RSSArchive for October, 2012

Zombies, witches, and nurses?

As the end of October quickly approaches, children and adults alike are finalizing their choices for Halloween costumes, and it is highly likely that some variety of nurse costume will be among the options. The “naughty nurse” is an image that pervades our culture, and unfortunately detracts from the many positive images that nursing professionals strive to uphold.  According to an article in the Los Angeles Times, nurses are tied with ghosts at number eight in a list of the 10 most popular Halloween costumes. Why does the nurse costume remain a popular option year after year?

Halloween costumes run the gamut from scary to silly, as the article in the L.A. Times shows. Traditional costumes such as witches and vampires are joined by superheroes, princesses, and politicians. The holiday marks an occasion to become something or someone else for an evening, and of course it is all in good fun, but the trend towards the “sexy” or “naughty” nurse belittles the profession and in many ways mocks the work that nurses do each day. People who dress up as an Olympic athlete are typically showing their admiration of that athlete’s achievements; people who dress up as a naughty nurse are typically displaying a lack of originality.

Do you feel that the “naughty nurse” costume perpetuates a bad image for nurses? Share your thoughts in our comments section?

When disrespect becomes a safety issue

A dysfunctional culture rooted in widespread disrespect is a significant barrier to patient safety, and affects everyone in a healthcare organization, according to a pair of papers published in the journal Academic Medicine earlier this year. The papers’ authors identified six broad categories of disrespectful behavior, including degrading treatment of nurses, residents, and students, passive-aggressive behavior, and dismissive treatment of patients. Other behaviors included disrespect for system-wide policies and processes, disruptive behavior, and passive disrespect. The authors concluded that such behavior prohibits teamwork and undermines morale, which in turn threatens patient safety.

Most, if not all, organizations have at least one practitioner who seems intent on making everyone else miserable. While these disruptive practitioners may only be a small percent of the people working in a hospital or other healthcare facility, their behaviors and the influence of their attitudes can have much larger implications, as the authors of the papers point out. Nurses are particularly at risk for taking the brunt of a physician’s abuse; in several recent studies, more than 90% of nurses reported experiencing verbal abuse.

The second of the two papers focuses on creating a culture of respect. The paper’s authors call on an organizations leader, specifically the CEO, to initiate changes within an organization. However, anyone in a leadership position could address the need for change and begin working towards a cultural shift. The paper recommends five major tasks: motivate and inspire, establish preconditions for a culture of respect, lead the establishment of policies regarding disrespectful behavior, facilitate frontline worker engagement, and create a learning environment for resident and students. By recognizing that there is an issue with disruptive behavior and taking steps to eliminate those behaviors from your organization, you can begin to move towards a culture that is respectful and safe.

How has your organization addressed disruptive behavior in the past? Leave a comment and let us know!

Heading down the virtual road

An article on Advance for Nurses this week explores the dynamic between the well-informed patient and the well-educated nurse, weighing the pros and cons of patients who thoroughly research their symptoms and diagnoses prior to an appointment. On the one hand, patients who take charge of their health can be more collaborative and active in their treatment, but on the other hand these well-educated patients may challenge nurses about prescriptions and treatment options. According to the article, nurses with well-informed patients should listen carefully and establish a dialogue with patients and their families to avoid any potential aggression that might stem from disagreements about care options.

The article also points to telemedicine and the advances in technology that allow patients to communicate with nurses and other healthcare professionals easily and get quick answers to any questions they may have forgotten to ask during an appointment. It also allows nurses to monitor patients with chronic diseases more effectively.

While the internet might improve the ways in which patients can communicate with their nurses, it could also lead to increased expectations for round-the-clock care and instantaneous feedback, which might not always be possible with a hospitals’ budget and resources. Adding a virtual element to the work nurses perform daily makes for greater responsibility and accountability, especially if individual nurses are expected to maintain email communications with patients. What happens if a nurse forgets to check her email, or sees an email from a patient but does not respond quickly? Technology has the potential to improve healthcare, but it seems certain precautions should be taken when implementing telemedicine programs or when interacting with patients who have conducted extensive online research about their diagnoses.

Does your organization encourage online interaction with patients? Have you seen an increase in patient engagement in light of online communication and research? Leave us a comment below!

Medicare performance penalties and incentives are in effect

Editor’s note: This blog post originally appeared on the Patient Safety Monitor blog.

As of October 1, two provisions of the Patient Protection and Affordable Care Act will impact Medicare payments at hospitals across the country.  The Act calls for a 1% cut of Medicare payments across all eligible hospitals. The $963 million expected to result from those cuts will be placed in a fund for redistribution among hospitals that scored well over the course of a performance period that ended last June. Hospitals’ scores are based on patient satisfaction surveys and adherence to 12 quality measures.

The Centers for Medicare & Medicaid Services predicts that approximately 40% of the hospitals will receive their 1% share of the pooled money, plus additional funding, while another 500 hospitals will received their 1% share back, without additional money. Approximately 1,377 lower performing hospitals will receive less than their 1% pool funds back.

As the payment adjustments begin to impact hospitals’ finances and the penalties increase in the coming years, it will be interesting to see how these organizations react to the incentives. The intended goal, of course, is to improve quality across the board, but how different hospitals will accomplish that goal remains to be seen.