Nursing Notes

December 26, 2011

Please thank your nurse this Christmas

Filed under: Nursing — Shirley @ 11:41 am
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Here’s an article that I found on CNN that I hope you will enjoy.  Christmas is one time of the year when nurses have to sacrifice time with family to care for patients.  It’s nice to see in print that someone, somewhere notices. 

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

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

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

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

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

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

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

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

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December 10, 2011

A growing number of registered nurses in California, U.S.

Filed under: Nursing — Shirley @ 8:17 pm
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Here’s an article from the Los Angeles Times that I found very interesting.  At first I read this thinking, “Great, a good article about nursing for a change.”  Then I reread the article and had a change of heart.  It seems that California, a state with a legally mandated nurse-to-patient ratio, is seeing more growth in the nursing field than any other state.  Imagine that–hmmm, I wonder why that might be?

Then the Rand Corporation goes public to announce THE END OF THE NURSING SHORTAGE is at hand!  But not until 2030.  Isn’t next year 2012?  Sounds like a lengthy shortage to me.

Then, this article talks about a Cardiac nurse, a Nurse Practitioner, and a Research nurse who wants to be a Nurse Practitioner.  Where are the lowly bedside nurses?  Why are we never consulted or included in these events?

I think I must be extremely biased, but you read the article and make your own conclusions.  Let me know what you think of this article, won’t you?  Maybe I am way off track, but I don’t think so.

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If the trend continues, say researchers at the Rand Corp., there may be enough nurses by 2030 to meet the projected needs of aging baby boomers and the expansion of the healthcare system.

By Anna Gorman, Los Angeles TimesDecember 6, 2011

Lauren Mills’ counselor in college pushed her to consider nursing. She heeded the advice, graduated from Cal State Long Beach in 2007 and now works with cardiac patients at an Orange County hospital. It’s proved a challenging and gratifying choice, said Mills, now 27.

“You are using your brain and in a way you are using your heart too,” she said. “You feel good when you go home. You feel you made a difference.”

Increasing numbers of women like Mills are helping swell the ranks of registered nurses, easing chronic shortages in both California and the nation, according to a study released Monday by the Rand Corp.

Nationwide, the number of registered nurses ages 23 to 26 grew from 102,000 in 2002 to 165,000 in 2009, according to the study. The current cohort of young nurses is expected to be the largest ever, the study said.

If the trend continues, there may be enough nurses by 2030 to meet the projected needs of aging baby boomers and the expansion of the healthcare system, researchers said.

“Compared to where nursing supply was just a few years ago, the change is incredible,” said David Auerbach, lead author of the study. “If it keeps going, it turns everything on its head and it’s a major revolution.”

California has seen an even more dramatic rise in the number of new nurses, said Joanne Spetz, a professor at the Institute for Health Policy Studies at UC San Francisco. “We are seeing a lot of young people entering the field, which is fabulous. These are the people we need to be moving into the nursing workforce.”

More than 11,500 people graduated from California nursing schools in 2010, up from 5,300 in 2002, according to a report Spetz did for the California Board of Registered Nursing. Much of that is due to a concerted effort by hospitals, foundations and policymakers to expand nursing school slots, she said.

Researchers previously predicted that the U.S. could be short as many as 400,000 registered nurses by 2020. In California, experts believed that the state could see a shortage of about 89,000 by 2030…[read more]

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October 27, 2011

Engage Nurses to Raise Your Patient Safety Scores

Filed under: Nursing — Shirley @ 1:13 pm
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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?

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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]

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October 14, 2011

More Friday Videos

Filed under: Nursing — Shirley @ 5:03 am
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Once again, it’s video time. Watch these videos about nursing school, tips for surviving nursing school, and finally what kind of salary you can expect as a nurse. These are all worthwhile videos I hope you enjoy.
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October 12, 2011

Governor Signs Healthcare Law to Save Backs and Bucks

Service Employees International Union

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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.

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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.

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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?
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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]

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September 30, 2011

Friday Videos

Filed under: Nursing — Shirley @ 4:09 am
Tags: , , , , ,

Let’s watch movies!!

This is about Men in Nursing:

Here’s why you go into nursing:

This is about clinic nursing in the Air Force:

And finally, some humor:

September 28, 2011

Nurses and Pandemic Outbreaks

The bombed remains of automobiles with the bom...

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This will be a different type of post than I usually do.  I don’t have a specific article to post and editorialize today.  Instead, I want to talk about a movie.  I went to see Contagion the other day and, although it is a good movie, there were two different scenes in the movie that really made me upset.  Now, you would figure that a movie about a disease that kills 20% of the Earth’s population would be enough to make me angry, but that wasn’t what did it.

During this movie, there are two separate scenes where nurses are trashed.  You don’t see nurses tending to any of the sick because, “They have all gone on strike because there are no protocols for dealing with this.”

You see doctors tending patients, you see nuns tending patients, you see scientists tending patients.  It seems that everybody wants to be a nurse except the nurses–in this movie.

I was so incensed after the movie that I went right home and Googled for hours and hours to find facts and information about the role of nurses in pandemic outbreaks, about the role of nurses in capturing information regarding pandemics, about the dilemma of nurses during pandemics.

What I found was this.  First, check the Code of Ethics with the state board of nursing.  It seems that nurses have a responsibility to educate, to collect data, to identify problem areas, and to meet any National Health Objectives set forth.

Nurses encounter personal risk when providing care for those with known or unknown communicable or infectious disease.  However, disasters and communicable disease outbreaks call for extraordinary effort from all health personnel, including registered nurses.

So, why then did this movie portray nurses as being unwilling to provide care?  That is really the question isn’t it?  Twice they made a point of saying that there were no nurses to provide care to the sick because the nurses would not come to work (they were on strike).

I don’t know about you, but this was very distressing to me personally and professionally.  I don’t know of any nurse who would purposefully ignore a sick or dying patient.  Nurses frequently are first responders in disasters and in accidents along our nations highways.

I lived in OKC at the time of the bombing.  I know what the nurses working downtown did.  I know first hand how they all as a group responded.  Not one nurse said, “I can’t help because there is no protocol for dealing with this disaster.”  Nurses were there helping the injured, collecting body parts, combing the ruins of the Murrah building for survivors.

Let me know what you think about this, if you can.  I am very upset still and I wanted to get some feedback from other nurses out in the world.

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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.

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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]

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August 24, 2011

Seventeen Percent of Cancer Nurses Unintentionally Exposed to Chemotherapy, Study Finds

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Here is an interesting article from Science Daily about nurses’ exposure to chemotherapeutic agents.  What I love about the articles I find at Science Daily is the exposure you get to new and exciting scientific data.  The information is usually the early results of formal investigations, but it is interesting to get this glimpse into the workings of the medical, environmental, psychological, biological, and anthropological scientist’s minds.

With that in mind, I present this article about the cost to nurses who are routinely exposed to chemotherapy.  This is probably going to turn into the next big push for safety in the nursing field, so it is pertinent to discuss here.  Please read this article and visit the original site for others similar; then come back here and let’s discuss.

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ScienceDaily (Aug. 23, 2011) — Nearly 17 percent of nurses who work in outpatient chemotherapy infusion centers reported being exposed on their skin or eyes to the toxic drugs they deliver, according to a new study from the University of Michigan Comprehensive Cancer Center.

The study surveyed 1,339 oncology nurses from one state who did not work in inpatient hospital units. About 84 percent of chemotherapy is delivered in outpatient settings, largely by nurses. Results appear online in the journal BMJ Quality and Safety.

“Any unintentional exposure to the skin or eyes could be just as dangerous as a needle stick,” says lead study author Christopher Friese, R.N., Ph.D., assistant professor at the U-M School of Nursing.

“We have minimized needle stick incidents so that they are rare events that elicit a robust response from administrators. Nurses go immediately for evaluation and prophylactic treatment. But we don’t have that with chemotherapy exposure,” Friese says.

Safety guidelines for chemotherapy drug administration have been issued by organizations such as the National Institute for Occupational Safety and Health. But these guidelines are not mandatory. Guidelines include recommendations for using gowns, gloves and other protective gear when handling chemotherapy drugs.

The U-M Comprehensive Cancer Center adheres to these safety guidelines and has procedures in place to implement and enforce them for all staff who administer chemotherapy drugs. U-M nurses did not participate in this study.

The study authors found that practices that had more staffing and resources reported fewer exposures. Also, practices in which two or more nurses were required to verify chemotherapy orders — part of the suggested guidelines — had fewer exposures.

“This research shows that paying attention to the workload, the health of an organization, and the quality of working conditions pays off. It’s not just about job satisfaction — it’s likely to lower the risk of these occupational hazards,” Friese says.

Unlike needle sticks where a specific virus is involved and preventive treatments can be given, it’s more difficult to link chemotherapy exposure to a direct health effect. That makes it more difficult for health care systems to respond to these incidents. Unintentional chemotherapy exposure can affect the nervous system, impair the reproductive system and confer a future risk of blood cancers.

Friese collaborated in this study with the U-M School of Nursing’s Occupational Health Nursing Program, which focuses on training nurses to promote injury prevention and protect against work-related injuries and environmental hazards on the job. By combining this practical occupational health perspective with the expertise of quality and safety researchers, the team hopes to better understand what happens during chemotherapy exposure and what can be done in the work place to prevent it.

“If we ensure patient safety, we should also ensure employee safety by strictly adhering to the national safety guidelines…[read more]

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