Two of the lasting images of early healthcare professionals is the doctor with their big bag making house calls and a midwife rushing to a family home to facilitate a birth. As healthcare has advanced, we’ve moved away from this home-based model toward the consolidated approach of the modern hospital. However, some practices have returned to house calls, with some positive results.
Independence at Home, a program created by the Centers for Medicare and Medicaid Services (CMS), seeks to identify patients that would benefit from homecare or cannot be helped in a hospital setting. The project sends mobile interdisciplinary healthcare teams, lead by physicians and nurse practitioner, out to the homes of these patients and provide care.
According to a recent Medscape article, the program reports a few different benefits. The patients receive more attention and care from providers, and the setting can foster trust between patient and provider. Hospitals and nursing homes can be difficult places for many patients, and they would prefer to get treatment in their homes. Terminal patients particularly benefit from this; as one provider notes, hospitals are not where people want to die.
The providers benefit from the more personalized patient relationship as well, but there are also financial incentives for homecare. CMS reports that they saved $25 million by using this system and $11.7 million of that went back to the providers. Because the system targets some of the most expensive Medicare patients, hospitals can save a lot by providing in-home care in this system. In addition to the CMS program, Veterans Affairs Medical Centers report that providing home care for some of their patients cost 12% less than standard care.
Editor’s Note: This originally appeared in the OSHA Healthcare Advisor.
In a highly-anticipated move expected to significantly affect the regulatory rules that hospitals and other healthcare facilities are held to, the Centers for Medicare & Medicaid Services (CMS) has officially adopted the 2012 edition of the Life Safety Code® (LSC).
CMS has confirmed that the final rule adopts updated provisions of the National Fire Protection Association’s (NFPA) 2012 edition of the LSC as well as provisions of the NFPA’s 2012 edition of the Health Care Facilities Code.
Healthcare providers affected by this rule must comply with all regulations by July 4—60 days from the publication date of the rule in the Federal Register.
The adoption of the rule has long been anticipated, as the LSC, which governs fire safety regulations in U.S. hospitals, is updated every three years, and CMS has not formally adopted a new update since 2003, when it adopted the 2000 edition. As a result, CMS surveyors have been holding healthcare facilities to different standards to other regulatory agencies that have gradually adopted provisions of the new LSC in their survey requirements.
Some of the main changes required under the final rule include:
- Healthcare facilities located in buildings that are taller than 75 feet are required to install automatic sprinkler systems within 12 years. after the rule’s effective date.
- Healthcare facilities are required to have a fire watch or building evacuation if their sprinkler systems is out of service for more than 10 hours.
- The provisions offer long-term care facilities greater flexibility in what they can place in corridors. Currently, they cannot include benches or other seating areas because of fire code requirements limiting potential barriers to firefighters. Moving forward, LTC facilities will be able to include more home-like items such as fixed seating in the corridor for resting and certain decorations in patient rooms.
- Fireplaces will be permitted in smoke compartments without a one-hour fire wall rating, which makes a facility more home-like for residents.
- For ASCs, alcohol-based hand rub dispensers now may be placed in corridors to allow for easier access.
Visit https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-10043.pdf to read the full final rule.
View the CMS press release here: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-05-03.html
Many companies have clear guidelines for onboarding a new hire; they often have formal training, manuals, and extra resources to help them adjust to their new responsibilities. However, many nurse leaders are promoted from within, and their training path is often less clear. As a new study suggests, the training process for internal promotions is often inadequate, and internal hires require just as much support as external ones.
Michael Watkins wrote in the Harvard Business Review about this issue, and coined the term “inboarding” to describe the process of training internal hires for their new position. About two thirds of the new hires in his study were internal; 70% of them said that their transition was as difficult as joining a new company, and 35% found the transition more difficult. This results in unnecessary failures and difficulties for the organization.
Watkins identifies the lack of support given to inboarding as one of the main reasons for this disparity. So how can an organization make inboarding easier? To start, leaders should adopt a common methodology when approaching new hires. This includes using the same framework and tools for all leadership transitions. Watkins also suggests performing a risk assessment for transitions: identify the potential difficulties (such as relocation, new business divisions, or shifts in work culture) and provide additional support for those risks. This might sound simple, but changing an organization’s culture can be difficult and the first step is identifying that internal hires need the same support as external hires.
Did you receive formal training when you got your first leadership position? Did you feel prepared for your new responsibilities? Let us know in the comments, or take our Strategies for Nurse Managers Poll.
Wednesday, April 20, 2016
In 2015, the number of millennials in the workplace surpassed baby boomers as the largest segment of workers. This future generation of nurses has very different career expectations than the generations before them. Millennials expect more feedback, greater collaboration, interaction with nurse leaders, an 8-hour workday and better work-life balance. Unlike their parents, they rarely intend to stay with one employer for their entire career—or possibly even more than a few years.
The shift in attitude has many organizations struggling to retain millennials and learning to adjust management strategies to accommodate their unique style. Join Kathy Bonser, Vice President of Nursing and CNO at SSM Health DePaul as she discusses the importance of leveraging the differences to create a win-win environment for staff and frontline leaders.
Take part in this live 60-minute webcast to:
- Uncover how making changes in leadership behaviors can bridge the generation gap
- Discover new onboarding processes that support the growing millennial workforce
- Devise a structured approach to providing regular employee feedback
- Understand the importance and value of engaging millennials early and often
- Improving nurse retention, especially in the first year after hire
- Understand communication preferences
- Text or call? How to decide
- Use of social media
- The importance of strong onboarding and engagement processes
- Scheduled touchpoints
- Celebration of milestones
- The need for performance feedback
- The need for transparency
- Explaining the why behind decisions
- Seeking out nurse feedback and acting on it
- Shedding light on how their contributions make a difference
- Live Q&A
HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. HCPro provides 1.0 nursing contact hours for this educational activity.
For more information or to register for the webcast, click here.
Last week, we discussed some of the benefits of having nurses in executive positions. It is crucial to bring a myriad of perspectives to these positions, and nurses are significantly underrepresented in hospital leadership. This week, Becker’s Hospital Review has offered up some tips about how nurses can prepare for hospital board seats.
The first thing an aspiring nurse should consider is the core competencies of the hospital board. This can be a little different for each hospital, so having a specific facility or type of facility in mind would be helpful; if you can find a facility that matches your nursing specialty, even better. Often, boards have lists of competencies, so not having the right core skills can sink an application right away.
Once you establish the required skills would need, you can begin working towards that goal. Many nurses don’t have opportunities to develop governance skills on the job, so it might be helpful to look outside the hospital for that. Volunteer board positions in their community or at a nonprofit organization can be a great way to get experience in governance and make nurses more appealing candidates for board positions.
Connections are key in this process as well. Nurses should meet with board members and the chair if possible, to better understand the board’s mission and how they might align with it. These relationships can be crucial to obtaining a board position, but also to keep it. Board members can become mentors that can teach nurses how to navigate their new responsibilities and help them through the gauntlet of new board membership.
Performance review time is never easy. Managers have the uncomfortable task of assessing their team, and the staff is uneasy about what a poor review could mean for their career; if a review goes poorly, it can lead to tension and dissatisfaction long after the review. A new study in The Nursing Management Journal proposes a new way of approaching performance reviews that could make the process a little easier on everyone.
A task force of nurse leaders from a Magnet® recognized hospital system sought to make their process more objective after receiving staff feedback that their performance reviews were too subjective. Previously, the nurse manager would evaluate staff based on the fulfillment of their job description, meeting performance outcomes, and following care commitment guidelines. The team revised the RN job description to better fit the staff’s responsibilities, then created performance metrics based around the revised job description. They hoped that this would provide the staff with measurable results for their performance review and tangible goals for improvement.
The staff responded to this new criteria-based model for reviews. The surveyed nurses said that the new system was more transparent and consistent, and they liked that the results were evidence-based and didn’t hinge on personal bias. Overall, 71.7% of the surveyed staff felt the new process accurately reflected their performance, versus the 37.8% under the previous method. So while performance reviews will always be a headache, perhaps moving to a criteria-based model will help ease the pain.
Want to receive articles like this one in your inbox? Subscribe to Nurse Leader Insider!
Changing specialties has become an integral part of a nurse’s career growth. We spoke with Elaine Foster, Ph.D., MSN, RN, Associate Dean, Nursing Graduate Programs at American Sentinel University about this trend and what nurses should consider when making a change.
“Nurses have a powerful thirst for knowledge and a strong desire to learn and grow, and this often translates into motivation to make a career change. Many will reach a time when they would like to experience different professional opportunities,” says Foster. “In the nursing world, we need to actually help people plan out their career strategies, and it would help new nurses if they received more guidance; we don’t spend a lot of time painting the overall picture of healthcare.”
So where should a nurse considering a career change start? Foster advises that a nurse should start by researching their areas of interest and finding a specialty that fits them. “Read articles, talk to nurses in that field, assess the job market in your area, and learn everything you can about the specialty you are interested in.”
Another important factor to consider is education: does the specialty require more education or certification? Foster notes that in the past, it was more common for nurses to receive on-the-job training and end up in management positions without formal training, but in recent years, nurses require formal education and credentials to advance their careers.
After conducting your research, Foster suggests talking to people currently working in the field. Networking is crucial to making a career shift, and making a connection with an experienced nurse in your field provides plenty of benefits. Shadowing a nurse in your field gives you first-hand experience with the day-to-day demands of the position, and if you do end up pursuing the new specialty, your contact could provide job leads or even become a preceptor in the future.
Finally, before you make a career change, Foster advises that you reflect on the benefits and consider the costs. “Think about how this change will impact you in the future and what you might have to give up now to get that future five years down the road,” she says. “It took ten years to get my PhD; I had to give up a few things, but I’m grateful that I did.”
For more career-shift strategies, check out American Sentinel University’s guide.
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!
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]
As promised last week, we’ve added a free download from Kathleen Bartholomew’s Ending Nurse-to-Nurse Hostility, Second Edition, in honor of being the only book chosen by the American Nurses Association as a recommended bullying and horizontal hostility prevention tool.
To access the download site for a tool you can use to evaluate the health of your workplace as regards bullying, lateral violence, and other undesirable behaviors, click here.
To read last week’s story the ANA position statement on workplace violence and the nursing profession, click here.