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Combating racism in healthcare

Nurse managers and their staff often face racism in the work place. In 2013, Minority Nurse reported that almost half of minority nurses said they experienced barriers in their career because of their race and educational background. In addition to institutional barriers, there is also the problem of patient racism, where patients refuse care based on the race or ethnicity of the provider. As a nurse, you might be put in the unenviable position of deciding how to handle one of these situations. Do you refuse care to the patient? Do you acquiesce to the patient’s unreasonable demand?

A Cautionary Tale

Plainfield Healthcare Center was faced with a similar dilemma, when some residents of the facility refused care from nonwhite staff members. The center had a policy of honoring such racial preferences, citing the patient’s right to select their providers.

For Brenda Chaney, a CNA at Plainfield Healthcare Center, this caused issues with both her workplace experience and patient safety. Patients verbalized their preference on a regular basis, causing distress and a hostile work environment for Chaney. Additionally, the policy created safety risks for the patients; Chaney shared one such situation: after finding that a patient fell and couldn’t get up, instead of assisting the patient herself, she had to hunt for nonblack staff members to help the resident return to her bed.

Chaney responded to a call one morning from a resident who was struggling to get out of bed. The patient refused her help, and when she eventually helped another staff member with the patient, the staff member reported that Chaney used profanity when helping the patient. After investigating the complaint, they found no evidence to substantiate the complaint, and the resident’s roommate heard no profanity during the incident. Despite this, Chaney was still terminated.

After her termination, Chaney filed a lawsuit under Title VII of the Civil Rights Act of 1964, where she alleged that Plainfield Healthcare Center’s adherence to resident’s racial bias was illegal and contributed to a hostile work environment. The suit was supported by the Equal Employment Opportunity Commission. After an appeals process, the 7th U.S. Circuit Court of Appeals sided with Chaney and found the practice of allowing patients to refuse care based on race in violation of Title VII. Both parties eventually settled the case, with Chaney receiving $150,000 settlement.

Preventative Measures

The New England Journal of Medicine published an article that provides some useful information about how to handle patient racism. The authors point out that there are a number of concerns to take into account, both legally and ethically. The situation pits a number of rights and laws against each other, including the patient’s right to refuse medical care, laws that require hospitals to provide medical care in emergency situations, and employment rights that dictate that hospitals cannot make staff decisions based on race. Nurses that have been reassigned based on a patient’s racial demands have successfully sued their employers, but if a patient doesn’t receive proper medical attention in a timely manner, facilities are equally liable.

The journal lays out five factors to consider when faced with this difficult situation:

  • The patient’s medical condition: If the patient is unstable, treat the patient right away, regardless of the patient’s preference. It is possible that their current condition is impairing their mental faculties.
  • The patient’s decision-making capacity: Try to assess if the patient is capable of making decisions for themselves; psychosis or dementia are important factors to consider. If the patient lacks decision-making capacity, try to persuade the patient to reconsider their request.
  • Reasons for the request: If there are clinical or ethnically appropriate reasons for reassigning staff, that should be taken into consideration. For example, if there are language barriers or religious concerns, it might be reasonable to accommodate the patient.
  • Effect on the provider: Always take into account the effect a decision might have on the employee. “For many minority health care workers, expressions of patients’ racial preferences are painful and degrading indignities, which cumulatively contribute to moral distress and burnout,” according to the article. Always try to support staff when possible, and discuss their preferences when deciding how to respond.
  • Options for responding: In some situations, staffing might dictate your decision. If the department is understaffed and you cannot provide proper coverage by reassigning, try to persuade the patient.

If faced with a non-emergency situation and a patient is deemed capable of making decisions, the article suggests that it may be best to suggest that the patient seek care elsewhere; though that also has its risks depending on the availability of other treatment.

For more information on this difficult issue, including a useful decision-making tool, read the New England Journal of Medicine’s full article.

The 2017 Nursing Salary Report

HCPro recently conducted a survey among 291 nursing professionals in the healthcare industry regarding their work experience, environment, salary, and benefits. The results show that while careers in nursing careers are more varied and higher paid than ever, nurses are working later in their career and the age gap is growing.

A majority of the respondents were over 50 years old with over 10 years of experience. Respondents had a wide variety of education background, job titles, and salaries. While salaries overall are higher than ever, most respondents say that wages have not increased in the past year, and that benefits for many positions are lacking.

Click here to download!

 

Time management and preceptorship

This is an excerpt from The Preceptor Program Builder

The three primary tasks affecting time management in healthcare include organization, prioritization, and delegation. It is especially challenging for preceptors to manage their time when given the added responsibilities of working with preceptees. Only by developing their skills in these three tasks can preceptors gain perspective and control over their time in any effective way when working with preceptees.

The following tips should help you to manage your time more effectively:

  • For example, schedule interruptions. Do not chart every event as it occurs. Set aside time once or twice during your duty hours to stop what you are doing and update your reports:
  • Keep your work and practice settings clear and ready for action. Papers, tools and supplies, and items waiting for attention should not clutter the desk or work area but rather should be organized and easily accessible.
  • Do one thing at a time. Studies suggest that multitasking is not effective and can lead to increased errors. Complete one task before moving on to the next.
  • Determine what must be done versus what you would like to do. They are not always the same. Say “no” if you have too many duties to handle responsibly or safely. Preceptees try very hard to please preceptors, coworkers, managers, and educators. They may take on too many tasks or responsibilities if they do not know how—or when—to say “no” occasionally.
  • Avoid time wasters: the activities, things, people, habits, or attitudes that divert us from our primary objectives. They reduce our effectiveness and interfere or prevent us from completing our tasks or achieving our goals. Time wasters result from ineffective or a lack of planning, ineffective or a lack of priority setting, over commitment, clutter, interruptions, failure to delegate, unnecessary telephone calls or emails, paperwork, perfectionism, procrastination, conflict, ineffective problem-solving skills, daydreaming or escape activities, and hurrying (haste makes waste).
  • Increase time savers: the activities, things, people, attitudes, or habits that direct us to meet our primary objectives or goals. They increase effectiveness and efficiency and enhance completion of tasks. They include planning and controlling time, making lists, setting priorities, creating agendas for meetings (Do we really need to meet? How much can be done by email, for example?), handling paper only once, not procrastinating (do it now), and delegate, delegate, delegate. Preceptors and preceptees need to know how to:
  • Manage interruptions, emergencies, and crises with tact, diplomacy, and courtesy
  • Become better at solving problems and resolving conflict (use tried and true models)
  • Be assertive (say “no”)
  • Control the controllable and accept the uncontrollable
  • Keep interruptions short—be ruthless with time, generous and kind to people
  • Occasionally become invisible and not so completely available
  • Avoid getting angry or hurt if possible—these waste time and energy
  • Maintain a sense of humor
  • Remember to plan and make personal time for fun and recreational activities
  • Delegate routine tasks or projects. Set deadlines when you delegate. Ask for help from coworkers and specialists (e.g., educators) instead of trying to do everything alone. Delegate a task to your preceptees that you thought only you could do. Encourage preceptees to delegate tasks to coworkers when appropriate.

We all are given 168 hours per week, no more and no less. How we spend those hours affects our outcomes, professional and work goals, and job satisfaction. Preceptors can increase efficiency and induce wiser use of time through planning, thereby increasing productivity and decreasing stress.

Preceptors should determine the best use of time and help their preceptees do the same.

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.

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

Nurses push to prevent assault in healthcare

Healthcare professionals are four times as likely to be assaulted on the job compared to other professions, and lawmakers in Massachusetts are looking to strengthen protections for nurses and healthcare workers.

Last week, the Massachusetts Nurses Association (MNA) endorsed bill S.765/H.795, which would strengthen penalties against assaults on healthcare workers. The MNA has called the bill Elise’s Law, in honor of Elise Wilson, a nurse that was stabbed multiple times on the job last month. The bill would increase the penalty for assaulting emergency medical technicians, ambulance operators and attendees, or healthcare providers from a misdemeanor to a felony. The bill would also streamline how victims of healthcare violence can use the justice system, making it easier to seek legal recourse for their injuries.

The bill is part of a larger effort to improve prevention and response to workplace violence in healthcare. “Health care professionals are being assaulted at a rate four times greater than those working in other industries,” said Donna Kelly-Williams, RN, president of the MNA, in a press release. “Fear of violence and actual violence is rampant in Massachusetts health care facilities. An assault on a nurse is a serious action and should be taken seriously by our judicial system.”

According to the U.S. Bureau of Labor Statistics, health care workers experience the most non-fatal workplace violence compared to other professionals, and account for 70% of all non-fatal workplace assaults. A survey conducted by the MNA found that 75% of nurses reported that violence was a problem in their workplace, and the Emergency Nurses Association reports that 80% of emergency department nurses have been a victim of workplace violence.

For information on how to prepare your facility for workplace violence, check out this excerpt from Preventing Workplace Violence: Handbook for Healthcare Workers.

Clinical Nurse Leaders, partners in quality improvement

Quality within any healthcare system depends on improving patient outcomes, which rely on continual nursing professional development and overall improvements in system performance. One of your most important resources for managing such improvements is the Clinical Nurse Leader (CNL). This clinician is a Master’s prepared Advanced Generalist nurse who builds quality measures in patient care outcomes and implements evidence-based practice principles at the clinical point of care and service. These outcomes align with the facility’s goals and strategic plan and can positively impact patient care processes.

 

For example, when working with a CNL, you can align the care team with strategic performance goals. CNLs and the Quality Systems team are important resources for strategic planning for quality and performance improvement (objectives, priorities, expectations, deliverables, and timelines). Working together, you can establish an infrastructure for engaging and motivating staff and other team members to work toward achieving improved patient care outcomes within the organization’s measures of performance. CPI only happens when everyone engages to improve management of operations and care delivery.

 

As the context of healthcare environments continually evolves and changes, your role becomes more complex and demanding. However, these growing challenges offer expanding opportunities for developing partnerships with your nurse manager, CNLs, and interprofessional team members to improve quality, practice, and competency in managing unit operations and coordinating patient care. By taking of advantage of these opportunities, you can help create a unit culture of safety, quality, and practice excellence.

Source: The Effective Charge Nurse Handbook

Include cultural diversity training in orientation

Healthcare professionals have varied views about what the term cultural diversity means and the actual purpose of cultural diversity training. They may believe that such training is initiated primarily to help them avoid professional and legal problems rather than improve patient care (Nisha et al 2007). Others are genuinely concerned about being culturally sensitive when working with patients and collaborating with colleagues. NPD practitioners know that the primary purposes of cultural diversity education are to improve:

  • Healthcare professional–patient communication
  • Healthcare professional–family communication
  • Communication among healthcare professionals
  • Patient and family outcomes

Cultural diversity education is also a requirement of some accrediting agencies.  However, this is not the primary purpose of such education. Your cultural diversity programming should be practical and based on evidence that directs its design.

It is not easy to add more content to an orientation program. However, cultural awareness will help new employees to assimilate into the organization. Role play, discussion, and distance-learning techniques can all be used to provide basic information. Allow time for in-person discussion as well. Include information about how cultural differences manifest themselves in patients, visitors, and colleagues and present learners with scenarios that require them to make choices based on cultural appropriateness.

What topics should you include as part of diversity education?

It is not possible to include all aspects of multiple cultures in a diversity program. However, if cultural diversity is part of your competency program, you can regularly add material about aspects of various cultures.

The following is information to include in your initial training:

  • How do members of this culture communicate? What significance do body language, gestures, tone of voice, and eye contact have? Which family members take the lead in communicating with people outside of their culture?
  • What specific family/gender issues exist? What is the woman’s role? How are major decisions made?
  • What role does religion play?
  • How is pain expressed?
  • What are common health practices (e.g., alternative medicine, herbal medicine, home
    remedies, etc.)?
  • How do families deal with pregnancy and births?
  • Is there a standard work ethic valued in the culture? How are specific occupations viewed
    in terms of respectability, financial need, and appropriateness?
  • Are there dietary restrictions associated with this culture?
  • Are there specific political beliefs that influence people of this culture?
  • Are there specific conflicts between certain cultural groups that may surface within your organization?

Source: Staff Development Made Simple

Blogging can be an innovative tool for nursing educational sharing

With the time-crunch worse than ever, it can be difficult to find the time to keep up with the latest in your facility, let alone the wider world of nursing. Early research conducted by Critical Care Nurse (CCN) suggests that blogs can be an effective means of communicating the latest hospital policies and best practices.

The cardiac intensive care unit at Brigham and Women’s hospital found that while many of their nurses attended professional educational opportunities, the staff had difficulty sharing information with the entire nurse staff. The staff simply did not have the time for peer-to-peer sharing of educational information. To facilitate educational sharing, the nursing practice council at the facility set up a simple private blog where staff could share what they’ve learned from various educational opportunities, such as professional conferences and panels.

After fifteen months, the hospital conducted a survey to measure the effectiveness of this approach. They found that 86% of their nurses thought the blog was an effective way to share professional education, 81% felt the blog kept them up-to-date on evidence-based practices, and 59% thought the blog led to changes in their practices. While the results are anecdotal and early, the authors of the study suggest that more rigorous research is required.

Does your facility use blogging tools or social media for education and professional development?

Allina and nurses agree to end strike

The Minnesota Nurses Association (MNA) and Allina Health have reached an agreement after months of negotiations and weeks of striking.

Last week, we reported that Allina nurses were about to enter their second month on strike after another round of failed negotiations. This week, the two sides finally reached a tentative resolution that should end the nurse’s strike.

Health care coverage had been a sticking point in negotiations; Allina wanted to transfer nurses away from their nurse-only insurance policy onto the more cost-effective corporate plan. The new agreement states that nurses will be moved off their current insurance by 2018, but the company has agreed to make additional contributions to HRA/HAS accounts in the next four years. The MNA representatives believe that this will protect nurses from any future benefit reductions.

Although the rank-and-file nurses still need to vote on the proposed terms, this deal is backed with the unanimous endorsement of the MNA, unlike the previous deal.