Nursing Notes

December 22, 2011

Group says El Paso’s nurse-patient ratios inadequate

Here’s an article from the El Paso Times that discusses the differing viewpoints of what is adequate and safe staffing.  When you have sick patients that are totally at your mercy for safety, how can you skimp on the number of nurses assigned to care for them?  It is a shame that this article will get little to no attention because the topic is being put forward by the nursing union and today everyone hates unions, it seems.

This is a timely and interesting article that I hope you will read to the end and leave your thoughts about.  When nurses strike or threaten to strike it most surely will be because of patient care adequacy or patient safety.  Rarely will you find a nurse who says she/he does not make enough money.

——————————————————————————————————————————-

Posted: 12/22/2011 12:00:00 AM MST

El Paso nurses alleged Wednesday that hospitals are jeopardizing patient safety by having inadequate nurse-to-patient ratios.

This is happening with greater frequency, and it has nothing to do with nurse shortages, said members of the National Nurse Organizing Committee (NNOC)-Texas/National Nurses United (NNU).

A group of registered nurses who belong to the organization had a news conference Wednesday across the street from Del Sol Medical Center to bring attention to patient, staffing and pay issues.

The NNOC/NNU said in a statement that nurses have filed 334 formal complaints known as ADOs against Del Sol and Las Palmas Medical Center.

“ADOs (assignments despite objections) are lodged when nurses are given assignments that, in their professional judgment, could affect patient care standards,” the statement said.

El Paso NNOC/NNU members Gloria Givens and Amy Peña said they also are seeking better pay for nurses at Del Sol and Las Palmas, which together employ about 800 registered nurses.

Guidelines for the ideal nurse-patient ratios vary, depending on the level of care required for patients.

The NNOC/NNU members said California is the only state that has codified nurse-patient ratios. Although national guidelines exist, each hospital in the rest of the states sets its own policies and procedures.

“Patient care is our first and absolute priority every day at both Las Palmas and Del Sol Medical Centers,” said Carla Sierra, spokeswoman for the two hospitals.

The allegations made by the National Nurses Organizing Committee (NNOC) about staffing issues at both hospitals are not true. We have been bargaining with the NNOC in good faith, and we will continue to do so in an attempt to reach agreement on a contract.”

At Las Palmas, nurses have complained about inadequate staffing and the treatment of nurses.

“For example, in the neo-natal intensive care unit — where the most critically ill babies are cared for — staffing standards are not consistent with either the hospital’s policy or national guidelines,” the NNOC/NNU statement said. “In the telemetry unit, where adult patients are monitored and cared for — a similar situation exists, where staffing ratios are below standards.”

At Del Sol, NNOC/NNU members said, nurses also have raised concerns with management, at the bargaining table and in individual units, including medicalÐsurgical, cardiac ICU, and telemetry units, about the hospital’s nurses staffing in these units required by the hospital’s own patient classification system.

“The nurses are in negotiations with their respective hospitals, owned by Nashville-based Hospital Corporation of America,” the NNOC/NNU statement said, and added that Hospital Corporation of America continues to rank at the top of the nation’s most profitable hospitals.

Peña said, “This is the time for hospital management to focus on a host of issues related to RN staffing. We have laid out these with detail and towards the goal of a comprehensive policy to ensure patient care standards.”

NNOC/NNU members said they are encouraged by the fact that registered nurses recently concluded a collective-bargaining agreement with an HCA-affiliated hospital in Las Vegas, which incorporates enhanced professional and economic standards.

“The gains we made makes me excited to continue my career in a facility that will really value skilled, experienced nurses,” said Liz Bickle, a registered nurse in the Las Vegas hospital’s progressive care unit.

The HCA Mountainview-Las Vegas contract creates a staffing committee to examine the hospital’s staffing levels. Registered nurses will also receive pay raises of 9 to 19 percent during the contract’s three-year period.

Diana Washington Valdez may be reached at dvaldez@elpasotimes.com; 546-6140.

Enhanced by Zemanta
Advertisements

December 18, 2011

Top 10 Nursing Stories of 2011

Filed under: Nursing — Shirley @ 10:51 am
Tags: ,
An oil lamp, the symbol of nursing in many cou...

Image via Wikipedia

Here’s a round-up of the top 10 nursing stories this year that I found at HealthLeadersMedia.com.  I only posted the first page here, so be sure to click over to see the remaining 2 pages.  I reread all the stories and each one is important and timely, so be sure to click on them too.

——————————————————————————————————————————————–

Rebecca Hendren, for HealthLeaders Media, December 13, 2011

2011 has been a tumultuous year as healthcare organizations come to grips with value-based purchasing, rules for ACOs, meaningful use, and financial upheaval. Nursing has dealt with continued cost cutting while also being expected to lead care delivery transformation, improve patient satisfaction, and reduce healthcare-associated infections.

Here’s a rundown of the most popular nursing stories we covered in 2011 in case you missed them or just want to have another look.

1. Five Reasons Nurses Want to Leave Your Hospital
Are your nurses engaged, committed employees? Or are they biding their time until they can go somewhere better? Mandatory overtime and ignored bad behavior are two issues that have nurses eyeing the exits.

2. Suicide After Medical Error Highlights Importance of Support for Clinicians
A tragic story about the death of a child from a medical error turned even sadder in the spring after the nurse who administered the medication took her own life. The incident served as a grim wake-up call for hospitals and how to deal with clinicians after errors.

3. 5 Ways to Retain New Graduate Nurses
New nurses have a difficult time bridging the gap from nursing school to practice and often don’t stay with their first job for the long term. Hospitals can recognize this transition and help new graduate nurses through the transition with these five strategies that ensure they are engaged, long-term employees.

4. Does Mandating Nurse-Patient Ratios Improve Care?
The debate intensified as more than a dozen states considered laws to establish hospital nurse-to-patient ratios. This article examined whether patients get better care, experience fewer adverse events, and have shorter lengths of stay and lower mortality with ratios…[read more]

 

 

 

 

 

Enhanced by Zemanta

October 27, 2011

Engage Nurses to Raise Your Patient Safety Scores

Filed under: Nursing — Shirley @ 1:13 pm
Tags: , , , , ,

Here is an article about patient safety and who owns the indices.  This article is good, in that it talks about how top-down changes never stick and that you have to involve and empower the hands-on staff if you want to make lasting changes.  That I like.  What I was not too keen on, and I could be way off target here, is it also felt that nurses not taking ownership because of administrations policy and ways of dealing with the problem, was somehow to blame for there still being a problem.

After reading the article, I felt “there’s just another thing to throw on the nurse’s plate” when nurses everywhere are already struggling to stay current and afloat with all the healthcare changes that are in the works.  Nurses just want to nurse.  Period.  Let them do what they became nurses to do and maybe some of these problelms would disappear.  However, you would have to have enough nurses first so that each nurse could actually do the nursing she/he went to school to do.  What a concept!  I’m being sarcastic, in case that does not translate well in print.

Here’s the article from HealthLeadersMedia.com so you can read it and decide for yourself how it makes you think and feel.  Let me know, won’t you?

——————————————————————————————————————————————

Rebecca Hendren, for HealthLeaders Media , October 25, 2011

Who owns the quality measure and patient outcome scores in your hospital? Most hospitals have quality, safety, and infection prevention professionals devoted solely to these statistics and ways to improve them.

All their efforts are meaningless unless nurses and other clinical staff are engaged in the process. Too often, they are not. Most staff nurses don’t know what value-based purchasing is or why they should care about it. All they know is that when Administration or “Quality” has a new scheme it will take nurses more time to do their jobs.

Nurses may fully support the changes because they will benefit patients, but they don’t own them and they don’t own those scores.

As the people who actually touch patients, all members of the nursing staff need to feel directly responsible for patient safety. Quality improvement becomes one more meaningless directive from “above” unless nurses feel engaged in the process, involved in the plans, and accountable for the results.

“Culture eats strategy for lunch,” says Mary J. Voutt-Goos, MSN, RN, CCRN, director, Patient Safety Initiatives and Clinical Care Design at Henry Ford Health System in Detroit. “If frontline staff aren’t in agreement and actively engaged in the process, it won’t happen. Top-down approaches to culture change are typically unsuccessful.”

This is one reason why scores can start creeping downward after a successful quality improvement effort has come and gone. If nurses aren’t engaged in the process, they have less inclination to remain on a directed path.

“All frontline staff, not just nurses, should be engaged, as well as empowered to act, if we really want to see a change in our culture of safety,” says Voutt-Goos.

One way to build a feeling of accountability in nurses is to empower them to solve the problems themselves—in conjunction with quality and patient safety professionals, of course. New procedures or processes are more likely to be met with acceptance and to become part of everyday practice when the caregivers themselves are involved in the design.

At Henry Ford Health System, the organization studied aviation industry principles of safety cultures and safety climate literature and identified global indicators of safety culture.

“We use these global indicators as a guiding framework for our culture of safety efforts,” said  Voutt-Goos. “One of the global indicators is employee empowerment.”

Empowering employees involves giving them a level of responsibility and knowledge, which sometimes they may not want, but is vital to achieving an end result of quality patient care in a financially healthy organization.

One common practice to reduce outcomes-related to issues such as patient falls or CAUTIs is to pit units against each other in competition and reward the winner with a pizza or ice cream. While it’s appropriate to celebrate success and recognize hard work, I think it’s a mistake to rely too heavily on competition.

Rewarding the unit that most improves its customer satisfaction scores or reduces patient falls by the greatest percentage is great at building enthusiasm and recognizing hard work, but it’s not an effective long-term strategy. Nurses should be treated like adults and involved in the imperatives behind process improvement, both those related to patient care and those related to the organization’s bottom line.

Just as the hospital should treat nurses as adults, nursing staff should be more interested in quality outcomes. They must seek out and embrace their level of ownership in these metrics. In today’s financial reality, it is no longer acceptable to not take an active role in quality improvement efforts. Organizations should engage nurses in frank and honest communication.

The financial imperative is such that hospitals can’t afford…[read more]

Enhanced by Zemanta

October 12, 2011

Governor Signs Healthcare Law to Save Backs and Bucks

Service Employees International Union

Image via Wikipedia

Here is an article about the new law in California to protect both patient and nurses from lifting injuries.  California has always been in the forefront of the public fight to protect both parties and improve nursing care for all patients.  Patient safety is the number one issue for all nurses; sometimes to our own detriment.  We, as a group, have the highest incidence of musculo-skeletal injuries.  We need some help, too.

This law that was just signed by the Governor is a good first step.  We can hope that the rest of the nation will follow suit; but that is not guaranteed–see the battle ongoing over nurse-to-patient ratios all over the country.

This is an article by the SEIU in California.

___________________________________________________________________________

Posted by Michael Cox, 916-799-6784 on October 7, 2011

AB 1136 will help prevent workplace injuries among hospital workers

Sacramento, CA – Today Governor Brown signed landmark Safe Patient Handling legislation (AB 1136) to prevent a staggering epidemic of workplace injuries among hospital workers while improving patient care.

“The SEIU nurses here in California have long recognized the need for safe patient handling legislation and this was the year to finally get that accomplished,” said Ingela Dahlgren, RN, the Executive Director of the SEIU Nurse Alliance of California. “Too many of our nurses and other healthcare workers have been injured on the job while moving or repositioning the patients in their care.”

Due to excessive unnecessary manual patient lifting and transfers, healthcare workers experience some of the nation’s highest rates of disabling neck, back, and shoulder injuries. However for more than a decade, mechanical lifting and transfer devices have proven to be remarkably effective in reducing these injuries while reducing serious patient skin tears and patients being dropped.

“There isn’t a nurse that I’ve met that doesn’t have a story of experiencing an injury while caring for a patient that took them off work either temporarily or permanently or at the very least isn’t dealing with chronic pain in their back, neck or shoulders,” said Dahlgren. “With this important legislation, not only will our patients be provided safer care, but hospitals will have the guidelines to better protect their employees and prevent career ending injuries.”

California nurses and healthcare workers have always lead the charge for safer working conditions and patient care, whether through Nurse-to-Patient ratios, safer needle legislation or Airborne Transmissible Disease Standards, and now Safe Patient Handling isn’t just a hope, it’s a reality.

The nation’s first Safe Patient Handling law requiring the purchase of safe patient handling equipment and training programs was passed in Washington State in 2006. As a result of the implementation of this law, a January 2011 study found that neck, back and shoulder injuries to hospital workers caused by manual patient handling have decreased by more than one third.1

California now joins Washington State and a half dozen other states where SEIU members have succeeded in passing Safe Patient Handling state laws. SEIU is continuing to work with legislators in other states to pass more Safe Patient Handling laws while pursuing passage of a federal law.

Enhanced by Zemanta

October 5, 2011

Nurses Don’t Want To Be Doctors

Here is an interesting article about the discord between nurses with graduate degrees and physicians.  This is a “hot topic” right now as the ANA encourages more and more nurses to pursue higher education as a means of advancing the practice of nursing.
Physicians have a point, I guess.  But mostly I think that they have missed the point. Nurses do not want to BE physicians, they want to be nurses.  But they want to be the best nurses they can be.  Receiving your doctorate in nursing only means that you value the profession and you want to pass on to your patients the benefit of you learning.  Nurses are much more global thinkers than physicians.  We are trained to look at the whole picture and then figure out the way the symptoms are affecting the persons health.  Doctors are symptom driven and deal with specifics.  Have you ever gone to the doctor with a complaint of, “I just don’t feel right” and gotten a concerned and interested response.  The usual response would be to send you for a million tests to rule out things.  Nurses will get inquisitive and ask lots and lots of personal questions until they have an “ah-ha” moment.
This article is from HealthLeadersmedia, which I have used before.  I really love this site and hope that you will click over to finish reading this great article.  Leave us both a comment about your take on this issue, won’t you?
————————————————————————————————————————————–
Rebecca Hendren, for HealthLeaders Media, October 4, 2011

As a child addressing thank you notes for birthday gifts, I was perplexed by the one relative whose address began “Dr. and Mrs. John Doe.” I knew he was not a Doctor and yet he was called doctor. My mother explained he was a doctor, but not a “Doctor,” and you can imagine the emphasis on the second doctor.

This was my first introduction to the confusing world of honorifics and it hasn’t become any simpler since.

We all know that the title “doctor” refers both to physicians with medical degrees and to people who have been awarded a doctorate in a certain subject. These days patients often visit “the doctor” and are seen by a nurse who has an advanced practice degree and whose title includes the right to use the honorific term doctor.

Physician groups have been voicing concerns that the growing numbers of nurses who are also doctors are confusing for patients. Nurses are concerned that advanced practice professionals who have received doctorates in their field are afforded the proper respect and receive the designation that advanced study and knowledge is usually afforded in other fields.

Patients are left in the middle. Most patients grasp the differences between a physician and a nurse practitioner (or a physician assistant). Where many patients become confused is when the advanced practice nurse is referred to as doctor. As in, “Hello Mr. Green, I’m your nurse, Dr. Blue.”

Nurse practitioners who use the title with patients in care settings makes some physicians apoplectic. Their reaction leaves advanced practice nurses fuming. It leaves me perplexed. Why would any nurse want patients to think he or she was a medical doctor?

Nurses don’t want to be doctors. Advanced practice nurses could have chosen medical school if they wanted to become doctors. Instead, they chose to expand their study of nursing through advanced practice programs such as anesthesia, nurse practitioners, or the rapidly expanding doctorate in nursing practice.

Choosing further study in the nursing profession is a commitment to the nursing model, which emphasizes holistic patient care. Nurses approach their profession in a very different manner than physicians approach theirs and both are valuable and necessary to the overall provision of care in this country. Indeed, given the physician shortage, particularly in rural areas, the only way to meet the country’s needs for primary care is through advanced practice nurses.

So advanced practice nurses are necessary, vital, and supported by the public. Study after study has shown equal, or in some cases better, outcomes in patient care from advanced practice nurses. A study in the northwest last year revealed patients found nurse practitioner care just as good as physician care and the nurse…[read more]

Enhanced by Zemanta

September 1, 2011

Nurse Staffing Costs Must Be Weighed Against Cost of Errors

Hospital

Here is an article that talks about staffing…again.  This article, however, is written from the administrator’s vantage point and is remarkable in what it states.  Nurses are necessary!  Nurses can affect the hospital’s bottom-line in either a good way or a bad way.  She also goes on to state that “a-nurse-is-not-a-nurse” which seems to be how most people think of nurses.  We are not all alike and my experience is of no use to me if I am sent to work in ER.  Hospitals should value nurses and plan to utilize nursing staff appropriately if they want to see improved patient satisfaction, decreased errors, and less turnover.  Overall, a very good article.  Please do visit the original site where you can find many other fine articles that apply to nursing today.

____________________________________________________________________________

Rebecca Hendren, for HealthLeaders Media , August 30, 2011

When revenues fall, hospitals stop investing in the biggest budget expense: nurses. That’s a bad short-term solution to a long-term problem. It’s time we change the way we think about hospital staffing.

“When we look at all the problems we have [in healthcare right now], what is the first thing we do? Start slashing nurses,” says Kathy Douglas, MHA, RN, president of the Institute for Staffing Excellence and Innovation, CNO of API Healthcare, and a board member of the journal Nursing Economic$, which has devoted a whole issue to examining the evidence around nurse staffing.

“Healthcare executives and nurse leaders need to be more aware of thinking about staffing and scheduling from a bigger perspective so we understand all of the financial implications,” she says. “How do we manage our way effectively through the maze and chaos we are in right now?”

To deal with ongoing challenges presented by value-based purchasing and healthcare reform, executives must acquaint themselves with studies demonstrating how nurse staffing affects a hospital’s overall performance and base staffing decisions on evidence.

“What we know from research and experience is that there are very direct links between staffing and length of stay, patient mortality, readmissions, adverse events, fatigue-related errors, patient satisfaction, employee satisfaction, and turnover,” says Douglas. “All of these things have studies that directly relate them to staffing. And all have the potential for significant costs. When we don’t look at the relationship between our LOS and our unreimbursed never events and our staffing, we’re not looking at the whole picture.”

Too few hospitals track staffing data in comparison to these big issues.

“Some of these things people might call ‘soft costs,’ like nurse turnover,” says Douglas. “But to me, money is money.”

Soft costs have hard financial implications. Value-based purchasing has already put real money behind patient satisfaction. To make the link to staffing research and why it matters, we have to stop looking at staffing numbers in isolation. Until we look at the whole picture, which includes everything associated with staffing, we’re not going to understand financial performance.

“Staffing costs sit in one part of the budget, so we think of the results there,” says Douglas. “Then the cost of errors sits in another part of the budget. If I could say one thing to healthcare executives it is to make staffing a top strategic priority in your organization. If you look at top priorities—LOS, safety, quality—all of these things have direct links to staffing.”

An organization that has cut back on staffing may not notice that it is overusing overtime and not notice that there’s a relationship between the overtime and the number of infections on a unit.

Peter I. Buerhaus, PhD, RN, FAAN, chair of the National Health Care Workforce Commission, a 15-member panel composed of distinguished leaders from academia and the healthcare industry created under The Patient Protection and Affordable Care Act, published research in 2008 looking at unreimbursed errors in healthcare, such as catheter-associated urinary tract infections and central line infections.

“I decided to get out my calculator and add them up. When I looked at it in one year the total came to $21 billion in unreimbursable events,” says Douglas.

“When hospital executives tell me there’s not enough money to staff well, my first thought is ‘what about the $21 billion we spend each year on unreimbursed never events?'”

Douglas believes the answers lie in using data and evidence to make effective decisions and utilizing technology in decision making. She is not a fan of blanket ratios.

“It’s not that ratios are bad in and of themselves. Ratios happened, in my opinion, because hospital leadership and nursing weren’t communicating well,” she says. “My issue with ratios is that it assumes [staffing] is about a number. I disagree with that. It’s not about a number. It’s about the right number with the right qualifications with the right competencies with the right experiences.”

Douglas says hospitals need to be free to examine all the factor…[read the rest of this article]

Enhanced by Zemanta

August 11, 2011

5 Reasons Nurses Want to Leave Your Hospital

Here is a really good article from HealthLeaders Media.  I frequently find great articles on this site, so I do encourage you to visit there and look for yourself.  After reading this article, I felt that my thoughts had been broadcasted out into the internet.  This article discusses the comments and thoughts of all the nurses I have ever worked with as well as my own thoughts.  I would like to add a 6th reason for a nurse to be looking to leave a hospital and that is personal safety.  If the facility does not think enough of its nurses to protect them from random attacks, it is definitely time to leave.

Please read this article and come back here to let me know what you think.  I love a good discussion, don’t you?

_____________________________________________________________________________

Rebecca Hendren, for HealthLeaders Media, August 9, 2011

Your nurses have one eye on the door if you do any of the following.

Although economic woes abound, nurses are planning their exit strategies and will make a move when things improve. A recent survey from healthcare recruiters AMN Healthcare found that one-quarter of the 1,002 registered nurses surveyed say they will look for a new place to work as the economy recovers.

Are your nurses engaged, committed employees? Or are they biding their time until they can go somewhere better? To predict whether you face an exodus, take a look at the following five reasons why your nurses want out.

1. Mandatory overtime

Nurses work 12-hour shifts that always end up longer than 12 hours due to paperwork and proper handoffs. At the end, they are physically, mentally, and emotionally exhausted. Forcing them to stay longer is as bad for morale as it is for patient safety.

Some overtime is acceptable. People get sick, take vacations, or have unexpected car trouble and holes in the shift must be filled to ensure safe staffing. Nurses are used to picking up the slack, taking overtime, and pitching in. In fact, overtime is an expected and appreciated part of being a nurse. Many use it to help make ends meet. Mandatory overtime, however, is a different matter. Routinely understaffed units that rely on mandatory overtime as the only way to provide safe patient care destroy motivation and morale.

Take a look at the last couple of years’ news stories about RN picket lines. Most include complaints about mandatory overtime.

2. Floating nurses to other units

One nurse is not the same as another. Plugging a hole in a geriatric med-surg unit by bringing in a nurse from the pediatric floor results in an experienced, competent nurse suddenly becoming an unskilled newbie. A quick orientation won’t solve those problems. Forced floating is usually indicative of larger staffing problems, but even so, its routine use is dissatisfying and compromises patient safety.

Instead, create a dedicated float pool staffed by nurses who volunteer and who can be prepared and cross-trained. Institute float pool guidelines that nurses float to like units. For example, critical care nurses find a step-down unit an easier transition than pediatrics.

Float pool shifts open up options for nurses who need more flexibility and offering a higher rate means you’ll never be short of volunteers.

3. Non-nursing tasks

Nurses are already understaffed and overworked. Hospitals with too few assistants rub salt on the wounds. RNs shouldn’t have to take time from critical patient care activities to clean a room or collect supplies. Gary Sculli, RN, MSN, ATP, patient safety expert and crew resource management author, offers a vivid analogy. Imagine if half way through a flight you saw the pilot come down the aisle handing out drinks because the plane was short staffed. It just wouldn’t happen.

Yes, cleaning a room is important, but don’t force nurses’ attention away from their patients. Distractions are dangerous and compromise patient safety…[read the rest]

 

Enhanced by Zemanta

July 12, 2011

Documentation, anyone?

Filed under: Nursing — Shirley @ 7:48 pm
Tags: , , , , , , ,

Here is an email I received that I thought was interesting

enough to post here.  I received it from the Nursing Center

e-News.  Feel free to check them out and get yourself added

to the email list.  I frequently get really good information and alerts from this source.

_____________________________________________________________________________

Inaccurate or incomplete documentation can lead to serious legal trouble. I’d like to share the following “red flags” to avoid in your documentation. These are from Stay Out Of Court With Proper Documentation in the April issue of Nursing2011.

Avoid the following in your documentation:

Read more about legal issues by exploring the articles in More Resources. You can also browse recent issues of JONA’s Healthcare Law, Ethics, and Regulation.

Our next issue will focus on hypertension and will include a new selection of CEs and articles. Be sure to check it out!


Lisa Bonsall, MSN, RN, CRNP
Clinical Edito
r

Enhanced by Zemanta

July 1, 2011

Patient Classification Systems Address Nurse Staffing Balance

Here is an interesting article from Health Leaders Media that I found.  I have read this article several times, because I am impressed with the information it contains.  It is not often that you come across an article that actually gives nurses and nursing in general any credit for lowering bottom line costs and increasing productivity, while improving customer satisfaction.

As a nurse who has worked in the Sharp system as a travel nurse, I can say that their use of electronic staffing equipment far and away leads the nation.  The nurses working for this system really are satisfied and relatively happy with their current employment.  There is the ordinary stress-related bickering, but if asked, these nurses will mostly tell you that they like where they work.  That is a far cry from the responses I have gotten at other hospitals.

Please read this article and then let me know what you think.  Visit the original site, too, because there are many wonderful nursing articles available there.

______________________________________________________________________________

Susan Stone, PhD, RN, and Ruth Plumb, MSN, RN, for HealthLeaders Media , May 24, 2011
Determined to achieve meaningful use of electronic health records (EHR), hospitals and health systems will increasingly adopt clinical information technology between now and 2015. This is certainly a welcome development for our economy and patient health. However, because providers are putting larger investments into EHR systems, they are overlooking other strategies to quickly enhance clinical and financial performance and support their pending transformation to accountable care.

While EHR technology is key to reducing costs and improving care quality, safety, and outcomes, providers also can achieve these goals by leveraging patient classification software and managing nursing staff more effectively. When used in parallel or integrated with an EHR, these combined resources give organizations extra tools to realize even greater clinical and financial benefits. This is a lesson that San Diego-based Sharp HealthCare has learned and benefited from over the past two decades.

Since 1990, Sharp HealthCare has used a nursing staff management solution to assign nursing staff and resources appropriately, improve care, and manage RN labor costs and department budgets. Every hospital faces these common challenges, but addressing them successfully is especially difficult for California-based providers struggling to survive the Golden State’s unique and pervasive capitated environment.

Though health systems in other states have not been exposed to capitation, this will change soon with the Patient Protection and Affordable Care Act allowing the Centers for Medicare & Medicaid Services (CMS) in early 2012 to use payment models such as partial capitation. Under this particular model, providers and accountable care organizations will bear some but not all of the financial risk.

In addition to helping organizations better manage their bottom line in a risk-based reimbursement environment, a patient classification system makes it easier for hospitals to comply with nurse-to-patient ratio regulations. Fifteen states and the District of Columbia have passed nurse staffing legislation, according to the American Nurses Association. But with hospitals admitting a higher volume of sicker patients and cutting nursing budgets across the country, RNs and others are increasingly urging lawmakers in other states to pass laws to ensure sufficient staffing to meet patients’ needs.

Having the right skill mix and nurses with the necessary skills readily available to take care of the right patient at the right time is essential to quality of care, patient safety and financial health. Still, it is common for nurses, unions, and state regulators to question hospitals’ staffing level decisions. An intensive care unit RN, for instance, may contend that a patient’s acuity demands his or her sole attention or the services of an additional nurse. This questioning or complaint about inadequate staffing, which tends to increase when facilities institute layoffs in poor economic times, is often emotional.

A patient classification system enables hospitals to remove emotion from the equation by demonstrating through hard data that its decisions are valid, not arbitrary. The tool applies an evidence-based approach to assign, match, and schedule nurses where they are needed the most based on patient acuity level.

Institutions that use the technology to assess acuity on every shift across all patient care units are able to provide objective documentation showing they are not understaffed, which of course places patients at risk. This proactive assessment of patient acuity helps ensure business continuity when regular charge nurses are out sick or on vacation. Replacements typically are less familiar with a unit’s policies and procedures, which can result in poor patient outcomes and higher costs.

A patient classification system promotes operational consistency by offering data on fill-ins that can be used to run a department efficiently in the absence of the regular charge nurse. More importantly, the process of assessing acuity on every shift gives health systems the ability to act immediately to prevent understaffing and overstaffing, both of which result in higher costs from potential malpractice lawsuits, disputes with employees, lost productivity and overtime.

Lack of awareness among many nurses about the budget process, healthcare financial management principles and how assignments are determined is a major reason for those costs. When bedside RNs are unaware of the financial role they play in managing and determining the fiscal health of their employer, nurses and administrators are pitted against each other.

To eliminate damaging infighting and wasteful spending, Sharp HealthCare, which serves 1.3 million residents of San Diego County in southwest California, has made it a priority to educate nurses how to use the patient classification system to analyze, track, and monitor staffing, productivity, and nursing budgets. Its leaders discuss the critical role that technology, patient acuity, and appropriate nurse assignments play. Every Sharp HealthCare facility shares annual financial targets and justifies its department budget. Hospital executives and RN leadership emphasize that their budget development is comparable to how RNs manage their household finances. In other words, the health system deploys the funds it has to provide care in the most efficient and cost effective manner possible. Like nurses—or anyone else—Sharp HealthCare cannot spend money it does not have.

Today, RNs understand staffing decisions are based on patients’ best interests as opposed to driven by an effort to save money at the expense of quality care. The results are fewer misunderstandings, misconceptions, and conflicts that distract Sharp HealthCare hospitals and nurses from their core clinical mission.

Sharp HealthCare sets goals for facilities partly based on the location and the size of an institution’s nursing staff. As a not for profit healthcare system, the organization’s long-term viability is dependent on its financial health and well being.

Increased nurse awareness and the nurse staffing management system have helped Sharp HealthCare not only weather a weak economy for the past three years, but also post impressive financial results during the same period.

The outreach also gives nurses a clearer view of the economic picture at the facility and enterprise levels, and how their institution compares to local and national peers. Whenever a financial variance occurs in their unit, RNs now can easily pinpoint it and determine the reason why. The software enables Sharp Healthcare to:

  • Deliver accurate patient acuity, skill mix, and census data in real time, ensuring charge nurses and nursing managers have the information necessary to optimize clinical and financial outcomes
  •  Analyze retrospectively whether nursing assignments were a factor in near misses that harmed or placed patients at risk
  • Aggregate information to enhance clinical, financial, and operational decision-making
  • Benchmark internal evidence-based data against national standards for acuity
  • Develop and successfully manage nursing budgets

To further increase time savings for nurses and validity and reliability of data, Sharp HealthCare now is working to integrate the software with its EHR.

With health reform altering reimbursement models and the first of 78 million baby boomers beginning to turn 65 years of age in 2011, staffing, clinical, and financial pressures on providers will only intensify. Since RN labor costs represent providers’ single largest controllable expense and a significant percentage of their operating budget, it is critical to use nursing resources more efficiently and enlist RNs as strategic assets and financially oriented managers. Providers following this path will find it easier to navigate the rapidly changing healthcare ecosystem and meet their goals.


Susan Stone, PhD, RN, is chief nursing officer and Ruth Plumb, MSN, RN, is an acuity nurse specialist at Sharp HealthCare, which comprises four acute care and three specialty hospitals in southwest California.

Enhanced by Zemanta

June 13, 2011

Inglis: Efficiency can make health care better and cheaper

Kathleen Sebelius

Image via Wikipedia

Here is an article that ran in our Austin Statesman and was contributed by Toni Ingles, RN.  She is a very funny lady that I have emailed back and forth before and I am proud to list her among my associates and friends.  The article is about the visit of Health and Human Services Secretary Kathleen Sebelius to the Seton Hospitals to see the innovation and changes made by nurses that impact the bottom line.

While this article lacks the humor I have come to associate with Toni’s work, it is still right on target which is also her trademark.  I am proud to be a Seton nurse and I would like to share here some of our successes.

_____________________________________________________________________________

Toni Inglis, Regular Contributor

Published: 7:14 p.m. Tuesday, May 10, 2011

There’s a little history leading up to Health and Human Services Secretary Kathleen Sebelius’ visit to Austin last week. It began in 1999, the year that health care across America woke up.

Sebelius’ visit coincided with the 12th anniversary of a report by the Institute of Medicine that upward of 100,000 people die in any given year from medical errors in hospitals. As if the 1999 data weren’t bad enough, a prestigious study published last month indicated that the number might be 10 times that much, with one-third of patients incurring illness or injury while in the hospital.

The Centers for Medicare & Medicaid Services’ stark, dark data show that the agency spent $4.4 billion in 2009 on care for patients harmed in hospitals and another $26 billion on patients who were readmitted within 30 days.

Enter the Patient Protection and Affordable Care Act. Its cumbersome name denotes what it is intended to do — protect patients, hold providers accountable and make health care affordable. The law intentionally left the job of cutting costs to the professional clinicians in the field.

The first year focused on insurance company reform. The second year zeroes in on clinical practice. That’s where the talents of President Barack Obama’s pick to head CMS, Dr. Donald Berwick, come in.

Berwick founded the Institute for Healthcare Improvement and over two decades enlisted thousands of hospitals worldwide to test and identify best practices for patient safety and to ensure their broadest possible adoption.

Sebelius has visited several sites that adopted Berwick’s model. She visited a hospital in Seattle for preventing patient falls and bed sores and a community in Ohio for preventing infection in children.

She visited ICUs in Michigan that used a simple checklist famously chronicled in “The Checklist Manifesto” written by a cancer surgeon at Johns Hopkins, Atul Gawande. Given the enormous potential for human error in such complex care, adopting a checklist including the simplest things like hand washing and donning sterile gloves, turned out to be enormously effective. In the first year, the Michigan hospitals reduced infections by two-thirds, saving 1,500 lives.

Sebelius came to Austin to learn about the Seton Family of Hospitals’ successes in patient safety. She learned of the nurse-led initiative that virtually eliminated bed sores, ranking Seton first internationally. She learned how major reductions in infections were achieved. She learned how University Medical Center Brackenridge achieves the national standard of restoring circulation in 90 minutes after an acute heart attack — 100 percent of the time.

The biggest draw for Sebelius, however, was to see how Seton dropped its birth injury rate to zero. Partnering with IHI, Seton nurses and doctors developed a bundling of best practices for obstetricians: no elective induced births before 39 weeks gestation and limited use of the drug oxytocin to shorten labor and of vacuum extraction of the baby.

Of interest to Sebelius was the saving in government spending by preventing birth trauma. In 2003, when the safety initiative began, Seton billed Medicaid $500,000. In 2009, Medicaid was not billed at all.

During her visit, Sebelius introduced Partnership for Patients, an initiative begun last month with Berwick’s design. The $1 billion government investment targets hospitals to help them learn about and implement proven methods to improve care. The partnership is expected to avoid millions of unnecessary medical injuries and complications and thousands of deaths. It is also expected to reduce Medicare costs by $50 billion over the next decade.

Her visit also coincided with the release of a federal rule to take effect in 2013. It will reward better-performing hospitals with commensurately higher incentive payments. Government will reverse economic incentives from quantity to quality of care.

Berwick, a recess appointment, might not be long for public office. He has been a target of political criticism and is not expected to win Senate confirmation to remain in his seat past 2011. Hopefully, his legacy of innovation for patient safety will continue. Through public office, his model to change the way health care is delivered represents the government’s first serious attempt to address patient safety.

Given the number of deaths, health care needs to view itself as an industry just as complex and high-risk as the airline and nuclear energy industries — both of which use checklists.

If corporations producing commodities like TVs, microwaves and cars can make better products and save money by eliminating waste and increasing efficiency, so can health care. Most Americans can afford a TV, but no uninsured American can afford health care.

Inglis is a neonatal intensive care nurse at the Seton Family of Hospitals and editor of ‘Seton Nursing News.’

 

 

 

 

Enhanced by Zemanta
Next Page »