Nursing Notes

May 31, 2010

Remember the nurses who served and lost their lives

Filed under: Nursing — Shirley @ 9:01 pm
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With today being Memorial Day, I thought we should take a minute to remember those nurses who went to war to serve the boys fighting for us.  Many of them lost their lives right along with their patients.  Many of them returned, damaged beyond repair from the stress and the sights of war.  So, while we remember our lost soldiers, lets also add our prayers for the military nurses who threw caution to the wind and went where they were needed, despite severe danger and loss.  These valient men and women epitomize the nursing profession.

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May 28, 2010

Health Care Costs and Financing

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This article is from the U.S. Department of Health and Human Services site for the Agency for Healthcare Research and Quality.

This article is an attempt to quantify the cost vs. savings of staffing units with only one additional RN per day in some of the highest acuity units.  The results are rather remarkable and should be enough to get the attention of all involved in patient outcomes.

I hope you find this information informative and can utilize this study in your facility.

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Higher nurse-patient ratios result in societal cost benefits for some hospital areas

Increasing nurse-to-patient staffing is recommended to improve patient safety and reduce adverse advents. A recently published simulation study shows that increased registered nurse (RN) staffing was associated with lower hospital-related mortality and adverse patient events. This approach can result in societal net savings, depending on the area of the hospital.

University of Minnesota researchers analyzed data from 27 published studies on patient outcomes and nurse-to-patient ratios. They estimated hospital savings and the number of adverse events avoided. They determined the savings-cost ratio from increased nurse staffing for patients in intensive care units (ICUs) and those admitted to medical or surgical floors. Increasing nurse staffing in the ICU had the greatest positive impact on societal savings from avoided deaths and patient adverse events. The monetary benefit of saved lives per 1,000 hospitalized patients was 2.5 times higher than the increased cost of one additional full-time nurse per patient day in the ICU. It was 1.8 times higher in surgical units and 1.3 times higher in medical units.

The researchers estimated that increasing nurse staffing by one full-time nurse in the ICU would save 327,390 years of life in men and 320,988 in women. This would result in a productivity benefit of $4 billion to $5 billion dollars. In surgical units, the staffing change would result in a larger productivity benefit of $8 billion to $10 billion dollars. While these are societal net savings, hospitals do not appear to reap sufficient monetary benefit from length of stay reductions produced by increased nurse staffing. The study was supported in part by the Agency for Healthcare Research and Quality (Contract No. 290-02-0009).

See “Cost savings associated with increased RN staffing in acute care hospitals: Simulation exercise,” by Tatyana A. Shamliyan, M.D., M.S., Robert L. Kane, M.D., Christine Mueller, Ph.D., R.N., and others in Nursing Economics 27(5), pp. 302-331, 2009.

Here is the link to the original article

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May 26, 2010

Nurses Find Simple Ways to Improve Satisfaction

Filed under: Nursing — Shirley @ 3:58 am
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This is another article about the effect of TCAB (Transforming Care at the Bedside) on the satisfaction of nurses.  As a member of my organization’s TCAB committee, I can see the benefit of this process for all nurses.  This small adjustment in the way “things have always been done” can make a huge difference in the way the shift flows and in the patient’s view of the care they are receiving.  Nurses who are satisfied with their work will give better care and have more satisfied patients.

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Healthcare leadership is well aware that many tasks keep nurses away from the bedside. There are the obvious ones, such as documentation, collecting medications, and hunting equipment. And there are the not-so-obvious ones, such as answering phone calls from patients’ concerned relatives.

Although a relatively minor clinical concern in a nurse’s day, relatives tend to call to check on patients right when nurses are first beginning their shift, when they are trying to hear reports and check in on their patients for the day.

To make the process simpler, nurses at Chilton Memorial Hospital in Pompton Plains, NJ, decided to designate a specific time for relatives to call.

The decision is part of the organization’s larger Transforming Care at the Bedside initiative, says Joanne Reich, VP and chief nursing officer at Chilton. The TCAB initiative is sponsored by the Robert Wood Johnson Foundation and the New Jersey Hospital Association with a goal to improve the quality of care on medical/surgical units.

“Our emphasis is on nursing staff taking a critical look at their care environment and how they can increase their satisfaction and effectiveness in care delivery,” says Reich. “Nurses have many interruptions, so they have been working on increasing time at the bedside.”

Nurses began tracking the number of calls they were receiving from families of patients and discovered the calls used up a significant amount of time and called them are away from the bedside just as they had started assessing their patients or receiving reports.

Having a designated time for families allows patients and families to coordinate the best time in the morning for them to call. Nurses now can plan their mornings better. They can accomplish what they need to do at the start of the shift, and they can ensure they are ready with the information needed when they know the call is coming.

The change was supported by leadership and has worked very well. “Nursing leadership recognizes the leader within each nurse,” says Reich, “and that each nurse is a professional and can bring to the table what they feel works best.”

Nurses also revamped how patient call bells are treated. In a collaborative project with other disciplines, such as physical therapy and respiratory therapy, the hospital created a “no pass zone.”

“It’s a commitment by all of the staff that if patient call bell is lit, no one will pass that room,” says Reich, “without going in and introducing themselves and seeing what’s the patient needs.”

Often, the staff member will be able to help the patient, such as by refilling a water pitcher, which increases patient satisfaction. If the staff member can’t help, he or she quickly takes the issue to the patient’s nurse.

Reich says the next project nurses are tackling will examine patient environment. This more in-depth project requires consideration of different concepts and ideas to determine what is best for patients and what is needed to implement the ideas.

“They want to ensure the patient environment is prepared in the manner that works best for patients,” says Reich. “They’re examining if patients have what they need in the way of water, tissues, food tray, etc. Our goal continues to be providing quality, personalized care to each of our patients. ”


Note: You can sign up to receive HealthLeaders Media NursingLeaders, a free weekly e-newsletter that offers concise updates on the top nursing leadership headlines of the week from top news sources.

Here is the link to the original article

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May 24, 2010

Rocking Eases Postop Ileus

Typical Finnish wooden rocking chair.
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I would like to use this blog to showcase some of the research that currently is in effect.  Nursing research is a growing area and I would like to present as much of this research as I feel would be of benefit.

This article, though found on a medical news site has nursing research as the primary source:

Primary source: Applied Nursing Research
Source reference:
Massey R “A randomized trial of rocking-chair motion on the effect of postoperative ileus duration in patients with cancer recovering from abdominal surgery” Appl Nurs Res 2010; 23: 59-64.

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Published: May 21, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.


Action Points

  • Explain to interested patients that use of a rocking chair can help ease postoperative abdominal discomfort.

Postoperative use of a rocking chair shortened the uncomfortable time until passage of first flatus following surgery for abdominal cancer, a randomized study found.Time to first flatus — the usual marker for relief of the dysfunction and loss of gastrointestinal motility common after abdominal surgery — was 3.16 days in patients who used rocking chairs compared with 3.88 days in patients who sat in nonrocking chairs (P=0.001), according to Robert L. Massey, RN, PhD, of the University of Texas M.D. Anderson Cancer Center in Houston.

“Patients often describe the period immediately after surgery, prior to the resolution of [postoperative ileus], as the most uncomfortable part of their post abdominal surgery recovery experience,” Massey wrote in the May issue of Applied Nursing Research.

Factors that are thought to contribute to postop ileus include activation of inflammatory mediators, secretion of gastrointestinal hormones, the effects of anesthesia and opiates, and physical status.

Researchers have hypothesized that the rhythmic repetitive motion of rocking stimulates the vestibular nerves and has a modulating effect on the stress response.

A standard-of-care intervention used to help resolve postoperative ileus involves having the patient get out of bed, sit in a chair, and begin walking on the first day after surgery, but evidence for the efficacy of this remains unconvincing, according to the Massey.

Previous studies have suggested that the back-and-forth motion of rocking can help relieve intestinal gas buildup, abdominal distension, and pain in surgical patients.

Rocking also was shown to lessen medication requirements and shorten hospital […]

Please click the link above to read the rest of the article.

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May 21, 2010

Quality Safety Investigator program empowers nurses

Here is an article about involving the bedside nurse in improving patient safety.  While I applaud this effort, I believe that it has always been the bedside nurse who worried and addressed patient safety on the unit.  We have always been responsible for managing patient care to prevent falls, slips, errors in treatment, etc.  So, while this program is great, I am not clear on how this is new.

Maybe I simply am not seeing the bigger picture, so I am keeping an open mind and am willing to entertain differing viewpoints.  The information at Health Leaders Media is always timely and informative.  I frequently come away with a new understanding of a current problem in nursing simply by seeing that problem viewed from another stance.

I highly recommend this site to all nurses.

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The University of Kansas Hospital (KUMED) has created a program to encourage nurse involvement in patient safety. Called the Quality Safety Investigators (QSI), nurses in the program are bedside caregivers who are given tools, resources, and training by KUMED to focus on unit-specific initiatives.

I heard of the QSI program during an interview for an article about the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program® (MRP). I spoke with Liz Carlton, RN, MSN, CCRN, director of quality, safety, and regulatory compliance at KUMED who also had a hand in creating the QSI program. She extolled the virtues of giving staff nurses the power and responsibility of being in charge of improvement projects, and also the benefits of being in a type of membership group at the organization.

Those nurses who are interested in becoming QSIs go through an application process and once they are selected, their managers must also sign contracts stating that they will allow the QSIs to participate in activities away from the unit because of their QSI status.

To read more, see the full article published with HealthLeaders Media.

Does your facility have any type of nursing empowerment group, like the QSI program? If so, do you think it is of benefit to both the facility and the nurses who are a part of it?

About the Author: Heather Comak is a Managing Editor at HCPro, Inc., where she is the editor of the monthly publication Briefings on Patient Safety, as well as patient safety-related books, webcasts, and audio conferences. She is also is the Assistant Director of the Association for Healthcare Accreditation Professionals (www.accreditationprofessional.com) and manages Patient Safety Monitor (www.patientsafetymonitor.com), of which this blog is a part. Contact Heather by e-mailing hcomak@hcpro.com

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May 19, 2010

Telehealth Services, Jobs on the Increase:

Filed under: Nursing — Shirley @ 3:57 am
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Cell Phone
Image by JonJon2k8 via Flickr

This article simply shows the future of nursing and the openings that will be arising for nurses.  Nurse entrepreneurs will be interested in this trend because it will facilitate better access for nurses to teach their patients; nurses who work in a health-care facility will also be interested in this trend, as how we nurse changes daily with the advent of new and better technology.

Let me know what you think of this trend, won’t you?

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Study By Amy Tierney, TMCnet Web Editor

As more and more companies look for ways to cut healthcare costs, the adoption of telehealth services – the delivery of health-related services using telecommunications technology – is on the rise, a new report found.

According to InMedica, the medical research division of IMS Research, a specialist supplier of market research and consultancy services, healthcare providers will start to increase their adoption of telehealth technology by 2012. In a recent report, the company found that number of gateways used in telehealth applications will soar to more than 1 million in 2014 and reach about 3.6 million by 2018.

While the number of number of integrated cellular handsets used as telehealth gateways was low in 2009, they are projected to grow to more than 350,000 in 2014, the report said.

And with the growing adoption of telehealth services, so too, will the number of jobs for nurses and other healthcare professionals.

“The use of mobile phones as telehealth gateways has had a surge of interest over the last couple of years; with patients and device companies recognizing the benefits of data transmission on the move. We anticipate […]

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May 17, 2010

Level of frailty predicts surgical outcomes in older patients, researchers find

Live surgery webcast from Christiana Care Cent...
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This is a wonderful bit of research that we nurses should and can implement into our daily nursing.  Complications of surgery occur, but based on this study, there may be a way to identify targets who are at-risk for complications.  That is phenomenal.  Please visit the site and read this article as well as any of the others that are listed there.  This site is really very informative about many issues we are facing today, not just nursing issues.

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ScienceDaily (May 13, 2010) — A simple, 10-minute “frailty” test administered to older patients before they undergo surgery can predict with great certainty their risk for complications, how long they will stay in the hospital and — most strikingly — whether they are likely to end up in a nursing home afterward, new research from Johns Hopkins suggests.

“There’s been this hunger to have some sort of scientific way to predict surgical outcomes in older people,” says Martin A. Makary, M.D., M.P.H., an associate professor of surgery at the Johns Hopkins University School of Medicine and the study’s leader. “We think we have a way now to accurately measure risk instead of eyeballing somebody or guessing.”

The key is a means of measuring frailty using a five-point scale, developed at Johns Hopkins, Makary says. It includes loss of 10 pounds or more within the previous year, weakness as measured by a handheld dynamometer, exhaustion, low physical activity and slowed walking.

On the scale, one point is given for each problem. Scores of 4 or 5 mean that patients are considered frail; 2 or 3 mean they are considered intermediately frail. The test for frailty is simple to perform, taking just 10 minutes to complete.

In a study reported online and in the June issue of the Journal of the American College of Surgeons, Makary and his team applied the frailty test to 594 patients over age 65 who had elective surgery between July 2005 and July 2006. Results showed that patients who were frail were 2.5 times as likely as those who were not to suffer a postoperative complication, 1.5 times as likely to spend more time in the hospital and 20 times as likely to be discharged to a nursing home or assisted living facility after previously living at home.

Previous research has also linked frailty to poor outcomes even in patients not undergoing surgery and has associated frailty with mortality, morbidity, falls and increased hospitalization.

Surgeons have long known that some patients over age 65 do quite well after major surgery even though they appear feeble at the outset, while others who seem to be healthier before an operation emerge diminished. Predictive formulas based on […]

Level of frailty predicts surgical outcomes in older patients, researchers find.

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May 14, 2010

Stressed nurses’ heart attack risk revealed

Here is another great article from Nursing Times that I want to showcase here.  I read this article with trepidation, but I read it anyway.  I did not realize the implications that this study sets forth.  I hope you read this and leave me some feedback.  I hope you visit this phenomenal site and read some of the wonderful studies and articles they have there about nursing.

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The risk of heart disease may be higher for young women who work in stressful jobs, scientists in Denmark have suggested.

Although similar studies in the past have mostly focused on men, it has been known that so-called high-flying jobs can cause the disease.

The 15-year research, known as the Danish Nurse Cohort Study and involving 12,116 female nurses aged 45-64, showed that women who said their job was a little too pressured and stressful were 25% more likely to develop heart disease than women who deemed their job manageable.

Women who said their job was far too stressful were 35% more likely to develop heart disease than those who said they were not under stress at work, after other factors such as whether they smoked were considered.

By 2008, 580 of the nurses involved in the research had developed heart disease, 138 of whom had had a heart attack, 369 had angina and 73 had other types of the disease.

The scientists also investigated how much control the women believed they had over their job and                   concluded that […]

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May 12, 2010

‘What struck me was the powerlessness many nurses felt’

Filed under: Nursing — Shirley @ 1:03 am
Tags: , , , , ,

This article is very interesting and is also very timely.  Although the author is writing in and about nursing in England, I feel the information can be applied to all nurses, so I am posting it here.  Please read this article in its entirety and leave me a message about your opinion on the topic.  I think this topic could begin a lovely and lively debate here because it will do so anywhere you talk about shifts and changing them.

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6 May, 2010 | By Jill Maben

Returning to short shifts would be like “turkeys voting for Christmas”, suggested one reader in response to my opinion piece, with another saying “hands off our long days”. I never imagined the storm it would create.

I argued that: “Twelve hour day shifts may have implications for staff wellbeing in terms of stress, burnout and physical injuries.” And wondered whether nurses could “give the same unwearied, dignified and compassionate care after 11.5 hours as they can after just one hour when fresh on duty”.

The piece generated 116 comments on nursingtimes.net. Nurses were divided. Many felt that with no rush to “hand over” their patients, they could plan care over the whole day, get to know their patients and had time to chat in the evenings. “The benefits [include] better staff morale on 12 hours; the nurse being able to spread out the nursing tasks; and better consistency with patients during the day and night.” Some suggested long days worked well in areas such as accident and emergency, theatres and intensive therapy units, and some noted the importance of time off for “child care or other caring responsibilities”. Many also felt it should be a matter of individual choice, and staff should be allowed to work flexibly – although some managers suggested this would “open a can of worms” […]

Here is the link to visit this site where you can find numerous wonderful articles and blog posts about the trials and tribulations of nursing across the pond.  I love this site..Nursing Times.

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May 10, 2010

Quality: The Medical Home as Community Effort

Filed under: Nursing — Shirley @ 8:37 am
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This article, found at HealthLeadersMedia.com, really interested me.  As a nurse, I am all about maintaining health and empowering my clients to make informed decisions.  The concept of an Accountable Care Organization (ACO) is not new to me, but the actual fact of the existence of such an organization is new.

I frequently worry about the recidivism and relapse of my patients.  Most do describe a “fractured” type of care that they have been receiving out of the hospital.  They see one doctor for this problem, another doctor for that problem, and an entirely different doctor for another type of problem.  The only point of convergence can be the pharmacy; but then you have the patients who use several different pharmacies based on nearness to the doctor’s office or some other reason.

When I do a thorough head to toe assessment, I ask, “Who treats you for _______?” or “Who do you see for this condition?”  Frequently, I will end up with a list of doctors who may or may not be aware of each other and their place in the care of my patient.  It’s scary to me.

So when reading about this ACO in Michigan, I was excited.  I hope you are too and will read this entire article.

Let me know your thoughts, won’t you?

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Janice Simmons, for HealthLeaders Magazine, April 8, 2010

A collaborative ACO model is yielding clinical and financial results.

One of the first sites in the country to test the relationship involving a patient-centered medical home, value-based insurance design, and a community collaborative that includes healthcare providers, local employers, consumer groups, and payers initially got a kickstart with a rejection.

Today, this Michigan collaborative, called “Pathways to Health,” has been garnering national attention because it has the outlines of the new delivery model—an accountable care organization (ACO)—that has received close attention during the healthcare reform debate. Plus, new data show that patient health is improved and money saved when it comes to using this patient-centered model to care for patients with chronic conditions.

Several years ago, Integrated Health Partners, a physician hospital organization that joins the Battle Creek (MI) Health System and the Calhoun County Physicians Organization, had been participating in a BlueCross BlueShield of Michigan’s (BCBSM) Physician Group Incentive Program that financially rewarded physicians in a PPO network by addressing issues such as chronic disease management and generic drug use.

It studied the improving chronic care model developed by Ed Wagner, MD, and his colleagues at Seattle’s McColl Institute, and became intrigued. “After we looked at it, we said this just makes sense. It’s pretty intuitive that this is how medicine should be practiced and how patients should be engaged,” says Ruth Clark, IHP’s executive director.

“We started thinking about this and planning about how we might get this to happen,” Clark says. Three years ago, they came across the notice of a Robert Wood Johnson program grant for assistance in improving healthcare quality. They decided to apply.

“As a PHO, we have relationships with folks at health plans. We have physician relationships. But when it came to employers, for the most part, they didn’t even know that we existed,” Clark says.

IHP engaged the help of Pat Garrett, the then-CEO of Battle Creek Health System, a multicare system formed 20 years ago from the merger of two local hospitals. Garrett, who often heard the refrain from local employers about what could be done to lower healthcare costs, was able to convene a panel of about a dozen employers, including the Kellogg Company and the city of Battle Creek.

They were joined at the table by consumer advocates, consumers, and health plans; a leadership team with the stakeholders was formed. Eventually, Pathways to Health was under way. But then came the bad news: It did not receive the grant it was anticipating.

“I think that was really an important moment—not getting the grant. They queried the stakeholder group about folding it up or moving ahead with their plans. At that point, they thought [the collaborative] was a good idea—we were making progress,” Clark says. “They decided to move forward and see where we could go.”

“Did we want to be in the front of the steamroller or under the steamroller?” says Mary Ellen Benzik, MD, IHP’s medical director. “Clearly we decided to drive it.”

“I think we’ve always understood that to transform care and make it cheaper, it’s really good for the economics of our community,” Benzik says. “I think we’ve always had in the back of our heads that this is important—the accountability to Battle Creek. We didn’t want the city to die like other cities in Michigan.”

“What’s really cool was hearing employers vocalize the same thing,” Benzik says. “What they’re saying is if you don’t change how much . . . we pay for healthcare in our community, we can’t be sustained as employers. They saw this pathway . . . as the route to economic recovery.”

To get started, the advisory council—made up of insurers and large and small businesses in the city—began meeting. So far, three employers are looking at the use of value-based insurance design: The Kellogg Co., the city of Battle Creek, and the Battle Creek Health System with its own employees.

“The collaborative model basically took the idea of networking and best practices sharing and added a third element to the planning,” says Bill Greer, a compensation consultant for Kellogg. This is the use of value-based insurance design, which focuses on lower deductible rates and coinsurance on services that make a difference in improving employees’ health.

Pathways to Health also has meant moving in other directions that “have just made sense to us,” says Benzik. It has, for instance, emphasized a patient-centered medical home among its many small practices.

“You create the system. You create the kind of work environment that you want to be in—and the kind of relationship you want with your patient and your team while putting a whole community of support around you,” Benzik says. “It’s just fun watching reenergization of providers. It’s fun watching physicians return to the joy of practicing primary care.”

No major changes—such as reducing patient panels—were made in setting up the medical home concept. Emphasis, though, is placed on keeping accurate patient data and putting the PDSA (Plan-Do-Study-Act) process into action to see what is working and what is not. “It’s just been organic—how healthcare can be and should be—but someone keeps putting a name on it,” she quips.

Assisting in the move toward medical homes is a payment structure that rewards improved care. “We created a model that basically defrayed many of their costs of participation,” says Thomas Simmer, MD, a BCBSM senior vice president and chief medical officer.

These physicians are compensated for lost revenue—for instance, the times they go to meetings or receive instruction. They also are “rewarded for their patient improvement and performance along the way,” Simmer says. They could receive up to a 10% increase in their office visit fees—if they achieve the patient-centered medical home designation.

And while the information is preliminary, BCBSM has found that for the three years the patient medical concept was in effect, the hospitalizations “for those conditions that better ambulatory care can prevent” dropped by 40%. “It’s an example of the costs that you want to take out of the system. It’s not rationing care—but simply never getting sick enough to need the care that costs so much,” Simmer says.

The next stage is building “around the primary care foundation” of an ACO that allows the entire system to work effectively between “fragmented parts of the delivery system,” Simmer says. “I suspect that as more definitions develop nationally about what it means to be an ACO, we’re going to be applying those principles in Calhoun County.”


Janice Simmons is senior quality editor for HealthLeaders Media. She may be contacted at jsimmons@healthleadersmedia.com.

Here’s the link to this article and many others just as informative you will enjoy.

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