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The flu season, and flu shot debate, persists

Although the Centers for Disease Control and Prevention (CDC) notes that flu activity is decreasing in many parts of the country, 47 states are still reporting widespread geographic influenza activity. The southern and southeastern parts of the country, along with New England and the Midwest, are seeing a decline in the number of flu cases, while populations in the Southwest and Northwest have seen an increase in activity. According to the CDC, more than 130 million doses of the flu vaccine have been distributed as of January 18, and state that there are sufficient vaccinations for those who have not yet received the flu shot.

Along with the flu, the debate rages on as to whether healthcare workers should be required to receive the vaccination. Last month, eight nurses at an Indiana hospital were fired for refusing the mandatory flu shots, causing both positive and negative reactions from the public and the healthcare community.

In a poll this month at StrategiesforNurseManagers.com, we asked readers whether or not nurses at their organizations are required to receive a flu shot. The results were almost evenly matched, with 58% saying flu shots are mandatory and 42% responding that the flu vaccination is optional.

How do you feel about mandatory flu shots? Do you agree with firing nurses who refuse, or do you feel that it is a right to refuse the vaccine? Weigh in on the issue in our comments section!

Proposed 2014 National Patient Safety Goal on alarm management

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

On January 15, the Joint Commission issued a proposed National Patient Safety Goal (NPSG) on management of alarms. Alarms are intended to avert caregivers of potential patient problems, but if they are not properly managed, they can compromise patient safety, and there is a general agreement that this is an important safety issue, according to the release.

This proposed NPSG focuses on managing alarms that have the most direct relationship to patient safety. As alarm management solutions are identified, this proposed NPSG would be updated to reflect best practices. A survey in the release contains 15 questions and respondents will be able to offer their comments directly to the Joint Commission. The survey is open until February 26, 2013.

View the proposed NPSG requirements.

Take the online survey.

Submit comments via online form.

Review finds quality of NP care equal to physician care

Care provided by nurse practitioners (NP) is comparable to care provided by physicians in terms of patient satisfaction, prescribing accuracy, preventative education, and time spent with patients, according to a literature review conducted by the National Governors Association. The group examined 22 articles and studies regarding scope-of-practice for NPs.

The review found that NPs could successfully manage chronic conditions such as hypertension, diabetes, and obesity, and rated favorably in gaining patients’ compliance with recommendations and reductions in blood pressure and blood sugar. The report notes that patients often stated a preference for a care from a physician when it came to medical aspects, but had no preference with regards to nonmedical aspects of care.

NPs are currently allowed to practice and prescribe independently in 16 states and the District of Columbia, while NPs in the remaining 34 states must have some level of physician involvement in order to practice. The authors of the report note that expanding scope-of-practice laws for NPs could help states meet the increasing demands for primary care services. The debate over whether or not NPs should be allowed to practice independently has been ongoing for several years, with many physicians groups opposing NP independence. However, those states and healthcare systems that have expanded the role of NPs have reported positive results, according to the report.

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.


The practitioner will see you now: Physicians oppose independent nurse practitioners

The debate about who is qualified to provide primary care rages on this week, following the release of the report Primary Care for the 21st Century: Ensuring a Quality, Physician-led Team for Every Patient  from the American Academy of Family Physicians (AAFP).  In the document, the AAFP advocates for a team-based approach to primary care–in which a physician leads a groups of nurses, nurse practitioners (NP), physician assistants (PA), and other healthcare professionals to provide comprehensive and high quality care –while criticizing proposals to allow NPs to practice independently.

A national shortage of primary care physicians has led to efforts to substitute independently practicing NPs for physicians, but the AAFP points out that NPs “do not have the substance of doctor training or the length of clinical experience required to be doctors.” While it is an inarguable fact that physicians receive several years of training and clinical experience beyond that of NPs, the debate centers more around whether NPs and PAs can provide the necessary healthcare services that patients require while maintaining a high quality of care, without the direct supervision of or collaboration with a physician.  Some states, such as Massachusetts, have already granted a greater degree of independence to advanced practice professionals.

While the AAFP’s argument for solving the primary care gap by instituting ideal ratios of NPs to physicians is compelling, and the model of physician-led healthcare teams does hold promise for improving the healthcare system, the report nonetheless seems to fan the flames when it comes to practitioner qualifications. NPs are referred to as “less-qualified health professionals” and “lesser-trained professionals” who are able to handle only patients with “basic,” “straightforward,” and
“uncomplicated” conditions. The language of the report does not seem to give NPs much credit when it comes to their training and education.

While the AAFP rules out the idea that two models of healthcare–physician-led teams and independently practicing NPs–could coexist harmoniously, one has to wonder whether ultimately the patient should be allowed to decide which model best meets his or her needs. Shouldn’t patients be trusted to make informed decisions about their healthcare? If a patient is aware of the amount of training an NP has received, is aware that it does not equal that of a primary care physician, and is comfortable with that concept, why shouldn’t a patient be able to seek those (potentially more convenient) services rather than hunt for a physician-led team model? The issue is complex, but a solution that allows all Americans to receive quality healthcare must be reached.

What are your thoughts on the AAFP report, and the debate about granting NPs autonomy? Share your comments with us!

Physician places weight limits on patients in the name of safety

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

A physician in Massachusetts gained attention last week when she announced that she would no longer accept patients who weight over 200 pounds. According to Helen Carter, MD, two of her staff members have sustained injuries from treating obese patients. One suffered a neck strain when attempting to pull out an examination table foot rest while the 284-pound patient was lying on the table, and the other staff member herniated two lumbar spine disks while performing a physical examination. According to Dr. Carter, her exam tables are ill-equipped for heavy patients, and she cannot afford the estimated $7,000 electric exam table.

In an interview for CommonHealth, Dr. Carter stated that she is not dismissing any of her current patients who are obese, but instead is encouraging them to lose weight. She compared her policy to turn away new patients who are overweight to turning away people seeking treatment for addiction, since she is not an addiction medicine specialist. She recommends that obese patients instead seek treatment at facilities with equipment designed to safely handle patients’ extra weight and specific programs to assist with weight loss.

Dr. Carter’s policy has been met by mixed reviews. Some of the sources interviewed for the articles mentioned above see the policy as discrimination against obese patients, while others agree with the policy and note that obesity is contributing to rising healthcare costs and safety issues.

It’s a difficult argument from either side, however. Dr. Carter can justify her decision under the American Medical Association’s (AMA) Medical Code of Ethics, which states that physicians may choose whom to serve, and her argument for the safety of her staff and the lack of proper equipment is compelling. However, by refusing to treat patients she is arguably putting them at risk, and possibly violating another of the AMA’s principles: providing competent medical care, with compassion and respect for human dignity and rights.

Is Dr. Carter within her rights to refuse treatment for obese patients, or does this move beyond a safety issue to one of prejudice? Share your thoughts in the comments section!

Burnout: A preventable occurrence or a likely outcome?

If you work in healthcare, it’s highly likely that you have worked with at least one colleague who has experienced burnout. It’s possible that you have suffered from burnout yourself. We’ve previously discussed nurse burnout and depression on this blog, and there have been several studies on the underlying causes of burnout, such as poor environment, staffing, lack of teamwork, as well as the effects of burnout on patient care. Most recently, a study conducted by researchers at the University of Pennsylvania showed a correlation between a high rate of nurse burnout and the number of healthcare-acquired infections.

As if the findings on nurse burnout were not alarming enough, a study recently published in the Archives of Internal Medicine found that physicians are more likely to experience burnout than other U.S. workers.  In a national survey of 7,299 physicians, 37.9% of physicians were likely to have symptoms of burnout, compared to 27.8% of a sample of 3,442 working adults. Physicians were also almost twice as likely to be dissatisfied with work-life balance than workers in other professions. Physicians practicing general surgery and its subspecialties, as well as physicians practicing obstetrics and gynecology reported the lowest rates of satisfaction with work-life balance, while physicians in emergency medicine, internal medicine, and neurology had the highest rates of burnout.

As the authors of the study point out, burnout can have serious effects on the personal and professional lives of physicians, including alcohol abuse, destruction of relationships, and thoughts of suicide. Several studies have also found evidence that burnout adversely affects the quality of care. The researchers of the physician burnout study state that the high rate of burnout among U.S. physicians “implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals.”

In an interview with HealthLeaders Media, one of the authors of the report noted that physicians affected by burnout are more likely to see other people as objects rather than people, and become callous towards others. He compared the feeling of burnout to constantly feeling emotionally exhausted and “at the end of your rope.”

It is interesting to get a perspective on physician burnout when considering the impact of job dissatisfaction and fatigue in an organization. It seems as though healthcare professionals are experiencing increasingly high rates of burnout, yet little research has been done into methods for preventing burnout. Is it possible that burnout is just a given in healthcare? Should students head into healthcare professions anticipating burnout within a decade?

We want to hear from you: has your organization ever addressed the issue of burnout? If so, how? Leave your comments below!

Do as I say, and as I do: Setting a healthy example for patients

More than one-third of U.S. adults are obese, according to the Centers for Disease Control and Prevention, and many speculate that percentage will continue growing in the coming years. With so many health issues linked to being overweight or obese, it is in the best interest of patients to listen to their healthcare professionals’ advice and move toward a healthier lifestyle and a lower weight. But what happens when physicians, nurses, and other healthcare professionals are the ones with the extra pounds?

Two students from Johns Hopkins School of Medicine asked this question, and responded by establishing The Patient Promise, an initiative aimed at addressing clinician health and encouraging physicians and other healthcare professionals to adopt the healthier habits they prescribe to their patients. The initiative’s website cited data that found 63% of physicians and 55% of nurses were overweight or obese, and pointed to additional research that showed physicians who live healthier lifestyles and are at healthier weights are more likely to address weight issues with their patients. Within a few weeks of launching The Patient Promise, 300 healthcare professionals and medical students across the country had signed the pledge to show their support.

Earlier this year, we posted on the blog about a study from the University of Maryland that examined the impacts of job stress and irregular work hours on nurses’ weight. The obesity issue, and more broadly the issue of leading a healthy lifestyle, is one that needs to be addressed, and projects like The Patient Promise are steps in the right direction. As the Patient Promise website says, “Hippocrates, not hypocrisy.” Nurses and physicians have the opportunity to lead by example and make a positive change in both their own lives and the lives of their patients; it is an opportunity that should not be wasted.

Leave a comment and let us know about any initiatives your organization has in place or is considering for promoting a healthier lifestyle among your nurses and physicians.

Nurses are twice as likely to experience depression as the general public

Most nurses would agree that a typical shift requires a high level of focus on tasks, good time management, and a positive attitude when interacting with patients. But according to a study published recently in the journal Clinical Nurse Specialist, 18% of nurses experience depressive symptoms, a rate that is twice as high as that of the general public. Symptoms of depression include low mood, difficulty concentrating, and lower total output in the workplace. Those experiencing depression are also more accident-prone and less able to perform mental or interpersonal tasks, a fact that concerns researchers due to the likelihood that a nurse’s depression could have serious ramifications for coworkers and patient care.

Nurses who are experiencing depression and are unable to perform their jobs at the high level required of healthcare professionals pose a risk to patients, as an inability to concentrate could lead to serious or fatal medical errors. Depressed nurses need to receive treatment for their illness, not only because of the potential for lower quality of patient care, but also for the personal well-being of the depressed nurse. Researchers involved in the study noted that advanced practice nurses may be the key to recognizing depression in staff nurses and educating nurses about screening and treatment for depression. By raising awareness about the prevalence of depression in nurses and treatment options, advanced practice nurses and other leaders in the organization can move the topic of depression from the realm of taboo subjects. If nurses realize that their depression will be handled confidentially in a sensitive and supportive environment, they may be more likely to seek treatment.

Does your organization have a policy for handling depression? Have you ever needed to address a concern of depression among your nurses? Please leave us a comment and share your experience.

Murse World keeps men in nursing looking their best

A couple of months ago we ran a poll on StrategiesforNurseManagers.com to find out how many men were on the staffs of our readers’ organizations, and the majority of respondents indicated that less than 10% of their staff was male. However, as noted in the article from The New York Times that sparked the discussion, the number of men working as nurses has been climbing steadily over the past few years.

One company caught on to the fact that an increasing number of men in nursing means an increased demand for men’s medical uniforms, and so the concept for Murse World was born. Murse World, the first online medical uniform store exclusively for men, stemmed from the common complaint that most uniform stores only offer a limited selection of scrubs designed for men, compared to the wide variety of scrubs available for their female coworkers.

On Murse World’s website, men can find a large selection of brand-name uniforms, such as Dickies, Ecko, and Cherokee, in a variety of colors. For those men who like to be bold, Murse World offers several scrub tops with cartoon character and superhero prints. The website celebrated its grand opening last week.