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Nurses identify barriers and facilitators for clinical practice guideline use

Nurses’ adoption and use of clinical practice guidelines is largely affected by external barriers such as social and organizational factors, according to a study published in this month’s issue of American Journal of Nursing.  Clinical practice guidelines, which the Institute of Medicine defines as “systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances,” are designed to close the gap between evidence for best practice and actual patient care. Researchers chose to focus on nurses’ applications of clinical practice guidelines due to several previous studies that found that nurses were most often identified as being primarily responsible for ensuring patient safety.

Researchers examined responses to open-ended survey questions asking nurses about barriers and facilitators to using clinical practice guidelines. The top three most-identified categories for facilitating the use of guidelines were education/orientation/training, communication, and time/staffing/workload; similarly, these were also identified as categories in which there were barriers to guideline use. 44% of nurses responded that their ability to use guidelines was impeded by a lack of time and a heavy workload, while 25% cited a lack of education, orientation, and training and 22% cited poor communication as barriers. Researchers found that 91% of nurses identified at least one external barrier, or those outside of the individual nurse’s control, and 53% of nurses identified more than one external barrier.  Fewer than 10% of nurses identified internal barriers such as lack of awareness of guidelines or willingness to change practice to better adhere to guidelines.

The research suggests that social and organizational factors can be crucial in the use of clinical practice guidelines. Organization leaders should find ways to ensure that nurses receive sufficient education and adequate time to successfully implement guidelines. In addition, effective communication and cooperative teamwork should be encouraged and practiced by everyone within an organization. The study’s researchers conclude that nurses should ideally be involved in all stages of guideline development, implementation, and use.

How do your nurses respond to clinical practice guidelines? What are some ways you have found to ensure guideline use among your nurses? Share your thoughts in the comments section!

Social media as a healthcare business tool

American Medical News released a story last month highlighting four ways that social media can be used to improve a medical practice. By now, many people in the healthcare industry recognize that social media can be a powerful tool for communicating with patients, albeit a tool that can have terrible consequences when used incorrectly. The article from American Medical News focuses its attention on social media as a business intelligence resource and customer service tool, as well as a means for reporting to move toward improved care and outcomes. Although the article is primarily focused on how physicians can use social media, the principles discussed can be applied by any leaders within a healthcare organization.

One of the main topics of discussion in the article is using social media to gain insight into what services patients are seeking and what obstacles patients are facing. By identifying health trends and reacting with targeted programs and informational posts, healthcare leaders can use social media to address patient needs quickly and effectively.

Similarly, social media can be a platform for addressing complaints, negative comments, and feedback from patients. Practitioners should exercise caution in keeping specific details about patients offline and out of the public sphere, but can nonetheless use social media channels to provide an apology and offer to correct a situation. Ideally, the disgruntled patient feels as though his or her complaints are being addressed in a timely manner, while other patients see that customer service is a priority for the organization.

Given the ubiquity of social media in most patients’ lives, as well as the nearly non-existent cost of creating and maintaining social media sites, using these resources makes sense for any organization looking to improve patient engagement and interaction. As for any business, developing and implementing an effective social media initiative for a healthcare organization requires careful planning, proper management, and constant monitoring and maintenance. But the benefits of improving overall quality and patient satisfaction could make social media engagement well worth the effort.

What are your thoughts on social media as a tool for healthcare organizations? Does your organization use social media in the ways described here? Leave a comment and share your thoughts!

Core curricula, examinations, and national certification on the horizon for preceptors

The American Academy for Preceptor Advancement (AAPA) has selected The College Network® and LearnScale™ Solutions to develop core curricula and examinations for certifying individuals as preceptors. A lack of national standards, national certification, and consistency in development has made it difficult for the healthcare industry to validate the abilities of preceptors. AAPA, The College Network, and LearnScale aim to prepare nurses and other healthcare providers for successful careers as certified preceptors following the completion of their formal education, according to a June 14 press release from The College Network.

“Precepting is a unique specialty with its own core of knowledge and expertise associated with competent and engaged preceptors,” Diana Swihart, PhD, DMin, MSN, APN CS, RN-BC, said in the press release. Swihart has written multiple books on nurse preceptor programs and training, and has spoken at national conferences on topics related to nursing, shared governance, and staff development.

AAPA started out in 2009 as The Preceptor Certification Steering Committee, which began developing drafts of standards for preceptors, criteria for preceptor advancement, and core curriculum for certifications. AAPA was officially established earlier this year. Swihart serves as chief executive officer for the group, with Solimar Figueroa, MSN, MHA, BSN, RN, acting as chief nursing officer.


Working while sick: Is it really worth it?

It happens to everyone at some point: you wake up with a cough, a headache, or a stuffy nose, and all you want to do is go right back to sleep. But more often than not, something pulls you out of bed and you force yourself through the daily grind. After all, you can’t afford to miss that meeting or leave your colleagues in the lurch, right?

But your illness could affect those around you, particularly if you are working in a healthcare setting with patients whose immune systems may already be compromised. According to a survey published this month in the Archives of Internal Medicine, more than 50% of residents reported working at least once when sick with flu-like symptom, while 16% reported working at least three times while sick. The survey included 150 resident physicians from 20 internal medicine programs in Illinois.

The survey asked residents their reasons for working when sick, and the most common responses were that residents felt an obligation to colleagues and an obligation to patient care. Second-year residents were more likely than first-year residents to state that patient care prevented them from taking time off due to sickness, and female residents were more likely than their male colleagues to list patient care as their reason for working while sick.

In light of this research, we posted a poll on asking readers how often they worked when sick. More than 60% of participants responded that they often go into work when sick, and 20% said they always go into work regardless of feeling sick. Only 2% responded that they always stay home when sick, with the remaining 18% of respondents reporting that they rarely go into work when sick.

While it may seem harmless to suffer through a day at work despite a few sniffles or a bad cough, healthcare professionals who work while sick risk passing their illness along to patients, which could put patients at risk. A cold that seems mild in someone with a healthy immune system could have devastating consequences for an elderly or frail patient. Researchers involved in the study noted that working while sick could also cloud judgment and lead to poor decisions with regard to patient care.

Do nurses and others in your organization often work while sick? What is the typical response to those who come in when they clearly should have stayed home? Share your thoughts in the comments section!

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.

How healthcare reform has already changed the way hospitals think and operate

In terms of better quality of care (and perception thereof by the patient), healthcare reform is still an ongoing and debated process. HCAHPS and 30-day readmissions for certain conditions are already linked to reimbursement. Hospitals now publicly report all types of data to Hospital Compare, to the chagrin of many.

Quality of care is tied to reimbursement; we know what’s implemented, we know what’s coming, and we know it’s hotly debated. Should patient surveys determine reimbursement, considering surveys are inherently subjective (and perception easily manipulated)?  We know one poor customer service—not clinical care—related incident might lead a post-discharge patient to rate a hospital badly. Should this count as much as it does? Should readmissions be tied to reimbursement, considering hospitals face incredibly different challenges throughout the nation?  Is this a good idea?

It might be worth looking at how these rules have already begun to change the way hospitals educate, operate, build, and generally conduct their business.

Should hospitals install welcome signs in 10 languages, valet parking and free Wi-Fi like Maimonides Medical Center in Brooklyn? Should they buy state-of-the-art patient communication systems whose developers cling to the tie in reimbursement as their main selling argument?  Should they train nurses and physicians to communicate better, even through the repetitive use of certain key words found on the survey? Should they work on creating a quieter environment?

Should these hotel-like amenities be the focus? They may seem small and unrelated to the real issue at hand—excellent clinical care free of patient harm. But if they don’t negatively affect care, or take away from that focus—in short, if they do no harm to care, these initiatives might be important. These new reimbursement rules are forcing hospitals to think differently, to try different things. Some will work, some will not, but we will find out and learn from it. Hopefully, we will figure out what makes for a better environment, better communication, and maybe even which fun new software and other technology gadgets might be worth investing in.

The worry, I think, is ensuring clinical care doesn’t get left behind or overshadowed by new patient rooms or fancy software systems that may or may not actually aid communication. Hospitals must be vigilant and ensure that both clinical and satisfaction scores rise together in one tide. Strategic alignment toward one goal – a healthy and happy patient – must be the focus.

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

Murse World keeps men in nursing looking their best

A couple of months ago we ran a poll on 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.

Nurses’ float to honor Sally Bixby, RN at 2013 Rose Parade

Editor’s note: The following is a press release about the nurses’ float in the 2013 Rose Parade, submitted by Sharon Noot of Noot, Inc. Her contact information is located at the conclusion of this post.

Nurses’ Float to Honor Tournament of Roses President Sally Bixby, RN and all Nurses at 2013 Rose Parade

“A Healing Place” theme celebrates the unique qualities and skills of nurses

PASADENA, Calif. (May 22, 2012) – 2013 will be the first time that a nurse will be president of the Tournament of Roses, and only the second time that a woman was named to top role.   Five registered nurses in California formed a non-profit organization Bare Root to raise money and build a float to honor Sally Bixby and nursing professionals worldwide for their tireless efforts.

In 2007 this tenacious and passionate group of five registered nurses with skills that reflect the diversity of roles in nursing – management, marketing, education, and clinical expertise – began raising money in a truly grassroots fashion, sometimes $1 and $5 at a time, with help from peers in their industry.

“When we decided to build a float to honor Sally, we realized that we also wanted to honor nurses everywhere.  Nurses are really the unsung heroes of healthcare and healing,” said Monica Weisbrich, RN, president of Bare Root.

The image of the float serves as a metaphor for the healing environments nurses create through the use of their qualities and skills.  “A Healing Place” is created anywhere there is a nurse and a patient – from the hospital to the battlefield; from a school to a home; from a clinic to a specialty care center.  The words that surround and support the float explain those qualities.

To date, Bare Root has raised more than $300,000. One hundred percent of funds raised supported the development of the Nurses’ Float, with continued fundraising efforts being used for scholarships and grants to qualifying organizations.

There will be up to twelve float riders honored for their contributions to the project.  Current float riders include Providence Little Company of Mary in Torrance, Pomona Valley Hospital Medical Center, Sharp HealthCare of San Diego, St. Joseph of Orange, Huntington Hospital of Pasadena, and

The Nurses’ Float will bring unprecedented exposure to the often-overlooked profession. The event reaches 70 million viewers in 200 countries and is the 3rd most watched television event in the U.S.

For more information about the Nurses’ float, visit or the Nurses’ Float Facebook page at

An artist's rendering of the 2013 Nurses' Float


Sharon Noot
Noot Inc.

Involving patients to improve quality

Patient satisfaction is often emphasized as an overall indicator of healthcare quality, and some hospitals are taking an extra step to ensure the best possible experience for their patients. Fourteen U.S. hospitals have partnered with the organization Planetree, which recognizes and designates hospitals that meet criteria such as flexible visitation for patients’ families, patient education, healing environments, meaningful programs, and healthy, nutritious dining options. To attain Planetree designation, hospitals must pledge to put patients first and provide truly patient-centered care.

A poll conducted earlier this year by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health found that poor communication was a common complaint among people surveyed. Proponents of Planetree note that switching to a patient-centered model often results in improved communication not only between patients and staff, but also between physicians and nurses. One of the most important aspects of Planetree organizations is the involvement of patients and their families in their care.

Has your organization made an effort toward providing patient-centered care? What initiatives or programs, if any, have you put in place to involve patients in their treatment? Leave a comment below!

Perception versus practice in quality of care

Patients’ perceived quality of care varied greatly from the actual quality of care as defined by adherence to guidelines, according to a study published in the Journal of Clinical Oncology last month. Researchers surveyed 374 women receiving treatment for early stage breast cancer at New York City hospitals and asked the patients to rate the care they received. Only 55% of women indicated that they received excellent care, despite the fact that 88% of the women received care that is considered in line with the best treatment guidelines. The findings of the study could have huge implications for hospitals and other healthcare organizations, particularly as insurers use performance and quality metrics to determine reimbursement.

Several factors influenced the women’s perception of care and patient satisfaction. The ease or difficulty of obtaining initial treatment correlated to the rating of quality: 60% of women who said they received excellent care also said the process of getting care was excellent, but only 16% of women who rated care as less-than-excellent said that the process of receiving care was excellent. Race also contributed to perceptions of quality. The survey found that African-American women were less likely to report excellent care and less likely to trust their doctor than Caucasian or Hispanic women, and were more likely to say they experienced racism during the treatment process, despite the fact that there was no difference in the actual quality of medical care the women received.

Communication and interactions with medical personnel also made a difference in the perception of quality. Women who reported having good communication with their physician, a clear understanding of which staff member to turn to with questions, and generally excellent  treatment from the medical staff were more likely to rate their overall quality of care as excellent. The same group of women also felt less mistrust of the medical system.

Although this study examined only a small sample of patients, its findings can be applicable at most institutions. The researchers on the study conclude that healthcare organizations should improve the perceived quality of care by making it easier for patients to obtain care and by establishing trust between patients and healthcare staff. In both instances, clear and detailed communication could aid in improving patient perceptions.

Has your organization noticed a difference in the actual quality of care patients receive and patients’ perceptions of quality? What have you done to align the two? Post a comment below.