to the untrained or to the actual patient himself.  That, to me, would be unacceptable and a great loss for nursing.

We live in an era of dramatic advances in health care.

Wednesday, April 28, 2010

First, President Obama and others succeeded in passing a national health care reform bill that will make health care available to millions of people for the first time and will provide improved health care for millions of others.

Now, telemedicine — the next great reform — is beginning to be available and has the potential of making major advances in health care for everyone in the country.

According to the The Illinois Nurse publication, telemedicine has been defined as “the direct provision of clinical care via telecommunications — diagnosing, treating or following up with a patient at a distance.”

The American Medical Association’s Council on Medical Education and Medical Services has an expanded definition: “It is medical practice across distance via telecommunications and interactive video technology.”

In simpler terms, doctors and nurses can — without leaving their offices use the Internet, telephones, video technology and other means to keep in touch with their patients’ condition.

Another definition is “the use of telecommunications technology to provide and support health care when distance separates the participants.”

The benefits of telemedicine are clear: It keeps doctors and nurses in close touch with their patients’ illness and enables them to respond quickly when an illness becomes more serious.

In effect, a well-equipped telemedicine program enables doctors to give many more patients effective care.

“Telehealth” is the term preferred by the American Nurses Association because it is more inclusive. Like telemedicine, it is an umbrella term referring to all varieties of health care that make use of telecommunications.

Doctors and nurses can’t meet with every patient every day. As a result, care-givers are often unaware when a patient’s health suffers a serious decline. Telemedicine allows them to respond to changing conditions much more quickly.

According to The Illinois Nurse magazine, “A Kaiser Permanente study of telehealth nursing showed cost savings, positive health outcomes , and unexpectedly high patient satisfaction, especially in the elderly community. resulting from telehealth care.”

It is clear that doctors and nurses provide the best care if they can stay informed about any changes in their patients’ condition.

Telemedicine is a practical and effective way to do so and it is likely to bring about major improvements in the nation’s health care program.

Bill Boyne is a retired publisher and editor of the Post-Bulletin. His column appears weekly.

Here is the link to the original article.

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April 27, 2010

Do We Still Need Nurses Week?

Filed under: Nursing — Shirley @ 11:21 pm
Tags: , , , , , ,
Branch Hospital Nurses 1908 - Historical Cinci...
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National Nurses Week.  Hmmm.  That is coming soon, isn’t it?  I think the 6th of May will kick it off and it continues until the 12th.  Wow!! Big celebrations coming, right?  Wrong!

My past experience with this phenomenon leads me to be quite skeptical of the whole ordeal.  What usually happens is the “suits” of the hospital administration come to the units to “serve” the nurses some ice cream, lunch, snack, etc.  You can fill in the item based on your own experiences.  However, this usually only occurs on the day shift because we don’t really expect the administration to work our crazy hours do we?

The next thing that happens is every nurse in the facility will be given a special Nurses Week gift.  In the past, I have received plastic mugs, canvas bags, book bags,  flowers, pens and badge holders, magnets, towels with the hospital logos, t-shirts, and once I even received a very special gift, a camping fold-up chair.  Really, you can never have enough of this stuff, right?

After all the above, do I feel valued and special because I am a nurse and do my job to the best of my abilities?  No.  Anyone who believes that I should needs to have a reality check done.  None of those things had anything to do with my profession or my place in the facility.  All of those “gifts” were generic things purchased in bulk to be handed out to every nurse during this week.

I do commend the administration for making the effort, but the result is too little, too late.  Nurses want to be able to nurse properly without being harrassed and harried.  Nurses want to have some type of voice in patient care and nursing care in their facilities.

So, because this week is fast approaching, I am including this article below.  Enjoy.


Rebecca Hendren, Editor
Each year, in hospitals across the nation, Nurses Week is marked by the parade of suits from the C-Suite bringing lunch or snacks to the units, the traditional exchange of trinkets, and mandatory maudlin accounts of the angelic nature of nursing. Is it just me, or is anyone else uncomfortable about the tradition and hoopla? Why do we need Nurses Week? Few other healthcare professions receive such singular attention. [Read More]
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April 26, 2010

MRSA More Likely to Lurk in Certain Patients

MRSA exploded
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MRSA has become a major issue nurses face daily.  It was once very rare, but now has become almost commonplace.

The question I have about this disease is what becomes of a nurse who contracts this organism while on the job.  Can he or she continue to nurse?  Will everyone they treat become infected?  I just don’t know the answers to this problem, but I do know that 4% of healthcare workers will contract this organism this year.

Nurses are constantly bombarded with all types of contagious agents.  Along with exposure you can add excessive stress and long work hours which both work to lower the resistance of a person.  So, with this in mind, it seems like a good question to find answers for, don’t you agree?

One in five long-term elder care patients carried the dangerous germ in their nose, study finds

FRIDAY, April 23 (HealthDay News) — Certain patients are far more likely than others to carry methicillin-resistant Staphylococcus aureus (MRSA), in their noses, a new study shows.

Although they are not infected with the potentially lethal germ, its mere presence heightens their risk of developing MRSA-related pneumonia, bloodstream infection and surgical site infection, the research concludes.

In the United States, about 1 percent of people carry MRSA in their nose. But this study of 2,055 patients found that MRSA was present in the noses of 20 percent of long-term elder care patients, 16 percent of HIV-infected patients, and 14 percent and 15 percent of inpatient and outpatient kidney dialysis patients.

“Hospitals performing active surveillance for MRSA should consider such patient populations for screening cultures,” study author Leonard Mermel, medical director of the department of epidemiology and infection control at Rhode Island Hospital, said in a news release.

USA100 — a health care-associated MRSA strain — was the most common MRSA strain detected in patients, but a more virulent community-associated strain known as USA300 was much more commonly found in HIV-infected patients, the researchers noted. They also detected some MRSA strains not previously identified in the United States, including an MRSA clone common in Brazil.

There were huge differences in the number of MRSA colonies in the noses of the patients in the study. Some had as few as three colonies of MRSA while others had as many as 15 million colonies.

“This finding is important because heavy MRSA colonization of the nose is an independent risk factor for the development of a surgical site infection,” Mermel said.

Further research is needed to learn why people have different strains and quantities of MRSA in their noses, Mermel said.

The study appears online and in the June print issue of the journal Infection Control and Hospital Epidemiology.

More information

The U.S. Centers for Disease Control and Prevention has more about MRSA.

— Robert Preidt

SOURCE: Rhode Island Hospital, news release, April 20, 2010

Last Updated: April 23, 2010

Read the original article here

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April 20, 2010

Better Training Needed to Curb ‘Fatism’ Within the Health Professions, Study Finds

What An Honor - I Am In Print
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Here is an interesting article that shows us an area we need to improve upon.  When I first read this, I thought it silly that Science Daily would be posting such an article.  Upon review and thought of past experiences, I find I am glad to see such an article.

As a nurse, I know the damage obesity can do to the human body.  I also know that overeating can cause obesity.  However, the belief that obesity is caused simply by overeating is wrong.  The logic is faulty.  As a psych nurse, I know that many of the medications I routinely give my patients will cause weight gain.  I know this because my patients tell me that weight gain is the main reason for going “off my meds”.  I also know that genetics, age, activity levels, mood, physical health, and medications all together play a part.

It is sad that the “helping profession” is seen as being biased toward the obese.  Instead, why are we not helping our obese patients to discover the underlying cause of the disorder and then making them a care plan to help resolve the problem?  Let me know you thoughts on this matter, won’t you?


ScienceDaily (Apr. 16, 2010) — Prejudice towards obese people is rife among trainee health professionals, but can be modified, new research has found.

The study, published in the journal Obesity, says weight-based discrimination by the public has increased by 66% over the past decade with anti-fat prejudice among health professionals found to be high in western nations, and often exceeding that found within the general population.

The research, by scientists at the Universities of Manchester and Hawaii and Yale University, suggests that medical and allied health professions need to present a balanced view of the causes of, and treatment for, obesity when training young professionals in order to reduce the strong prejudice towards obese people.

The team found that the prejudice could be either increased or decreased depending on the type of obesity training pre-service, health-professional students received.

Health profession trainees from Australia were randomly assigned to one of three intensive, seven-week tutorial courses as part of their degree. One tutorial course educated students about the role of diet and physical activity as the primary cause of, and treatment for, obesity. A second tutorial course focused instead on educating students about the uncontrollable causes of obesity, such as the contribution of genes and environmental factors, like junk-food marketing and pricing. Finally, a third control group of students attended a tutorial course that addressed alcohol use in young people.

Measures of obesity prejudice were taken before the courses and then two weeks after completion. Significant reductions in obesity prejudice of 27% and 12% were found on two forms of prejudice for the course delivering material on genetic and environmental factors, while students on the course focusing on diet and physical activity showed a 27% increase in obesity prejudice.

Lead author Dr Kerry O’Brien, from The University of Manchester, UK, said: “One reason for the high levels of obesity prejudice is that people only hear that obesity is due to poor diet and lack of exercise, which implies that obese people are just lazy and gluttonous, and therefore deserve criticism. But, uncontrollable factors, such as genes, the environment and neurophysiology, play an important role.

“Weight status is, to a great extent, inherited. It’s crucial that health professionals, such as nurses, doctors, dieticians and physical educators, are aware of these other influences, as well as their own potential prejudices, and don’t just blame the individual for their weight status.

“Those tasked with providing health services to obese people may become frustrated with patients when they do not lose weight following counselling and treatment, but the research shows that weight loss is extremely difficult to maintain long term. Obese people are constantly fighting their physiology and the environment. If professionals keep this in mind it may help in not stigmatising their clients.”

Reviews of both adult and child obesity stigma research by study co-authors Dr Rebecca Puhl, from Yale University, and Dr Janet Latner, from the University of Hawaii, have shown that weight-related teasing and obesity stigma have serious psychological, physical and social consequences.

People with obesity also report receiving poorer treatment and stigma from health professionals and are less likely to seek treatment for certain conditions because of a fear of being stigmatised.

Dr Puhl said: “Unfortunately, weight stigma towards obese patients is very common in health care settings and efforts are clearly needed to reduce biased attitudes among health professionals and to improve quality of health care towards this patient population.”

Dr O’Brien added: “We were surprised by how few efforts to reduce obesity prejudice or weight stigma had been made, particularly within health professionals who are tasked with treating overweight and obese patients. Perhaps this represents a tacit acceptance that obesity prejudice is somehow okay.”

The authors suggest the results should not be interpreted as providing justification for reducing the emphasis on diet and exercise as cornerstones of obesity prevention. Instead, they say health educators should ensure that balanced information on the causes of obesity is delivered in a convincing manner.

The study adopted a model of persuasion often used in advertising, but also provided motivation for students to process course material in depth, with related assignments contributing 10% to course grades. This may be a valuable component for other stigma-reduction strategies. By assigning a tangible value to the information presented, the curriculum reinforces the importance and credibility of that information to students.

Story Source:

Adapted from materials provided by University of Manchester.

Journal Reference:

  1. Kerry S. O’Brien, Rebecca M. Puhl, Janet D. Latner, Azeem S. Mir and John A. Hunter. Reducing anti-fat prejudice in pre-service health students: A randomized trial. Obesity, 2010; DOI: 10.1038/oby.2010.79

Here’s the link to the original article

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April 19, 2010

Nursing our way out of a doctor shortage

Here’s an article that talks about the physician shortage currently looming and the way nursing can help fill the empty spaces to provide basic care and free up the physicians to see the patients that really need them.  Nurses could care for simple things like colds, fever, stomach upset, check-ups and send seriously ill patients to the physicians.  Just thought I’d post this article here to see what you think about this topic.


Give non-physicians more freedom to help patients.

Steve ChapmanApril 18, 2010

Thanks to health care reform, millions of previously uninsured Americans will have policies enabling them to go to the doctor when necessary without financial fear. But it’s a bit like giving everyone a plane ticket to fly tomorrow. If the planes are all full, you won’t be going anywhere.

There are not a lot of doctors sitting in their offices like the Maytag repairman, playing solitaire and wishing a patient would drop by. Most of them manage to stay plenty busy. Nor is there a tidal wave of young physicians about to roll in to quench this new thirst for medical care.

On the contrary. The Association of American Medical Colleges says that by 2025, the nation could be 150,000 doctors short of the number we need. Meanwhile, the number of med students entering primary care, the area of greatest need, is on the decline.

It’s hard to quickly boost the supply of physicians, since the necessary training usually takes at least seven years beyond college. The result, as an AAMC official told The Wall Street Journal: “It will probably take 10 years to even make a dent into the number of doctors that we need out there.”

That, of course, is assuming that the new health insurance system doesn’t drive aspiring or existing doctors out of medicine, which is entirely possible. Regardless, there seems to be no doubt that it will get harder to find someone to treat you, it may cost more and you’ll spend two hours in the waiting room instead of one.

Or maybe not. What people with medical problems need is medical care, but you don’t always need a physician to get treatment. You might also see a different sort of trained professional — say, a nurse practitioner, physician’s assistant, nurse or physical therapist.

Not every ailment demands Dr. McDreamy, any more than every car trip requires a Lexus. If you have a sore throat, earache or runny nose, you probably don’t absolutely require a board-certified internist to conduct an exam and dispense a remedy.

But it may not be up to you to decide who is suited to provide the care you want. Different states have different rules on what these clinicians may do. In many places, a nurse practitioner has to be under the supervision of a doctor. In others, she may not prescribe medicines or use the title “Dr.” even if she has a doctorate (as many do).

Medicare typically reimburses nurse practitioners at a lower rate than physicians. In Chicago, an office visit that would bring $70 to a doctor is worth only $60 to a nurse practitioner.

But the need for more primary care is forcing a welcome reassessment of these policies. So 28 states are reportedly considering loosening the regulations for nurse practitioners, on the novel theory that any competent professional health care is better than none.

Private enterprise is already responding to what consumers want. Walgreens, for example, has established more than 700 retail health clinics staffed by nurses, nurse practitioners and other non-doctor professionals. CVS has its own version. The number of these facilities is expected to soar in the next few years.

You might fear that this sort of treatment is inferior to what you’d get from your personal doctor. Your doctor might agree. The American Medical Association, reports The Associated Press, warns that “a doctor shortage is no reason to put nurses in charge and endanger patients.”

But put your mind at ease. A 2000 study published in the Journal of the American Medical Association found that where nurse practitioners have full latitude to do their jobs, their patients did just as well as patients sent to physicians. Other research confirms that finding, while noting that retail clinics provide their services for far less money than doctors’ offices and emergency rooms.

Obviously, if you wake up with crushing pain in your chest or fall out of a second-story window, you’d be well-advised to see a specialist. But for common ailments that are mainly a nuisance, a physician may be a superfluous luxury.

Obama’s health care reform rests on the assumption that expanding access demands a bigger government role. But even its supporters should be able to see that sometimes, it helps to get the government out of the way.

Steve Chapman is a member of the Tribune’s editorial board and blogs at

Here’s the link to the original article

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April 14, 2010

Nurse Staffing Effectiveness in 2010: The Interim Standards

Here is an article I found that I really was amazed to find.  It seems the Joint Commission is about to step up to the plate in the debate over patient safety and nurse-to-patient ratios.  Hmmmm………..

I’ve read those articles that say there is no correlation between staffing and positive patient outcomes and I don’t believe one word of them.  For every one that says nay, I bet I can find another that says “yes, there is a definite correlation.”  Statistics can be manipulated.  What the real decider should be is how many patients get better in the hospital and how satisfied are they with their care?

Please read this article and let me know what you think.  I will certainly be taking a copy of this with me to my next Staffing Effectiveness Committee meeting.


Briefings on The Joint Commission, April 13, 2010

Originally introduced by The Joint Commission to the standards in July 2002, staffing effectiveness is the appropriate level of nurse staffing that will provide for the best possible outcome of individual patients throughout a particular facility.

When first introduced, hospitals were required to track two human resource indicators and two patient outcome indicators, track data, and determine whether the variation in performance caused by the number, skill mix, or competency of staff.

“Hospitals collected the data, nurse leaders looked for correlations, and no correlations have been found,” says Susan W. Hendrickson, MHRD/OD, RN, CPHQ, FACHE, director of clinical quality and patient safety at Via Christi Wichita (KS) Health Network.

Hendrickson says even if hospitals did find what they believed to be a correlation between staffing and a patient outcome, when the information was examined more closely, it was not statistically valid.

Fast-forward to June 2009: The Joint Commission suspended these standards due to the debate of the results from across the country.

However, this suspension proved to be short-lived. In December 2009, The Joint Commission announced the approval of its interim staffing effectiveness standards for 2010.

The new standards will become effective July 1, and will remain in effect as The Joint Commission continues to research the issues of staffing effectiveness.

Interim standards at a glance
The first requirement affects LD.04.04.05, element of performance (EP) 13, and states that at least once per year, the hospital/organization must provide written reports on all system or process failures, the number and types of sentinel events, information provided to families/patients about the events, and actions taken to improve patient safety.

“In a broader sense, EP 13 ties staffing to outcomes and puts accountability at the leadership’s feet,” says Hendrickson. She suggests hospitals submit the reports to the board quarterly or monthly, rather than annually.

“Think about this: Every time a medical error occurs and you have to document it, this may be a long report for the board to get a grip on,” says Hendrickson.

Rather than compile an itemized list of failures, hospitals should instead classify the events and report on them statistically.

“Sentinel events, you will want to try to discuss the events as soon as possible, and disclose general information to the board,” says Hendrickson. “And if a sentinel event did occur, then disclose information on any action taken to prevent similar events.”

In addition to EP 13, the new interim requirements affect PI.02.01.01, EPs 12–14.

EP 12 states that any time the organization has an undesirable event, it must evaluate its staff and their effectiveness. EP 13 states that if a negative trend in the staff is noted, a report must be provided to the leadership.

In EP 14, a written report of the identified issues must be provided at least once per year to the leadership in charge of the patient safety program.

“The organization needs to have a process or policy that speaks to this so the surveyor can review the information,” says Hendrickson. “The Joint Commission believes that if you are not in compliance, this is an immediate risk to patient safety because there are few processes to intervene.”

Now if an organization is cited for any staffing effectiveness, a short-term resolution is given, and the organization is required to come up with a solution within 45 days.

Turning to patient-staff ratio
In addition to the new interim standards, a more intricate part of staffing effectiveness under examination is the patient-to-staff ratio. However, California is no stranger to this because a staffing ratio has been imposed on all organizations in the state since 2004.

To meet the patient-to-staff ratio, many hospitals in the state used traveling nurses from all areas of the United States. By doing so, many of the new nurses ended up taking residency in California, skewing the numbers of the nursing shortage elsewhere.

Despite the additional nurses, the ratios between patients and staff were not always met.

“Meeting the ratio at all times was difficult,” says Cyndie R. Cole, RN, MSN, CNO at the Ventura (CA) County Medical System. “Going from three RNs on the night shift to five RNs on the night shift added a tremendous cost, and then during the day shift staff were not used to being forced to take their lunch break at a specific time.”

Over time, however, nurses managed to work together with the administration to come to a better understanding.

For this year, a set ratio for each unit in the hospital must be met at all times, with no exceptions. The patient-to-staff ratios for each unit include:

  • Critical care: 1:2
  • Neonatal ICU: 1:2
  • Postanesthesia care unit: 1:2
  • Labor and delivery: 1:2
  • Postpartum (moms only): 1:6
  • Pediatrics: 1:4
  • Step-down: 1:3
  • Telemetry: 1:4
  • Med-surg: 1:5
  • Specialty care: 1:4
  • ED: 1:4, 1:2, 1:1

“In the ED, the patient census is always changing, so three different ratios are set up,” says Cole. “On an hour-by-hour basis, we are checking and making sure we are adequately staffed.” To help with the ED’s unpredictability, Cole developed two tools over a three-year period, to work together to help ensure that the patient-to-staff ratios are always met.

The first tool is an hourly census that requires the charge nurse to document the patients in the ED and those patients in the emergency room waiting area. By tracking the patients in the ED and those waiting, the tool helps determine when the ED census will be at its highest and helps the facility call more nurses to meet the patient-to-staff ratio.

In addition to the hourly census, facilities utilize an Excel spreadsheet that automatically determines variance in the ratios.

“This gave us a tool to show where our major hours of being under the ratio occurred, and allowed us to present to our fiscal people hard evidence the times when we need more nurses,” says Cole.

The importance of staffing effectiveness
Staffing effectiveness is being addressed at a national level, with the possibility of all hospitals one day being required to meet a nurse-to-patient ratio.

“Staffing effectiveness in a hospital, meeting ratios, and meeting acuity plans is a day-by-day process,” says Cole. “It is something we have all worked hard to do, but it is still not perfected.”

Even with time, Hendrickson believes that it is still important for hospital leaders to look at staffing issues. “We need to understand how staffing affects outcomes, because we are all held accountable for patient safety,” she says.

Most importantly though, Hendrickson says, it is necessary for organizations to develop the evidence for their own practices. “We need to work together in order to determine what practices will improve the outcomes. And then we have to spread that information across our profession.”

This article was adapted from one that originally appeared in the March 2010 issue of Briefings on The Joint Commission, an HCPro publication.

Here is the link to the article I found

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April 13, 2010

The three-legged stool of quality

Filed under: Nursing — Shirley @ 4:18 pm
Tags: , , , ,

This was just a small blurb I found in an email today.  I posted it because I think we forget the importance of how everything has to work together to give our clients a good outcome.  This is just a quick tip for a refresher.

I thought this was a succinct and informative description of the process we, as caregivers, go through with each and every patient we treat.  It also has a link the site for managers to get information about ways to improve this process at your facility.

I hope you enjoy.


Quality professionals often describe quality as a three-legged stool, with process, structure, and outcome measures holding up the stool. Although the results of the HCAHPS survey can be considered an outcome measure, there is another way to think about the patient experience that emphasizes its centrality to all of the aspects of quality. The patient experience can be considered the seat of the stool—essentially the purpose for which the legs exist. An organization can build a strong stool with three solid legs, but if the seat is missing or has tacks on it, no one will want to sit on it and the stool is not serving its purpose.

Similarly, it is possible for a hospital to focus exclusively on clinical quality metrics without considering the long-term relationships being built between and among patients and staff members. The hospital may receive a perfect score on the three “legs” (the outcome was good, the clinical process measures were satisfied, and appropriate structures are in place), but if the patient had a horrible experience and has lost confidence in the hospital and the clinicians, the hospital may have set the patient up for failure. The stool will eventually fall apart without a good seat to tie everything together.

Here’s the link to the original article

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April 11, 2010

Not Enough Nurses, Not Enough Time: The Crux of Nurse-to-Patient Ratios

Here’s an article that looks at staff to patient ratios from a different perspective.  These nurses are in upper management and are not only concerned with staffing but with patient outcomes as it affects payment by the payor source.

At the hospital system where I work, the TCAB (Transforming Care at the Bedside) committees have initiated the PDA studies at various hospitals and on various units.  The information from these studies is very interesting and shows that nurses spend quite a bit of their time doing non-nursing things–faxing orders, waiting for the doctor to call back, talking to other departments about results, looking for lost items, gathering supplies.  So I was interested to see that our results were in line with the results in this article.

I encourage all nurses to take part in this movement to identify what exactly nurses are doing during the shift and to help quantify the time spent actually doing patient care.  After all, isn’t patient care really why we became nurses?


By Pat Muccigrosso, contributor

March 24, 2010 – How many patients per nurse is the right number to ensure patient safety? Or is it more than just a numbers game?

These questions have been a topic of debate for years; in recent years, they’ve become the object of legislation.  California led the way in 2004, when it enacted a law mandating nurse-to-patient staffing ratios.  To date, a total of 13 states have introduced legislation to address nurse staffing, and 25 states are considering additional laws.

Melinda Schoen, RN, MSN
Melinda Schoen, RN, MSN, VP of nursing at Masonicare Health Center, says that the ratio of nursing staff to patients affects patient safety.

But the question that started this rush to legislation remains:  Does adding more registered nurses help hospitals reduce adverse outcomes and “never events” like medication errors, falls and pressure ulcers?

“The ratio of staff to patient does affect patient safety.  The higher number of patients per nurse makes it more difficult because you are spreading yourself across a larger group of patients,” says Melinda Schoen, RN, MSN, vice president of nursing at Masonicare Health Center in Connecticut. “If you have fewer patients, you’re able to be spend more time per patient, be visible and involved throughout the shift, meeting their needs and preventing risky situations.”

Recent studies have also shown a correlation between nurse staffing and patient outcomes.  One retrospective study presented at the March 2010 American Academy of Orthopedic Surgeons meeting found that patients 65 and older with a hip fracture are more likely to die when admitted to hospitals with lower nurse staffing levels.  The researchers commented that nursing levels may affect mortality and other outcomes by influencing the chances of preventing complications, identifying complications earlier and mobilizing help quickly.

In another study published in the March issue of Medical Care, nurse staffing was shown to have a statistically significant, independent association with in-hospital mortality.

Lillee Gelinas, RN, BSN, MSN, FAAN, VP and CNO of VHA, Inc.
Lillee Gelinas, RN, BSN, MSN, FAAN, VP and CNO of VHA, Inc., says that nurse staffing levels and time at the bedside affect outcomes.

Lillee Gelinas, RN, BSN, MSN, FAAN, vice president and chief nursing officer, VHA, Inc., agrees that staffing affects outcomes, especially in these tough economic times.  “Hospitals have been downgrading or reducing staffing levels.”  Gelinas says hospitals may think they are helping their bottom line in the short-term, but in the long-term “they may be hurting themselves.  There are not enough nurses at the bedside to detect clinical deterioration which leads to this term ‘failure to rescue’ — a direct reflection of nursing care in a hospital.”

Failure to rescue became prominent in 2004, when the National Quality Forum (NQF) published its Nursing Sensitive Care Performance Measures and it was first on the list.  But Gelinas says that failure to rescue may just be symptomatic of a far greater issue.  “When we’re thinking about ratios and safety, I like to say we don’t have a shortage of nurses; we have a shortage of nursing care.”

Gelinas cites national research done by Kaiser Permanente that shows that when nurses spend 60 to 70 percent of their time in direct patient care, safety and outcomes are dramatically improved.  “In American hospitals, the average nurse only spends maybe 30 percent,” says Gelinas.

Margaret Cousart, RN, BSN, CRN-C, CCDS
Margaret Cousart, RN, BSN, CRN-C, CCDS, director of clinical improvement at VHA Georgia, discovered that nurses sometimes take on non-critical activities that take them away from the bedside.

A year-long effort by nurses at the Georgia VHA hospitals demonstrated that it’s not always a staffing shortage that keeps nurses from the bedside, and administrators weren’t the only ones who missed that.  “The perception of the nurses throughout the hospitals was that they actually were spending more time with patients,” said Margaret Cousart, RN, BSN, CRN-C, CCDS, director of clinical improvement at VHA Georgia.   “The reality was that they were only spending 30 to 40 percent of their time in direct patient care.”

Using proprietary software and retooled PDAs, nurses at 11 hospitals in VHA Georgia were asked to track how they were spending their time.  They found that they wasted a lot of time waiting for a lab result to come back or a drug to come up to the floor or for a phone call from a physician.  They also lost time at the bedside because they were dealing with lost and found items, handling security issues, coping with broken equipment or performing clerical duties like faxing, phoning and copying.

Although most of the nurses were aware of the non-patient care activities that used up their time, even they were surprised at the magnitude of the problem.

Once VHA Georgia discovered what kept nurses from the bedside, they took a closer look at the details, according to Cousart. “We did gap assessments across all our hospitals, and developed action plans to find ways to take away some of the things nurses had embraced as their job over the years but really weren’t. “

Getting nurses back to the bedside is the very place that registered nurse Nora Watts says nurses do the work that prevents “never events” and failure to rescue.  “I should be at the bedside looking at the patient.  Are they sweating?  Is there a change in their mental status?  Is there anything going on that would tell me that something is going wrong?”

Watts, who works in the ambulatory transfusion center at Newton Wellesley Hospital in Massachusetts worries that administrators might try to cut costs by hiring unlicensed people or simply buying more technology – but that would be another mistake.  “Technology is great but you have to correlate what you find to what you see is actually happening with that patient.  That is what we do, what nurses do at the bedside.”

While short staffing keeps nurses away from the bedside in some cases, Gelinas says that the shortage of care is the real, underlying problem. “For me, that is the bottom-line message.”

“I think there’s truth to both,” counters Schoen.  “As a profession, we do get pulled away from the bedside.”   But she agrees with Gelinas that adding staff, in and of itself, doesn’t necessarily solve the problem: quality and results are the keys. Solving the problem means achieving “statistics showing that you are able to reduce falls or reduce medication errors with a certain staffing level — putting black and white detail and information together.”

At the heart of the problem, says Gelinas is one simple fact.  “We don’t have cultures of safety in American hospitals.  We are so financially driven that the agendas and conversations in the C-suites are not around how we instill a culture of safety.”

One way to change the culture, says Gelinas is by “hitting hospitals in the financial area.  It’s already begun.  Last October, the Centers for Medicare and Medicaid Services (CMS) stopped paying hospitals for complications of care called ‘never events’ things that should never happen like falls, pressure ulcers.”

And that’s just the beginning.  Gelinas pointed out that on June 1, 2010, CMS will begin reporting failure to rescue rates.  “Hospitals that opt out of reporting their failure to rescue rates would have to accept a 2 percent reimbursement rate.”

As transparency becomes a larger part of the business of healthcare, hospitals that fail to ensure patient safety through safe staffing levels, more nursing time at the bedside and other measures may end up paying a far larger bill in the months and years ahead.

Here’s the link to the original article

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April 9, 2010

Nurse Appreciation 52 Weeks a Year

This is one of the best articles I have read in a very long time.  Nurses around the world need to read this and know that they are truly appreciated for all the things they do.

National Nurse’s Week will be here soon.  What do you really want from your organization this year?  A new mug?  A new bag? Or would you truly like to feel appreciated?


Nurses’ Week is coming next month.  Soon your facility will be scraping together some token of appreciation for your work, with little funding and minimal effort.  I have seen it over and over.  After 30 years of watching nurses in action, I can safely say that nurses give far more to their work places than they ever dream of receiving, monetarily or otherwise.

Years ago, my father taught me that there are two kinds of people in this world.  He says that there are givers and there are takers.  We nurses surely fit into the giver category.  We literally pour ourselves out for others, in caring.  How do we do this?  How do we give and give and care and care, over and over again?  What do we contribute to our community?  In my opinion, our greatest “giving” contribution to our community is our children.  You might feel this is irrelevant, but consider that most of us are parents or future parents.  We realize that loving, teaching, and preparing our next generation of productive citizens is the GREATEST gift we can give to our community.  We prepare our children for the joys and struggles that lie ahead for them.  The giving and caring starts in our homes where we make parenting a priority and tremendous sacrifices for the family.  Let us never forget the mighty work that dedicated parenting is for the community.

Beyond our homes, our attention and energy expands out to our studies and our work.  We chose to be givers in this world when we answered that calling into nursing which we hear initially.  We endure our rigorous studies and finally achieve that hard-earned goal, our nursing license.  When we enter the profession, we are enchanted and enamored by the excitement and challenges, but all too soon the disillusionment sets in.  We realize that things aren’t quite like the textbooks explain, and that maybe not every patient always gets the right amount of attention and effort devoted to them that they each deserves.

We realize that time and resources are finite, so we figure out ways to do more with less, and get more mileage out of our day.  We learn to multi-task better, to streamline our processes better.  We start to skip lunches, forget to drink and hydrate ourselves, and hardly ever make it to the bathroom.  We put ourselves aside for the sake of the patients.

Throughout our careers, we CONTINUE to show that we are givers by not only living out our higher calling, but by choosing to stay and remain in our work.  Even though we have our fair share of legitimate reasons to abandon ship, ALL of us here haven’t done that.  We have CHOSEN NOT to.  It’s our decision.  It’s our decision to stay.  It’s our decision to still care.  It’s our decision to continue to endure the sometimes harsh conditions and situations we find ourselves in.  The list of ways we show this determination and dedication to our patients is endless.

I am truly thankful to you for all your many sacrifices.  Remember the time you cried all the way home from work because of something traumatic that happened that day?  But you came back to work and punched in the next day, didn’t you?  I thank you for how you worked all the way through your pregnancies for as long as physically possible, for all the times you patiently oriented that new hire, and for taking the time to recruit that sharp tech into nursing.  I thank you for enduring those difficult moments when maybe you cried over the med cart or sustained a needle-stick.  Thanks for quietly enduring the moment when a co-worker may have disrespected you.  I thank and appreciate you for all the cross-training you’ve willingly done, all the codes you participated in, and for the time you stopped at the accident site to help the victims.

Thanks for being dedicated enough to cut back your hours to stay home “while the kids were little” and for the time you choose to find creative alternatives instead of using chemical restraints for your agitated patient.  I am grateful for when you stayed during the heavy snow and for helping with the tornado.  Thank you for attending your patient’s funeral for the sake of the family, and for following up on the woman after she lost her baby.  Please, accept my gratitude for all of the births you celebrated, all of the deaths you mourned, all of the education you have pursued, all of the times you were a strong leader, all of the times you deferred to follow, all of the times you advocated, all of the times you lobbied, all of the prayers you have said on behalf of others, and for all of the other unspoken sacrifices you make.  Be proud of yourself and accept this overdue expression of appreciation you so deserve.  And, as we look ahead to all our tomorrows, we are determined to continue to show how much we are willing to give and willing to care every time we answer the call light,  put on those surgical scrubs, cry with that family, breathe with that woman, stop that hemorrhage, or comfort that child.  Tomorrow we will show our determination to keep on caring when we teach that lesson, change that dressing, insert that tube,  present that idea in the board room, give the bad news, volunteer to fill in for a shift, feed that baby, make that phone call, travel to that disaster, or write that evaluation.  Tomorrow our caring will continue to come through every time we make that home visit, attend that funeral, give that pain med, go back to school, feed that elder, shock that chest explain that procedure or calm that family.  And so, tomorrow we will wake up and choose once again to let the giving and the caring flow through our hands.  I am so very humbled and proud to be able to say that I am a member of your amazing profession and your sacred work.  Wherever we are, whatever we do, let us always remember to give ourselves AND each other the gratitude and credit we so deserve.  Grateful nurses are happy nurses.  Grateful nurses are humble nurses.  Many thanks be to you, and thanks be to God for you.

Thank you for all your contributions!

About the Author: Christina Feist-Heilmeier, RN, MSN, author, and speaker has spent thirty years in the healthcare world, specializing in geriatric, obstetrical, and medical/surgical Nursing.  Christina is a strong advocate for nurses and is the author of Nurses Are From Heaven, which is being featured in the spring edition of the Journal of Christian Nursing, 2010.

Click here for more information on Christina Feist-Heilmeier.

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