Human nature contributes to bias by allowing us to use psychological “shortcuts” to reduce complexity and ambiguity in the world. We all wish that life were simpler, and our brains try to accommodate this wish by finding shortcuts to decisions by relying on past patterns of thinking. This enables us to provide a rational response within the context of a simpler and less-threatening world. The two main types of bias related to human nature are personal bias and group bias.
Personal bias has two aspects: emotion and thought. These biases come from our view of the world that is created by the sum of our individual experiences: where we grew up, our parents’ values, how our friends act, and how we were trained. Although we might make conscious efforts to overcome personal bias, we all retain some degree of it as part of our individuality.
Personal bias is more likely to affect peer review when individuals are not accountable for their decisions. This is not because these are bad people—they are simply good people in a flawed system. The case studies in this book provide several examples of peer review structures and procedures that, prior to redesign, increased the likelihood of personal bias, such as having a department chair conduct the entire case review process from case screening to decision. To reduce personal bias in peer review, consider requiring reviewers to provide a written rationale for their findings (even on care-appropriate cases), having a committee make the final decision on all cases, and implementing clear conflict of interest practices.
Group bias occurs when a group of individuals has a shared set of beliefs or experiences that result in a relatively predictable way of thinking or responding. This concept of “groupthink” results in the group tending to accept information that meets its common paradigm and reject, or at least not consider, information that doesn’t fit within it.
Lack of diversity in a group can create this bias. Therefore, to avoid group bias, structure the group to ensure that other views are included. There are two types of group bias that tend to affect peer review: professional bias (e.g., physicians think differently than nurses) and specialty bias (e.g., surgeons think differently than internists). One of the main reasons that medical staffs implement some form of multi-specialty peer review committees is that such committees reduce the likelihood of groupthink by bringing all perspectives to the table.
Source: Peer Review Benchmarking
Nurses at Methodist Health claim that the hospital docks lunch pay for breaks they aren’t able to take.
Robert Straka, a nurse at Methodist Health in Dallas, filed a collective action lawsuit in August against his employer. The issue in question is the hospital policy that dictates that nurses should be allotted 30 minutes every shift to take an uninterrupted break. He argues that nurses are still expected to care for patients during their break, and would often get pulled away to perform duties. Straka filed on behalf of almost one thousand nurses across Methodist’s five facilities.
Meanwhile, Methodist argues that this is not the case, and questioned the plaintiff’s interpretation of the rules. They’ve requested that the charges be dropped in a response sent last week. The judge in the case has mandated that each party meet and produce a report next month, that would outline settlement options and hopefully come to a resolution.
There’s been a concerted effort over the last few years to provide transparency for medical industries interaction with doctors, thanks to the Physicians Payments Sunshine Act instituted by the US Senate in 2010. The Sunshine Act requires medical manufacturers, such as drug and medical supply companies, to report payments and gifts given to physicians and teaching hospitals; the goal is to ensure that doctors are not swayed to make care decisions based on financial gains and prevent conflicts of interest. Last fall, two senators proposed a bill to amend the Sunshine Act that would include nurse practitioners (NPs) and physician assistants (PAs) as well, acknowledging that NPs and PAs wrote 14% of all drug prescriptions in 2014 and require the same transparency as doctors.
A new study released this week suggests that even registered nurses (RNs) without prescribing authority could be subject to these sort of interactions with the medical industry. All of the RNs that participated in the study said they had interacted with industry over the past year, averaging 13 one-on-one meetings over the year. Many also participated in sponsored meals or events, received gift offers and product samples, and some received payments for speaking, consulting, and market research work. Most interactions were with medical device and pharmaceutical companies, but some reported interactions with health technology and infant formula industries as well.
Though RNs don’t have prescribing authority, many nurses are part of purchasing committees for their facility. RNs play an integral role in decision-making throughout their facility, and there are no regulations for transparency between RNs and medical industries. Though the sample size is small (56 RNs participated in the study), the authors of the study think the results warrant additional research and regulation. As the largest and most-trusted healthcare profession in the US, it’s important to make sure RNs maintain their trustworthy reputation with their patients.
For more information about open payments data, check out CMS’s open payments site.
More healthcare personnel (HCP) are getting their flu shots, according to a Centers for Disease Control and Prevention (CDC) study, but there are still large gaps in immunization. During the 2014-2015 flu season, 77% of HCPs were vaccinated against the flu, a 14% increase from the previous season. The highest rates of immunization—at 90.4%–was with HCPs working in hospitals.
While the increase is a positive step, it was also revealed that only 75% of nonclinical personnel had received the vaccine, including food service workers, laundry workers, janitors, housekeeping staff, and maintenance staff. The numbers were even lower for aides and assistants, with only 64% immunized. [more]
Nursing Peer Review in Action: Experienced Nurses Share Best Practices and Lessons Learned
Thursday, December 3, 2015 at 1:00-2:00 p.m. Eastern
HCPro is hosting a free webcast on December 3 about formal, case-based nursing peer review. Join Sarah Moody, DNP, RN, NEA-BC, and June Marshall, DNP, RN, NEA-BC, for a free 60-minute webcast on how incident-based nursing peer review benefits an organization and elevates nurse practice.
These experienced speakers will clarify the difference between formal, incident-based nursing peer review and the type of review that involves peer evaluation of nurses’ performance. They will demonstrate how incident-based nursing peer review can elevate quality and the professionalism of nursing through sharing case studies and lessons learned.
Moody and Marshall have many years of experience leading nursing peer review committees as incident-based nursing peer review is mandated by the Texas Nursing Practice Act.
For the full agenda and to register for this free webcast, visit http://eventcallregistration.com/reg/index.jsp?cid=58467t11.
Incidents reports are a pain to fill out, but vital for documenting what happened and for protecting yourself and your staff. This week, we’re republishing a popular post full of best practices, provided by Patricia A. Duclos-Miller, MS, RN, CNA, BC.
Yesterday we looked at the purpose of the incident report and the value of documenting facts as well as the patient’s responses to care in the nursing progress notes (see Incident Reports: Part One). Today we’ll look at eight risk reduction recommendations you should follow to limit the number of incidents you face. We’ll also give you a check list of tips for writing incident reports should adverse events occur. (I’ll make the checklist available as a PDF download in a few days, so check back for the link.)
RISK REDUCTION RECOMMENDATIONS FOR NURSE MANAGERS
- Be sure that everyone is clear as to who is managing the patient. This is especially critical in complicated cases with numerous consults. One of the major factors in adverse events is fragmentation or lack of clear communication between providers. Therefore, use the medical record as a communication tool for all providers and encourage your staff to read notes from other providers and disciplines.
- Be sure staff understand and utilize the chain of command when necessary. They are considered patient advocates and must speak on behalf of the patient to ensure quality patient care. Documentation of the chain of command process should be factual and blameless.
- Advise your staff never to create notes at home concerning the event. They should not discuss the event with other care providers without having someone from risk management present, unless the discussion is in a quality-review process or in the presence of the facility’s attorney.
- If an adverse event occurs, the staff must know that attention to patient needs is first and foremost. If a patient is injured, nursing and medical interventions take precedence over everything else.
- Follow the organization’s policy on medical-event disclosure. It is important that staff understand who is designated to inform the patient/family. Documentation should include who was present during the discussion, what information was discussed, and all of the patient/family responses.
- Ensure that the patient/family receives compassionate care and that everyone involved maintains a professional relationship.
- If an adverse event occurs, contact the risk manager. Discuss the case discretely, because conversations are not protected under a quality statute or attorney-client privilege, and therefore may be discoverable.
- Work with the risk manager. The risk manager can help you and your staff promote patient safety and proactive strategies to avoid injuries.
Incidents reports are a pain to fill out, but vital for documenting what happened and for protecting yourself and your staff. This week, we’re republishing installments of a popular post chock full of best practices, provided by Patricia A. Duclos-Miller, MS, RN, CNA, BC.
We work in high-stress, fast-paced environments. It is your responsibility as a member of the nursing management team to understand the importance of incident reports, to ensure that your staff completes them, and to investigate incidents to avoid any further occurrences. Your investigation will also provide possible defense if during your investigation you identify a system failure and take the necessary corrective action(s).
The purpose of the incident report is to refresh the memories of both the nurse manager/supervisor and the staff nurse. While the clinical record is patient-focused, the incident report is incident-focused. The benefit to you and your staff is [more]
Enjoy a FREE white paper on preceptor competency assessment and verification!
This white paper is compiled from the third edition of the groundbreaking book,
The Preceptor Program Builder, written by Diana Swihart, PhD, DMin, MSN, APN CS, RN-BC, and Solimar Figueroa, MHA, MSN, BSN, RN. It discusses and defines the competencies developed in preceptorships, explores the goals and essential elements of competency assessment and verification, and takes a close look at the categories of competencies and methods for assessing and verifying them within the context of the preceptor relationship.
Click here to download the white paper: Preceptor competency assessment and verification.
The Preceptor Program Builder provides professional development staff the keys to creating a successful preceptor program in the healthcare environment. Learn more here.
Click here to view our full range of nursing resources.
Do you have an EBP story to share?
For nurses just getting started with evidence-based practice, the steps between deciding on an area to research and implementing a plan for improvement can be overwhelming. Identifying sources of qualified research, interpreting the results, translating procedures from theory to practice… It’s complicated, to say the least.
I’m looking for a few brave souls who would be willing to share what I’m calling “EBP notes from the field.” If you’ve gone through the process from start to finish, would you be willing to share your story? I see these as 1-2 pages looking into the decision making process, the research you chose, the steps you took to get buy-in from management. What did you learn in the process? How did you implement your research? Have you been able to measure the results?
I’d like to include a few of these stories in an upcoming book project: a simple EBP guide for working professionals. It will be very practical, straightforward, and [more]
There is a connection between nurses’ feelings about
their work environments and nursing quality and safety
Rebecca Hendren recently posted about a June 2015 Healthleaders magazine article focusing on steps organizations are taking to measure and improve nursing staff satisfaction. For anyone who hasn’t yet read it, I just want to share my favorite quote from the article. In it, Linda Aiken, PhD, a nursing workforce researcher and director of the Center for Health Outcomes and Policy Research (U. Penn) is quoted as saying that
Nursing “is the single biggest factor
in how patients rate their hospitals”
Do you agree with this statement? Have you seen the impact of improvements in nursing staff satisfaction on care quality, outcomes, and patient ratings? What tools or strategies have you used to improve staff retention and satisfaction? Please leave a comment sharing your experiences with your fellow nurse leaders.
For more details on the kinds of nursing staff surveys conducted by organizations that have received designation as ANCC Magnet Recognition Program® hospitals as well as those that have not, plus the source of the headline quote (which no one would dispute!), click here to go to the HealthLeaders article.