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ANA comes out against latest GOP healthcare proposal

In a statement released today, the American Nurses Association (ANA) said that the organization “adamantly opposes” the Graham-Cassidy healthcare proposal being considered in the Senate.

The ANA expressed major concerns about the Senate’s proposal, saying that it would make severe cuts to Medicaid, erode protections for pre-existing conditions and other essential health benefits, and wipe out subsidies for the purchase of private health coverage.

ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, gave the following statement: “ANA denounces the latest Senate proposal as its worst yet. This proposal limits care for those that need it most and fuels greater uncertainty in the insurance market. It poses a serious threat to patients’ care, especially those that need coverage for illnesses or pre-existing conditions. Patients deserve better and we won’t rest until they get it.”

In the wake of disaster, nurses answer the call

While most people were running away from Hurricane Harvey, a team of nurses from the Christus St. Michael Health System flew into the storm to help others.

With just two hours’ notice, the 13 nurses boarded a plane to San Antonio, arriving shortly before Hurricane Harvey made landfall in Texas. Word had spread throughout the health system that patients from around the state were being transferred out of the hurricane’s path into hospitals in the San Antonio area, and they would need more nurses to handle the influx of patients.

By the time the nurses reached the Christus San Antonio Medical Center and Christus Santa Rose New Braunsfel hospital, an additional 70 patients were transferred to these facilities and needed care. One of the nurses, Kelli Thompson, BSN, RN, WCC, SCRN, ended up working the night shift in the MICU with other volunteers. “We helped with admissions, started IVs, cleaned up patients. We did whatever they needed us to do,” Thompson said. “They had patients who were very sick and needed a lot of care.” The MICU had a significant increase in patients, over 150% of its regular capacity. “It was a big difference from what they were used to,” Thompson said.

The volunteer nurses slept in empty patient rooms on cots and hospital beds; flooding concerns meant that they stayed in the hospital for four days straight so they wouldn’t miss a shift. Though the experience was trying, the volunteers felt welcomed by both the patients and the staff nurses. “The nurses who were based there were wonderful and very appreciative of us being there,” Thompson said.

Micah Johnson, MSN, RN, director of nursing at Christus St. Michael Hospital-Atlanta, was also one of the volunteers; for him, the biggest take away was how nurses were able to rally together in a time of crisis and help patients in need.

Source: Nurse.com

The Roots of Peer Review

The following is an excerpt from Nursing Peer Review, Second Edition

Medical staffs have been peer reviewing their cases for decades, and as fellow professionals, we must hold ourselves to the same high standards. Nurses are professionals who must hold each other accountable and evaluate patient care so we can eliminate system and human errors. Nurses are no different than physicians in this way.

 

An early crusader for quality improvement, E. A. Codman helped develop the concept of outcomes management in patient care. He was a proponent of peer review and quality programs for healthcare delivered at the hospital level.

 

Practicing in the early 20th century, Codman was a founder of the American College of Surgeons and its Hospital Standardization Program. Eventually, that program would morph into what we know today as The Joint Commission. His statement from 1916 calling for review and transparency are as relevant today as they were a hundred years ago:
I am called eccentric for saying in public that hospitals, if they wish to be sure of improvement, must find out what their results are, must analyze their results to find their strong and weak points, must compare their results with those of other hospitals, must care for cases that they can care for well and avoid attempting to care for cases which they are not qualified to care for well, must welcome publicity, not only for their successes, but for their errors. Such opinions will not be eccentric a few years hence.

—E. A. Codman, A Study in Hospital Efficiency, 1916

 

Codman would likely be happy to see today that the practice of physicians reviewing the work of other physicians—peer review—is a common practice and is considered to be a crucial element of ensuring that quality medical care is provided to patients.

 

That element is just as crucial in the nursing profession. The major reason for implementing a peer review process is to improve patient care. If nothing else, peer review is the right thing to do to protect the patient from potential harm. It is just a matter of time before external accreditation agencies, the government, and your hospital will require a formal peer review process of nurses.

 

More and more, healthcare organizations are required to be transparent about quality performance metrics. While the information that is publically reported is aggregate data, it is important for the healthcare organization to know person-specific performance data so that they can drive improved patient outcomes.

 

Typically, the outliers or underperformers are a small number of nurses who may not know they are not performing to the standard of care. It is important to give them specific and periodic performance feedback so that they can adjust their care model. Additionally, providing performance data to nurses helps them understand where they rank among their peers. When doing so, it is important to report the data in an anonymous way so that each nurse is uniquely identified using a coding system. This can be useful when metrics are performance based and specific in nature. Transparency is the way of the future, and moving in that direction will help the nursing infrastructure catch up with performance models used by physicians.

 

The goals and benefits of peer review include:

  • Improving the quality of care provided by individual nurses
  • Monitoring the performance of nurses
  • Identifying opportunities for performance improvement
  • Identifying system-wide issues
  • Identifying educational needs of nurses

If the process of peer review is to be effective, then a formal structure must be created to allow for the tracking and trending of information and the identification of potential system or human failures. Case review is useful for this, as it presents opportunities to identify failures through investigation so nurses and other team members can correct them before injury occurs in another patient or patients.

The key to nurse retention

The following is an excerpt from Essential Skills for Nurse Managers.

Put aside all the tips and tools for retention for a moment and remember this:

Of 1,500 nurses surveyed, their #1 incentive was noted to be personal recognition by their manager.

Imagine you are a staff member who helped out the department by covering an extra shift due to a sick call. Sure, at the end of the pay period they will be smiling with the overtime in their check. Do you know what will make them smile just as much, or for some even more? If the next time they worked an envelope was in their mailbox or locker and inside was a single wrapped life saver with a note signed by their manager that simply read:

  • Many thanks for helping out by picking up the extra shift. You are a life saver!

After much conflict in the department related to precepting issues and a lack of interest among the staff to contribute to the ongoing educational needs of the new graduate staff, one employee stepped forward to offer to assist. He understood there was no extra pay differential for taking on this challenge when he agreed to the role. However, that did not matter because he found in his locker an envelope with a single wrapped “treasures” chocolate candy and a note from the manager that read:

  • Many thanks for volunteering to work with our new grads—we treasure you as part of our team!

Sometimes a trip down the candy aisle at the grocery store with a pad of paper is not about the eating; instead, it is about creating a memorable message that means something to an employee. Be sure that part of your retention strategies include your “shining stars.” Many managers assume these high-level performers do not need or desire recognition or praise; this is far from the truth. They may want to be recognized in different ways from the rest of the staff, but they still deserve to be reminded of the vital role they hold in the department. Sometimes the employees we desire to hold on to the most are the ones for which we use the least retention efforts. Do not make this mistake and be alert to the fact that many assumptions are made about top performers.

Rewards for employees should match and be in line with how and what they contribute to the department/organization. Just because employees perform well does not mean they are easy to get along with, welcoming to new hires, etc. And always remember that current performance may not be an indicator for future potential in a “shining star” Schmidt (2010). Be sure to balance your attention and recognition efforts among all of the team members, shining stars or not.

What providers can do this National Suicide Prevention Week

National Suicide Prevention Week is September 10-16, bringing awareness to the 10th leading cause of death in the United States. This week is a time for physicians, nurses, and other providers to learn more about how their healthcare organizations can help suicidal patients.

In 2013, 9.3 million adults had suicidal thoughts, 1.3 million attempted suicide, and 41,149 died. Even more worrying is that the rate of suicides has increased 24% between 1999 and 2014. And as of March 2017, Joint Commission surveyors have been putting special focus on suicide, self-harm, and ligature observations in psychiatric units and hospitals. Surveyors are documenting all observations of self-harm risks, and evaluating whether the facility has:

  • Identified these risks before
    •    Has plans to deal with these risks
    •    Conducted an effective environmental risk assessment process

To learn more about suicide prevention in healthcare, check out the following websites and articles.

Resources

Nurse’s controversial arrest sparks outrage and reform

Last week, body-cam footage was released of a Salt Lake City detective arresting a nurse for refusing to let them draw blood from their unconscious patient. Alex Wubbels, RN, the head nurse at the University of Utah Hospital’s burn unit, was following hospital policy and state regulations by refusing consent, but she was still handcuffed and arrested despite protests from the hospital staff.

Shortly after footage of the incident was released, The American Nurses Association (ANA) issued the following statement, “The ANA is outraged that a registered nurse was handcuffed and arrested by a police officer for following her hospital’s policy and the law, and is calling for the Salt Lake City Police Department to conduct a full investigation, make amends to the nurse, and take action to prevent future abuses.”

In the video, Wubbels consulted with her supervisors and presented details about the hospital’s policy, which states that that blood could not be taken from an unconscious patient unless a warrant was issued for the blood draw or the patient consents. The officer stated that they had implied consent to get the sample; however, implied consent has not been Utah law for over a decade, and the Supreme Court ruled against warrantless blood tests in 2016. When Wubbels and the hospital staff continued to refuse, the officer grew irritated and made the arrest.

“It is outrageous and unacceptable that a nurse should be treated in this way for following her professional duty to advocate on behalf of the patient as well as following the policies of her employer and the law,” said ANA President Pam Cipriano, PhD, RN, NEA-BC, FAAN.

In a press conference last week, Wubbels’ lawyer Karra Porter called her arrest unlawful: “The law is well-established. And it’s not what we were hearing in the video,” she said. “I don’t know what was driving this situation.”

In the same conference, Wubbels gave the following statement: “I want to see people do the right thing first and I want to see this be a civil discourse. If that’s not something that’s going to happen and there is refusal to acknowledge the need for growth and the need for re-education, then we will likely be forced to take [legal action]. But people need to know that this is out there.”

The mayor and police chief of Salt Lake City have apologized to Ms. Wubbels, and have agreed to perform an investigation of the incident. The police officer involved and his supervisor have been suspended as well.

Because of this incident, facilities throughout the country are reassessing their policies. The University of Utah has already changed their policy so that nurses will no longer have direct contact with the police, and other facilities are hoping to do the same.

Relationship of Nursing Excellence to Evidence Based-Practice

For many years, the American Nurses Credentialing Center (ANCC) Magnet Recognition Program® (MRP) has been synonymous with environments in which nurses prefer to practice and patients achieve the best outcomes. Nurses that are retained in a Magnet-accredited hospital are involved directly in making choices on patient care, and they are active in contributing to healthcare changes based on EBP. “A growing body of research indicates that Magnet hospitals have higher percentages of satisfied RNs, lower RN turnover and vacancy, improved clinical outcomes, excellent nurse autonomy and decision-making capabilities, and improved patient satisfaction” (Drenkard, 2010, p. 264). Brown (2009) wrote, “Evidence-based practice (EBP) is recognized by the healthcare community as the gold standard for providing safe and compassionate care. It is an essential component of any organization having achieved MRP status.”

You can think about this information when you address the need for EBP support at your facility. EBP’s central importance to nursing excellence and its flagship status at any organization deemed worthy of MRP designation indicates that EBP support should move out of the category of “nice to have” and into the category of “need to have.”

Recognizing quality patient care, nursing excellence, and innovations in professional nursing practice, the MRP program provides consumers with the ultimate benchmark to measure the quality of care they can expect to receive. When U.S. News & World Report published its annual showcase of America’s Best Hospitals, designation as an MRP facility contributed to the total score for quality of inpatient care. In 2013, 15 of the 18 medical centers on the exclusive U.S. News Best Hospitals in America Honor Roll, and all 10 of the U.S. News Best Children’s Hospital Honor Roll, are ANCC Magnet-recognized organizations (ANCC, 2014).

MRP designation is based on quality indicators and standards of nursing practice as defined by the American Nurses Association’s Scope and Standards for Nurse Administrators (2009). The Scope and Standards for Nurse Administrators and other foundational documents form the base upon which the MRP environment is built. The designation process includes the appraisal of qualitative factors in nursing, and these factors, referred to as the 14 Forces of Magnetism, were first identified through research conducted in 1983. The 14 Forces were reconfigured under 5 Model Components in 2008, which places a greater focus on measuring outcomes.

The full expression of MRP designation embodies a professional environment guided by a strong visionary nursing leader who advocates and supports development and excellence in nursing practice. As a natural outcome of this, the program elevates the reputation and standards of the nursing profession.

Source: Evidence-Based Practice Made Simple

Ethics for Charge Nurses in Frontline Leadership

This is an excerpt from Charge Nurse Leader Program Builder.

Like your practice, your frontline leadership requires that you adhere to ethical principles (ANA, 2015). There is value added when you practice within your professional code of ethics and abide by policies, facility ethics guidelines, and legal standards, such as employee confidentiality. You often serve as advocate, negotiator, protector, preceptor, and counselor to team members, patients, and families. Additionally, you help new staff members settle into their new roles and positions and may preceptor or mentor students completing clinical assignments on your unit.

A code of ethics is a set of principles of conduct within an organization that guides decision-making and behavior (Makaroff, Storch, Pauly, & Newton, 2014). Applying ethical, legal, and policy rules is essential to the safe, effective nursing practice and leadership. Most ethics codes specify that members conduct themselves honestly, fairly, competently, and justly.

Ethics exercise: This exercise will help you consider some of these potential ethical questions and principles you may encounter as a frontline leader and ways to anticipate them with proactive problem solving (Gantt, 2014):

  • Read your specialty practice or profession’s code of ethics: What issues are discussed? What was the outcome? What might be done differently?
  • Draw on personal, practical, lived experiences: What about a situation or question was troubling? Review the Choice and Awareness Model and consider how it might apply to the ethics of the discussion or situation. This model offers one approach for ethical decision-making and working through ethical dilemmas. What other models have you used?
  • Look through books and journals on ethics that include situations testing personal or professional values, beliefs, or morals in how to perform work or interact with co-workers, colleagues, or customers/clients/patients. How do these examples fit situations you encountered during a preceptorship or mentorship? How will your decisions be affected by the ethical choices made by those in the books or journals?

Leadership in an Age-Diverse Nursing Workplace

Book excerpt from Managing the Intergenerational Nursing Team.

Your challenge is to keep all generations engaged, motivated, and satisfied in their jobs in order to increase productivity, morale, and job satisfaction. It is expensive to replace a nurse employee, so you must also find ways to decrease attrition and turnover. You are going to need to build more personal relationships with your staff nurses to increase team morale and make them feel needed and wanted.

Great leaders have a vision of the future that they can sell to others to get their buy-in. Your managerial style will benefit from having a vision of the future that your staff will support. Then you can persuade them to join as a team to bring that vision into reality. Your job is sales—selling your vision. Your job is production—giving them the tools to do the job right. And your job is cheerleader—motivating and supporting them in their efforts.

Successful and fair management of an age-diverse group begins with an open discussion of the differences between the generational cohorts while you maintain a positive attitude. Generational stereotyping can be a risky practice, so look at the needs of your diverse team in the context of their generation with caution. It would be a mistake to assume that everyone in that generation thinks the same or wants the same things. You will need to tailor your leader­ship techniques accordingly, including communication styles, conflict resolution, coaching, and motivating. Some of your staff will eagerly follow your leadership. Some of them will question and even dismiss your efforts. Knowing the preferences for each generation can provide insight to help motivate and affirm yourself during the rough times.

Generational considerations can also show you the path to solidify your work team and bring out the potential in every individual. When the team wins, you win; so set them and yourself up with every advantage to be a productive and effective work team by attending to their genera­tional needs. It will be time and energy well spent.

McCain votes no, derails “skinny repeal” in marathon session

This article appeared on Kaiser Health News on July 28, 2017.

By Michael McAuliff

WASHINGTON — Sen. John McCain (R-Ariz.), who interrupted brain cancer treatment to return to Capitol Hill and advance the health law repeal efforts, cast the dramatic and decisive “no” vote in the early morning hours that upended the Republican effort to repeal the Affordable Care Act.

The Senate struggled late into the night to craft and then vote on a “skinny repeal” of the health law, but came up empty as the bill was defeated in a 51-49 vote that prompted gasps in the chamber. McCain’s vote was unexpected and ends — for now — the Republican Party’s effort to kill Obamacare.

Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) cast the two other Republican “no” votes in a cliffhanger drama that ended just before 2:00 a.m. Friday.

Earlier, a group of Republican senators trashed the new measure, widely dubbed a “skinny repeal,” saying it would only worsen the health care system, and they demanded unprecedented promises from their House colleagues to change it.

“The skinny bill in the Senate doesn’t even come close to honoring our promises of repealing Obamacare,” said Sen. Ron Johnson (R-Wis.). “Virtually nothing we’re doing in any of these bills and proposals are addressing the challenges, the problems, the damage done [by the Affordable Care Act].”

Staff of Senate Majority Leader Mitch McConnell (R-Ky.) crafted the new bill, which was under discussion all afternoon and posted publicly late Thursday evening.

The slimmed-down version of the Senate bill — The Health Care Freedom Act, which the White House refers to as the “freedom bill” — included an end to key elements of the health law. Among them were rollbacks of the mandates for individuals and employers to buy health insurance, changes to waivers available under Section 1332 of the ACA that would give states more leeway to alter essential benefits in insurance plans, and a repeal of the medical-device tax.

It was not immediately clear how the bill achieved savings similar to $133 billion in the House’s version of repeal legislation. An equal or better level of savings is required under the arcane budgetary process that is being used to advance the bill, known as reconciliation.

Budget reconciliation allows the measure to pass the Senate on a simple majority vote, but requires that all of its provisions pass muster with the Senate parliamentarian as budget-related. The text of the bill posted publicly at 10 p.m. The CBO report on it began circulating on Twitter around midnight and the vote finally closed around 1:45 a.m. Friday.

One provision that had been restored after the parliamentarian initially struck it was an attempt to defund Planned Parenthood for a year. The new provision took in at least one additional abortion provider, and was expected to survive. The funding for Planned Parenthood was to be shifted to community health centers.

Keeping the attack on Planned Parenthood solidified Murkowski and Collins’ opposition to the vote.

This new iteration of the repeal comes after two versions failed to win over the 50 GOP senators needed. But even with all the rewriting and behind-the-scenes negotiation, four senators called a press conference to declare they will not vote for this “skinny repeal” unless House Speaker Paul Ryan (R-Wis.) promises not to merely pass the measure but send it to a conference committee between the two chambers, where it can be substantively altered.

The four senators slammed the trimmed-down compromise.

“I am not going to vote for a piece of legislation that I believe is not a replacement, that politically would be the dumbest thing in history to throw this out there,” said Sen. Lindsey Graham (R-S.C.).

He said that he, Johnson and McCain and Sen. Bill Cassidy (R-La.) would not vote for the skinny repeal until Ryan pledges to “go to conference,” where Graham can include a measure to shift current Obamacare funding into a block-grant program for states.

His fear, Graham said, is that the House might simply take up and pass the skinny repeal in order to be done with it and notch a win in their seven-year battle against Obamacare.

Graham referred to estimates that said the repeal of the ACA mandates would “collapse the individual market” and leave the GOP to “own the problem at a time when Obamacare is collapsing.”

Ryan did release a statement with a conditional promise to take the bill to conference. Initially, it did not satisfy Graham or McCain. Graham and Johnson were persuaded, however, after a phone conversation with Ryan. McCain was not.

For their part, Democrats uniformly panned the GOP’s efforts.

“We’ve had one bad bill after another. There is no bill that is a good bill,” said Sen. Dianne Feinstein (D-Calif.). “Every bill takes people off health care. Every bill makes you pay more for less. There’s a race to the bottom, so to speak.”

Sen. Chris Murphy (D-Conn.), hammered the entire process: “This is nuclear grade bonkers.”