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Brian Ward

Brian Ward is an Associate Editor at HCPro working on nurse management.

Trump: for every new healthcare regulation, two must be removed

On January 30, President Trump signed a new executive order declaring a “one-in, two-out” rule for healthcare regulations. Under the executive order, for a new healthcare regulation to be implemented two older regulations will have to be eliminated.

http://www.modernhealthcare.com/article/20170130/NEWS/170139994

“If you have a regulation you want, number one, we’re not going to approve it because it’s already been approved probably in 17 different forms,” Trump said during the signing. “But if we do, the only way you have a chance is we have to knock out two regulations for every new regulation. So if there’s a new regulation, they have to knock out two.”

http://www.nbcnews.com/politics/politics-news/trump-signs-executive-order-reduce-regulations-n714151

The order also sets an annual cap on the cost of new regulations and cuts the regulatory budget for fiscal year 2017 to zero. This means the only way to afford new regulations issued between now and September 30, 2017 is by repealing existing regulations.

While each agency will decide which regulations they think can be cut, the White House will ultimately decide which ones to gut. Regulations dealing with national security, foreign affairs, and the organization, management, or personnel of federal agencies are exempt.

Take Five: How renewal rooms revive stressed out nurses

With long shifts, hard work, and close contact with the sick and the dying, it’s unsurprising that many nurses are burnt out. One study found that nearly one-third of oncology nurses exhibit emotional exhaustion and 50% report levels of emotional distress. Despite the fact they might be hurting, nurses are often expected to “tough it out,” hiding their stress from the eyes of others.

Compassion fatigue is a huge issue for us all in bedside nursing, and we as leaders need to look into and address that,” says Jacklynn Lesniak, RN, MS, BSN, senior vice president of patient care services and chief nursing officer at Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center in Zion, IL.

In response, CTCA Midwestern created several “nurse renewal rooms,” with one in each inpatient tower, surgical department, and outpatient care area. The rooms were designed by Jillianne Shriver, RN, BSN, HN-BC who studied relaxation techniques and holistic nursing for three months for the project.

Only one nurse is allowed in the room at a time, giving them much needed private time away from the eyes of patients and coworkers. Each room is laden with relaxation material and décor: aromatherapy and meditation material, a yoga mat, a sand garden, books for reading and journaling, and music therapy.  When a nurse feels he or she needs to step back, they inform their charge nurse that they need to use the room. Then they hand over their communications devices and go into the renewal room for a couple minutes to decompress.

“I decided that I really wanted somewhere for the nurses to take that time to renew, rejuvenate, and recharge,” Shriver says. “To step out of whatever situation they may be in, whether that be a stressful or busy day, and have five to 15 minutes to themselves to be able to focus, ground themselves, take a deep breath, and then step back into practice.”

Not only did the renewal rooms work, they worked well. CTCA Midwestern reported that the first renewal room was used 422 times in the first three months and 96% of nurses said they felt better after using it. Which is pretty impressive when you consider the first renewal room was just a supply area with a massage chair and some relaxing decorations.

To read more in-depth about nurse renewal rooms, check out the original article at HealthLeaders.com.

What to know about new nurses: Tackling Turnover

Hiring a competent nurse staff is only half the battle. The other half is keeping them. A new study published in Nursing Ethics found the turnover rates for RNs is 16.5%, with each resignation costing a hospital between $44,380 to $63,400 a nurse. Furthermore, newly licensed nurses scored lower on job satisfaction and were more likely to leave their job within two years.

The Nursing Ethics report found that intergenerational conflict was a big part of nurse dissatisfaction; with millennials, Gen Xers, and baby boomers butting heads at the hospital.

“Younger generation nurses feel like they don’t have power over their practice, they’re not in charge, and that is logical because they are novice practitioners,” study author Charleen McNeill said in a press release. “However, they bring a knowledge of technology that seasoned nurses may lack. In turn, more experienced nurses support the clinical learning and professional role formation of new nurses. Successful nurse-leaders find ways to garner the strengths of each generation of nurses to achieve the best patient outcomes.”

McNeill said instead of looking at it as conflict, nurse-leaders need to leverage the strengths of each generation and determine strategies to empower all generations of nurses. Their research suggested a strong correlation between professional values and career development. They also found that both job satisfaction and career development correlated positively with nurse retention.

“The work culture that leaders create – the environment that nurses are working in – is the most important thing related to retention,” McNeill said. “It’s very expensive to hire new nurses. When we have good nurses, we want to keep them so we need to understand what’s important to keep them.”

For more tips on retention, conflict resolution and recruitment, check out the following articles from our Strategies for Nurse Managers site!

JAMA: Nurses key to surviving surgery

A study published in The Journal of the American Medical Association has found that surgery patients in hospitals with better nursing environments receive better care without drastically increasing costs. Researchers found the 30-day mortality rate for postoperative patients was 4.8% at hospitals with more than 1.5 nurses per bed (NPB), while facilities with less than one NPB had a 30-day mortality rate of 5.8%.

“It wasn’t just the number of nurses that made the difference. Magnet status hospitals recognized for having excellent nursing programs and cultures do better,” study author Linda Aiken, PhD, RN, said in a press release.  

While there’ve been numerous studies showing the benefits of a bigger nursing staff, the cost of hiring new staff has been an impediment for many facilities. Despite this, better staffed hospitals actually paid less ($163) overall per patient than understaffed hospitals.

What to know about New Nurses: Stuck in Place

The healthcare industry is facing a shortage of nurses as members of the baby boomer generation retire and the industry expands. The upcoming decades are going to be reliant on new nurses to fill the gaps left by their predecessors. As a manager, what do you know about the people that will make up your staff in upcoming years?

Take a map of the U.S. and point to any town with a population of 100 or more. Odds are that within 30 miles of town center you’ll find a post office, a police station, a bar, and a hospital.

Hospitals and healthcare centers are key facilities and can be found pretty much everywhere. Coupled with a growing healthcare industry and more people getting nursing degrees, you would expect that after getting their license most new nurses would flock to big cities and big states for more job opportunities.

A study done by the RN Work Project found that this wasn’t quite the case. Instead, 88% of new nurses find their first job in the same state they attended high school. In fact, 66% of nurses currently work within 100 miles of their high school, with 35% working less than 15 miles away!

There are several factors that a new nurse needs to consider when thinking about moving. There’s economic factors such as the cost of living and average nursing salary in a given state. It may be more feasible for a new nurse to live with their parents and keep their expenses low while they pay off student debt. Then there’s practical considerations like the number of job openings and competition for those openings, particularly considering the difficulty new nurses have finding work. Finally, there’s the social considerations of moving away from friends and family and starting a new career in a foreign environment.

Given the increasing needs for more nurses, this lack of mobility can be an issue for states with fewer nursing programs and smaller nurse populations. A short term solution is to target your job postings at local nurses. If you haven’t already, making inroads with nearby nursing degree programs can help drive more new applicants to your door.

As for long term, you should create some incentives to encourage out-of-state nurses to move to your area. Scholarships and internships for out-of-state nurses can help you recruit and retain new nurses. Starting an off-hours program where locals show newbies and interns around can help them feel more comfortable in a new town.

One big area to look into is tuition reimbursement. As of 2011, only 69% of healthcare facilities offered tuition reimbursement to first time nurses, down from 86% in 2005. Even offering partial reimbursement can make all the difference for a new nurse deciding where to start his or her career.

What to know about New Nurses: Unemployment

The healthcare industry is facing a shortage of nurses as members of the baby boomer generation retire and the industry expands. The upcoming decades are going to be reliant on new nurses to fill the gaps left by their predecessors. As a manager, what do you know about the people that will make up your staff in upcoming years?  

An experienced RN doesn’t need to worry much about finding work. In 2015, the unemployment rate for RNs was a measly 2%, with the industry expected to increase 19% by 2022.

While this is great news, most of these jobs are going to nurses coming out of retirement. During the recession, many nurses came back to work as pensions lost money and family members lost jobs. The fear of financial instability also convinced many nurses who were close to retirement to keep working.

Like many high-stress fields, healthcare facilities prefer employees with prior work experience. Small mistakes like a forgotten medication or unwritten note can have devastating consequences for patients and managers like to know their staff knows the ropes and can work under pressure.

While the preference for experienced nurses is understandable, many facilities won’t even consider applications from nurses fresh out of school. The RN Work Project found that even though RNs consistently have one of the lowest unemployment rates in the county, unemployment rates for newly licensed registered nurses (NLRNs) roughly tripled between 2005 and 2011, jumping from 15% to 31%.

While job prospects for NLRNs are expected to improve in a few years, many recent graduates are still having trouble finding work. Which is crazy considering how many healthcare facilities are understaffed and that larger nursing staffs have proven health benefits for patients.

In the end, it comes down to if being terminally short staffed is better than hiring a few college grads to pick up slack. Taking the phrase “no new graduates,” out of your job posting will greatly broaden your field of potential applicants, can give a new nurse a much needed chance and ease the burden on your existing staff.

Trust your nurses, everyone else does

Nursing has once again been named the most trustworthy profession in America. In their annual, “Honesty and Ethics rankings,” Gallup Polls found that 85% of Americans rated nurses’ honesty and trustworthiness “very high,” or “high.” The runner-up, pharmacists, only received a “highly trusted” score of 68%.

As a manager, you should take confidence in the fact that the general population places more trust in your nursing staff than they do physicians (67%), high school teachers (60%), police officers (56%), or even clergy (45%).

“It’s essential that we leverage this trust to lead and implement change in the healthcare system,” said Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association (ANA) in response to the poll, “Hospitals, healthcare systems and other organizations are lacking an important perspective and can’t make fully competent decisions if they don’t have registered nurses at the board table or in the C-Suite.  That’s why ANA is a member of the Nurses on Boards Coalition, working to place 10,000 nurses on boards by 2020.”

This is the 14th year straight that nursing has taken the top spot since being added to the list in 1999. The only thing that’s ever interrupted nursing’s winning streak was the one-time inclusion of firefighters to the list in the wake of 9/11.

Side note: it shouldn’t be a surprise to anyone that car salespeople (8%), telemarketers (8%), Congress members (8%), and lobbyists (7%) were voted the least trusted professions in the country.

What to get your nurses this year

The holidays are well and truly upon us, which means across the world people are panicking as they realize they haven’t bought any presents yet.

The holidays are a busy time of year for healthcare professionals, with nurses trying to balance an increased workload with holiday obligations. A few simple gifts can do wonders for morale and show nurses that they are appreciated for their work.

And if you miss the holiday deadline? Hand out presents on New Year’s. It’s a federally recognized holiday and gives you more time to buy.

  1. Keep Calm I’m a Nurse T-shirt

So nurses can go off the clock and still let the world know who’s boss. You can buy them on an individual basis or buy them in bulk for your staff.

  1. Coffee

Give the gift of caffeine. Either gift cards to Starbucks or (if you have $100 to spare) a Keurig brewing system for the nurses’ lounge.

  1. Scrubs Season One

Good for some laughs and to remind everyone that you work in a much less dysfunctional hospital. Or that you do, but at least your janitors aren’t actively conspiring against you.

  1. Chicken Soup for the Nurses Soul by Jack Canfield

Stories from the frontlines of nursing. Some are funny, some are uplifting, and some are moving. A good read for both new and veteran nurses.

  1. “Do not disturb: Nurse sleeping” sign

Need I say more?

  1. Things that they would like

This is your chance to show your nurses that you really know them. A running joke in the hospital, fixing something that’s been broken a long time, or something particular to your area. Be creative! And always leave the receipt in the wrapper.

More nurses mean fewer heart attack deaths

It turns out nurses are good for the heart. Provided they aren’t overworked and underappreciated.

A study published in The Journal of Medical Care found that 85% of patients who suffer an in-hospital cardiac arrest (IHCA) die before being discharged. This is despite the fact that 80% of IHCA cases are witnessed and 88% of patients were on cardiac monitoring equipment when the attack happened.

Nurses are typically the first to witness and respond to IHCA cases, making them crucial in a patient’s survival. It was found that each additional patient per nurse decreased a patient’s chances of surviving an IHCA by 5% and that a poor work environment dropped a patient’s chances of survival by 16%.

Researchers suggest improving nurse staffing in general medical-surgical units to increase IHCA survival rates. Medical-surgical units have the most variable staffing levels and would benefit the most with more nurses. Improving staffing may be difficult for some hospitals because of costs, though some of the pressure can be alleviated by hiring temporary nurses.

Temp is not the same as terrible: Study finds supplemental nurses have no negative effect on quality

What do you do when you don’t have enough nurses on staff and don’t have the funds to hire additional staff? A possible solution is to hire temporary nurses to fill the gaps made by retiring staff, seasonal needs, or new medical programs.

The Department of Health and Human Services found that there are 88,495 temporary nurses working in the U.S., making up 3.4% of the total nursing population. Most temporary nurses are experienced travel nurses who work with a hospital on three- to six-month contracts before moving on.

Yet many nurse managers are leery of using temp nurses because of a longstanding stigma associating such nurses with lower quality care. This belief has been reinforced by media exposés on shoddy temp agencies skimping on background checks and allowing temps to jump from hospital to hospital to avoid misconduct charges. [more]