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Live webcast on staffing costs, featuring Pamela Hunt, BS, MSN, RN

Join Pamela Hunt, BS, MSN, RN, vice president of patient services and chief nursing executive at The Indiana Heart Hospital in Indianapolis, on May 9, 2012, 1:00-2:30 (Eastern), for a live, 90-minute webcast, Creative Ways to Trim Nurse Staffing Costs: Answers to the Six Most Pressing Concerns for Any Nurse Leader .  This webcast features expert advice from the coauthor of The Nurse Leader’s Guide to Business Skills: Strategies for Optimizing Financial Performance, and will focus on practical solutions to the financial challenges nurse managers and leaders frequently face.

During the presentation, Hunt will use real-life examples to explain practical solutions for meeting productivity targets, getting the most from nurse labor budgets, and ensuring high-quality patient care.  She will discuss important considerations for nurse leaders regarding employee satisfaction and staffing concerns. The webcast will conclude with a live question and answer session.

Hunt is an authority on the challenges of nursing leadership and business plan development. Her articles have been published in nationally recognized journals and she has lectured on the national and international levels.

Please visit www.hcmarketplace.comto learn more about this program.

Men in nursing remain a rare breed

An article in The New York Times last month reported an apparent trend of men who have lost jobs at factories, warehouses, and manufacturing plants entering the nursing profession, where their services are in high demand. Many of the men featured in the piece had been laid off from their former positions as autoworkers or factory employees and decided to make a career change by returning to school and training to become nurses. The article noted that men are usually a rarity in nursing but their numbers have been steadily increasing over the years.

Following the Times article, a poll on asked nurses to estimate the percentage of men on their nursing staffs. More than two-thirds of respondents (76%) indicate that less than 10% of their staffs consist of men. Of the remaining responses, 18% replied that 10%-25% of their staff includes men, and 5% responded that 25%-50% of their staff consists of men. Only 1% of respondents estimate that more than half of the nurses in their facility are male.

Nursing is a profession still very much dominated by women, but as The New York Times article indicates, men are a valuable addition to any nursing staff. One of the men interviewed for the article noted that two of his friends, both female nurses, encouraged him to enter their profession, while another man said he needed to overcome his own biases against men in nursing before becoming a nurse.

Are there many (or any) men among the members of your nursing staff? How do you encourage both male and female applicants to open positions on your staff? Share your thoughts and advice in the comments section!

Does the solution to the nursing shortage start with education?

There has been a lot of discussion in recent months of a looming nursing shortage caused by the anticipated retirement of Baby Boomer nurses and an increase in demand for RNs. Karen Daley, president of the American Nurses Association, recently appealed to a congressional committee to request $251 million in funding for workforce development and nursing education. Daley noted in her testimony that although the Bureau of Labor Statistics projects a 26% growth in the number of practicing nurses by 2020, a retiring nursing workforce and an aging population will create a need for more than 1 million nurses. Without the funding to train and aid the next generation of nursing students, the shortage is inevitable, according to Daley.

Support from legislators could be crucial in minimizing the nursing gap, particularly when it comes to funding for educational programs. Take, for example, the state of California, which saw its overall number of nurse practitioners double between the years 2004 and 2008 and likewise saw enormous growth in the number of RNs employed in nursing following legislation for minimum nurse staffing ratios. The number of educational programs in California also increased, but the demand for nursing education still exceeded the available spots. A survey by the California HealthCare Foundation found that insufficient funding was one of the main barriers to program expansion.

If the findings in California are any indication, it seems that Daley is correct in stating that an increase in funding for nursing education is the place to start when assessing the anticipated nursing shortage. Creating more programs to meet the demand for nursing education will lead to an increase in the number of nurses entering the workforce, minimizing the gap caused by retiring nurses and growing healthcare demands.

What do you think? Will increasing the number of educational programs address the issue of the nursing shortage, or do you feel there are more effective initiatives to be explored? Let us know in the comments section below!

Transparency…are we there yet?

Apparently not. Public reporting of surgical site infections is required in only eight states. That fact was brought to light by a new Johns Hopkins University report, which calls for more reporting. Lead author of the report, Martin Makary, MD, notes that patients still have little information when choosing hospitals.

Personally, I think the bigger issue is that public reporting gives hospitals, from the top down, a real push to do better. I think Makary does too:

“Nothing motivates hospitals to improve quality and listen to their front line staff like public reporting,” he says. “In order for the consumer to interpret publicly reported SSI rates, it is imperative that the data be collected and reported in a standardized manner,” he and his co-authors wrote.

I would have to agree. Surgical site infections not only result in 8,000 deaths a year in the U.S., they occur in 4% to 25% of patients who undergo major surgical procedures, and their cost to the healthcare system is about $10 billion annually (these stats are mentioned in the report and come from other studies).

Makary calls out state hospital associations for not supporting public reporting. What do you think? Is public reporting the way to change hospital culture?

Source: HealthLeaders Media

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

Board membership and the role of nurses in healthcare decision making

Nurses hold leadership roles in healthcare organizations, yet nurses are not perceived as leaders in healthcare decision making, according to an article in the March issue of American Journal of Nursing (AJN). The article investigates the lack of nurse representation on hospital boards, drawing data from a 2010 American Hospital Association survey of more than 1,000 hospital boards that found that only 6% of board members were nurses, compared to a 20% board membership comprised of physicians. The Institute of Medicine urged healthcare decision makers to include nursing representation on boards and management teams in its report, The Future of Nursing: Leading Change, Advancing Health, but nurses must also take initiative in developing their own skills and acquiring the competencies necessary for leadership, according to the AJN article.

What are some of the essential capabilities of board members? According to the article, nurses already possess several: personal skills, professionalism, and collaboration. Other qualities, such as an understanding of business, finance, and human resources, can be developed over time with the help of continuing education. The article also profiles several nurses who serve as board members and who share the personal traits and professional competencies that are crucial to their success.

As a nurse leader, it is important for you to establish not only your capability in managing your staff, but also your ability to contribute to the development of your organization and the services it provides. Continue to demonstrate and enhance the skills and knowledge you bring to the board, and encourage your fellow nurses to do the same. Serving as a member of the board can be a rewarding and instructive experience.

Share your thoughts: Does your board have sufficient nurse representation? Would you want to take on a more active role in leadership and decision making as a member of the board? Leave a comment below!

Room for improvement remains in preventing sharps injuries

Although there has been substantial progress in reducing needlestick injuries in U.S. healthcare settings since the Needlestick Safety and Prevention Act (NSPA) of 2000, there is still room for improvement, according to a statement released by the International Healthcare Worker Safety Center and endorsed by the American Nurses Association. Data collected from both the EPINet Sharps Injury Surveillance research group in Virginia and the Massachusetts Sharps Injury Surveillance System in recent years shows that nurses sustain approximately 35% of total sharps injuries, while workers such as housekeepers, administrative staff, and clinicians sustain 30% of sharps injuries. The most common settings for injuries are patient rooms and surgical settings, according to the statement.

The statement also identifies five key areas for progress in reducing sharps injuries in healthcare workers: improving sharps safety in surgical settings, understanding and reducing exposure risks in non-hospital settings such as clinics and home healthcare, involving frontline healthcare workers in the selection of safety devices, addressing gaps in safety devices, and enhancing education and training. Each improvement area includes statistical information and recommendations for action.

This statement serves as a pertinent reminder that laws alone cannot guarantee a safe and injury-free work environment. You must continue to educate your staff on safe practices when using and disposing of needles, and remind them of the hazards involved with sharps injuries, including exposure to bloodborne viruses. You must also act as an advocate for the selection of safer devices to further prevent the risk of injury; you and the members of your staff should have be able to voice opinions on which sharp devices best suit your needs.

Weigh in below: what has your organization done to reduce rates of needlestick injuries? How do you work to establish a culture of safety with regard to sharps injuries?

Facebook photos lead to jail time for nursing assistant

How would you respond to disturbing images or posts by an employee on Facebook? The Regency Pacific Nursing and Rehab Center in Portland, OR, did not like the pictures posted on Facebook by nursing assistant Nai Mai Chao, and fired her following a conviction of invasion of privacy. Images of elderly or disabled patients using bed pans and the contents of the bed pans, dating back to April 2011, appeared on Chao’s Facebook wall; Chao admitted to posting the photos but denied taking them. In addition to losing her job, the 26 year old nursing assistant spent eight days in jail, surrendered her nursing certificate, has been ordered to write a lengthy apology to a patient, and is forbidden from working at any job caring for children or the elderly in the next two years.

Social networking sites can be wonderful tools for nurses looking to connect with others in their profession or stay informed with the latest news about nursing. However, these sites also blur the line between one’s personal and professional lives, and people tend to forget that they are sharing pictures, information, and comments not only with their friends but also with the rest of the online world. There’s a good chance the majority of your staff participates in some form of social media, and addressing appropriate and inappropriate uses for these sites is crucial to prevent not only outrageous incidents like the one involving Chao, but also more innocent-seeming posts that still put patient privacy in jeopardy.

Talk with your nurses about privacy policies and how Facebook posts about their jobs or their patients can lead to trouble, no matter how innocuous the information may seem. Remind your nurses that although they may utilize the maximum privacy settings to prevent information or photos from spreading, their Facebook friends could still “share” content with their own networks and reach unintended audiences. Develop and enforce a social media policy that clearly states what is considered inappropriate use and outlines the consequences of violating the policy. As social media permeates all aspects of personal and professional spheres, taking these actions and being proactive about Facebook and social media use is a must for nurse leaders.

What are your policies on social media? How do you address concerns about privacy when it comes to Facebook and other sites? Leave us a comment and let us know your thoughts!

Can you head off nurse burnout by hosting a nursing salon?

Communication is a key part of the nursing profession, and successful nurses must effectively communicate and collaborate with colleagues to ensure a high level of quality and patient care. While much has been written about the necessity of communication between nurses on the job, there is not an abundance of information or research regarding the frequency and the potential benefits of nurse socialization outside of the workplace.

A recent poll on asked nurses how often they spent time with fellow nurses outside of working hours. Of the respondents, 46% reported that they rarely spent time with their colleagues, and 23% said they never spent time with other nurses from their unit when not working.  Most of the remaining respondents (29%) indicated that they occasionally spent time with fellow nurses, while only 2% spent non-working hours with other nurses on a weekly basis.

Meeting with other nurses outside of the hospital could provide opportunities for nurses to talk about issues and concerns regarding their profession and potentially relieve feelings of burnout. It might give nurses a chance to vent about work-related frustrations or help them rediscover the reasons they chose to become nurses. This is the theory behind nursing salons, which have been gaining popularity in many areas; these events provide a casual atmosphere in which nurses can connect with one another and share their thoughts.

While it does not need to be an official or mandatory event, inviting the nurses in your unit to come together outside of their shifts could promote conversation and foster improved relationships among colleagues. It would also let nurses connect with you and express themselves in an informal, non-threatening environment.

Would you consider hosting a nursing salon or a get-together for the members of your unit? Do you think such an event could be beneficial? Share your thoughts in the comment section!

Ask your staff: How can we earn your trust?

Every time I explore a quality improvement initiative with a hospital for Patient Safety Monitor Journal, I always ask two questions:

  • What was your biggest challenge?
  • What advice would you give to other hospitals?

Especially as of late, the answers revolve around just culture. Quality directors, nurse managers, patient safety professionals, CNOs all tell me the biggest challenge is staff trust and buy-in; the key to success is involving them in the process. We all know the key to improving is knowing what’s wrong, but unless there’s trust between the organization and the staff, you won’t find out that information.

The most recent AHRQ Culture of Safety survey – Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Reportleads me to believe perhaps the knowledge of how to improve culture and safety is there, but it’s not yet in practice to the fullest extent.

This is a big survey, including data from more than a half million healthcare staff from more than 1,000 hospitals, and deserves a good look:

Teamwork within a unit was strong; 80% of respondents agreed or strongly agreed to that sentiment. Generally, staff felt that management supported them and a culture of safety, and that the organization was including systems meant to support staff and reduce errors. To me this says that the talk is there: Staff members are aware that managers and leadership care about safety, and those systems should support them, not hinder them. Seventy-five percent say that management’s actions show dedication to patient safety; 72% believe the systems are in place to prevent mistakes.

Yet when it comes to reporting or speaking up, staff are still wary. Only 62% felt there was communication openness in their organization, and the lowest scoring domain was nonpunitive response to error, with only 44% positive response to questions related to the subject.

When it gets more specific – and more personal–the rates drop lower. Most interestingly is the difference between these two questions:

  • Staff will freely speak up if they see something that may negatively affect patient care: 75% agree/strongly agree
  • Staff feel free to question the decisions or actions of those with more authority: 47% agree/strongly agree

To whom staff must speak their concerns seems to be a critical indicator as to whether they actually will. This is certainly an issue with culture. The vast majority of respondents (76%) had direct patient involvement, and 35% were nurses. Considering disparate levels of authority create the team responsible patient care, I find this low response to that particular question quite concerning.

Also noteworthy: exactly half believed mistakes are held against them. It’s no wonder the survey indicates vast under-reporting of adverse events, a claim supported by the recent report by the inspector general of the Department of Health and Human Services.

I think the next step for hospitals is to find out what it will take for staff to trust hospitals. What will it take to get a nurse to report an adverse event he or she was involved in? Or demand a time out be performed to a surgeon?

Such a large shift in thinking might take time, as we all know in decades past healthcare has been notoriously punitive. Still, perhaps we should start by asking our staff what it will take to earn their trust. After all, involving them has been the key to so many other instances of quality improvement success.

First published on Patient Safety Monitor Blog

All I’m asking is for a little respect

It’s no secret that nurses and physicians do not always maintain the friendliest interactions, and occasionally nurse-physician relations can become downright hostile. Poor relationships between nurses and physicians can lead to communication issues, increased errors, and a lower quality of patient care.  Although both parties might feel as though they are behaving cordially, a recent industry survey by HealthLeaders Media revealed a disconnect between nurses and physicians when asked about disrespect and physician abuse. While 42% of nurse leaders felt that disrespect of nurses was common, only 13% of physicians perceived disrespect as a common occurrence.

Communication issues seem to be the major cause for the disparate perceptions of disrespect toward nurses, according to the survey. For example, physicians who are looking to save time and want to hear only key data tend to interrupt or cut off nurses giving a more detailed report. Physicians often don’t realize their actions may be perceived as rude or disrespectful, according to HealthLeaders Media.

But what about physicians who are intentionally disrespectful of nurses? In his blog post “Listening to nurses is key to being a good doctor,” a physician who writes under the pen-name Doctor Grumpy, MD, asserts that “if you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do.” He continues on with an example of a fellow physician who ignored a nurse’s concerns about a patient’s heart, telling her rudely that he had already looked at the EKG. The patient, as it turned out, had developed a heart murmur, and listening to the nurse would have addressed the issue sooner and prevented the physician from being reprimanded. Doctor Grumpy demonstrates that an amiable relationship between nurses and physicians is not only possible, but also beneficial to both parties, and to the quality of care provided in an organization.

How can nurse leaders help improve nurse-physician relations? Communication is a major step in the right direction. Remind your nurses to treat physicians with respect, and encourage them to bring up any concerns about physician behavior. If nurses are uncomfortable directly addressing a disrespectful physician, they should share their concerns and perceptions of physician behavior with you. Communicate with the physician that his or her behavior has been perceived as rude or disrespectful, and take the conversation from there. By raising awareness of how actions and words are perceived by others, you can move toward creating a respectful and productive work environment.

We want to hear from you: have you noticed a lack of respect between nurses and physicians in your organization? Have you taken any steps to address these concerns?