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To err is human, but what can be forgiven?

Just one week after the news that nurses have once again been ranked as the most ethical and honest profession in the United States, a story has emerged in New Hampshire that has issues of trust and honesty in nursing at its core. Heather Stickney, a nursing student at NHTI in Concord, N.H., made the news recently when she was suspended for taking home scrubs she wore during her rotation at Catholic Medical Center. Her clinical advisor has accused her of stealing the scrubs and lying about it.

At first, it appears that the punishment is extreme for what could be described as a minor offense. After all, Stickney did not harm a patient or steal medications; she borrowed a set of scrubs to observe a procedure and said that she wanted to keep them as a memento. According to Stickney, she asked her clinical adviser whether she could keep the scrubs and was told to return them, but upon asking a man in the linen department the same question she was told she could keep them. The clinical adviser, noticing that the scrubs were still missing, gave Stickney an administrative failure, suspending her from the class and from the nursing program.

The issue raises the question as to whether Stickney’s actions should be interpreted as a “rookie mistake” or as a more significant character flaw, one that could lead to her lying about more serious offenses. Stickney has appealed the suspension and points to her otherwise exceptional record in the NHTI program, while nursing professors and nurse administrators indicate that nurses mist be trusted to tell the truth.

Errors happen in healthcare, and it is often how those errors are handled that makes the difference in the total impact of the incident. Nurse leaders are often told they must create an environment in which nurses feel comfortable coming forward and admitting to errors, rather than trying to hide them and potentially making the situation worse. Stickney made a mistake in disobeying her clinical adviser, but nothing in the news reports indicates that she has admitted to making a mistake or apologized for her actions. It may seem like a lot of fuss over a pair of scrubs, but it does highlight a need to instill values of honesty and ethics in nurses during training to carry over as they move into nursing careers.

Do you feel that Stickney’s suspension is an appropriate punishment for her actions? How would your organization handle a similar infraction? Leave a comment and let us know!

More time working with patients, less time documenting them

What would you be able to accomplish if you had one extra hour in your day? What about if you had several extra hours? Documentation, though a necessary part of healthcare, is potentially eating into hours that otherwise could be spent on patient care. Last month, MIT Technology Review wrote about a system designed by Xerox to automate and streamline some of the time-consuming tasks associated with technology, such as logging into computers, documenting details of patient care, reviewing patient files, and coordinating duties with colleagues.

According to the article, Xerox’s research into nursing documentation was spurred by a 2008 study published in The Permanente Journal that found that more than a third of nurses’ practice time was spent on documentation, with an additional 20% of nurses’ time spent on care coordination. Of the nursing practice time, only 20% was spent on patient care and 7% was spent on patient assessment and reading of vital signs.

We polled readers at StrategiesForNurseManagers.com to find out what percentage of their time was spent on documentation. Nearly half of all respondents (49%) indicated that documentation takes up more than 50% of their time, while another 22% estimated that it took 40%-50% of their time. A quarter of readers responded that 20%-40% of their day was comprised of documentation, and only 6% replied that documentation took up less than 20% of a given shift.

Given that nurses may also be working longer than their scheduled shifts to complete all documentation, and that longer shifts have been linked to nurse burnout and adverse effects on patient outcomes, is not unreasonable to connect the dots and state that less time spent on documentation could potentially improve patient outcomes and patient satisfaction. It seems that nurses would welcome any technology or system that would streamline documentation processes and allow them to get back to providing quality patient care.

Has your organization devised any methods for making documentation more efficient? Please share in the comments section!

Nurse intervention could reduce infection risk of needleless connectors

Needleless connectors for IV catheters have reduced the risk of needlestick injuries among healthcare providers but could lead to additional risks such as a catheter-related bloodstream infection, according to an article in the November issue of the American Journal of Nursing. In the article, Lynn Hadaway, Med, RNC, CRNI, describes the differences between the various types of needleless connectors currently used and lists potential complications. The article lists the following risk factors associated with needleless connectors:

Device design: The report notes that opaque or colored external housing could make it difficult to see residual blood or particulate matter, while the shape of the connection surface could cause contamination or cause difficulty in cleaning prior to connection.

User knowledge deficits: According to the report, staff training on the correct method for flushing and clamping needleless connectors is often inadequate. A 2011 survey  of healthcare workers revealed that more than a quarter of respondents did not know the specific type of needleless connector they used with short peripheral or central venous catheters, while nearly half of respondents did not understand the correct method for flushing and clamping a catheter.

Inattention to system management: Inadequate hand hygiene, nonsterile access devices, and frequent manipulation must be addressed in policies and guidelines, according to the report.

The report recommends that nurses and other staff are trained in the proper use of needleless connectors and syringes, and that facilities create written policies and procedures that address the specific types of connectors in use at that facility. Taking proper precautions could reduce the risk of infection associated with needleless connectors.

 

Simulations: A safe environment for student training

How can nursing students effectively learn to manage psychiatric patients without causing patient harm during training? Simulations could be the best answer, according to an article in the Pittsburgh Post-Gazette this week. The article profiled Ann Fallon, MSN, RN, APN, PMHCNS-BC, nursing instructor at The College of New Jersey, who uses a medical mannequin nicknamed Andrea Warhol to give students the experience of dealing with bipolar patients and other psychiatric conditions.

Prior to the exercise, students are taught about listening carefully, responding gently but firmly, and going through checklists to determine whether patients present a danger to themselves or others. Students are then placed in a room with the mannequin while Fallon delivers the audio portion of the simulation, which includes symptoms of bipolar disorder such as nonstop talking and resisting treatment. Fallon escalates or tones down the audio depending on whether or not the student is effective in communicating with the mannequin. Fallon often has another student act as the mannequin’s sometimes helpful, sometimes uncooperative sibling.

According to the article, students have responded well to the simulation and feel that it is an effective way to experience unmanageable patients with the opportunity to discuss how to best handle similar patients in the future. The use of mannequins and even actors in simulation allows students to practice appropriate responses to crisis situations, training which students can then draw upon in real-life situations. While no simulation can possibly address all the issues that could arise during actual patient care, exercises such as those conducted by Fallon can make students more confident when headed into real situations.

Did your training include simulations, or has your training program incorporated them? Do you feel simulations are an effective means for teaching nursing students? Leave a comment!

Poll results: Using technology to connect with patients

Last month, I posted about the ways that technology could improve patients’ communication with nurses but could also place a greater burden on nurses for round-the-clock care and feedback. To get a feel for how often nurses used technology and social media to interact with patients, we posted a poll on StrategiesForNurseManagers.com asking nurses and other healthcare professionals to weigh in.

Approximately three-quarters (74%) of those who participated in the poll responded that they did not use social networking sites such as Twitter, Facebook, or LinkedIn to interact with patients, while the remaining 26% replied that they do use those technologies for patient interaction.

While these results indicate that social networking sites have not become a place for healthcare communications, I still wonder whether nurses and other practitioners use other forms of technology, such as emails, listervs, or websites, to share information with patients and respond to questions about treatment plans. As mentioned previously, these resources have the potential to improve patient care, but they must be leveraged appropriately.

How do you communicate and follow up with patients outside of their scheduled appointment times? Leave a comment below!

Nurse burnout and patient dissatisfaction linked to longer shifts

The longer a nurse’s shift, the more dissatisfied the patient, according to a recent study from researchers at the University of Pennsylvania School of Nursing. Researchers found that nurses who worked shifts of 10 hours or longer were more likely to experience burnout and job dissatisfaction than nurses who worked shorter shifts. Of the nearly 23,000 nurses involved in the three-year study, 65% worked shifts of 12-13 hours; the percentage of nurses who reported burnout and/or intention to leave their job increased incrementally with the shift length.

Longer shifts not only had a negative impact on nurses, but also affected patients and patient outcomes. According to researchers, seven out of 10 patient outcomes were significantly and adversely affected by the longest nursing shifts. Additionally, higher percentages of patients reported that the sometimes or never received help as soon as they wanted, and nurses sometimes or never communicated well, in hospitals with higher proportions of nurses working longer shifts.

Researchers recommended that nurse management monitor the hours nurses worked, including second jobs, and consider restricting the number of consecutive hours worked. Nurse leadership should also “encourage a workplace culture that respects nurses’ days off and vacation time, promotes nurses’ prompt departure at the end of a scheduled shift, and allows nurses to refuse to work overtime without retribution,” according to researchers.

While this may all seem like common-sense advice, it is far easier said than done. There are so many factors that could prevent a nurse from leaving the moment a scheduled shift ends, and it would be difficult to enforce a policy for “prompt departure.” Likewise, if an organization is already facing nursing shortages, it’s unlikely that nurses will feel comfortable refusing overtime or taking adequate time off. However, these are issues that must be addressed to prevent nurse fatigue and job dissatisfaction that could put patients at risk. Researchers are correct in that change must come from the top, and nursing leadership must initiate the cultural shifts necessary to prevent burnout and ensure safe, high quality patient care.

What is the average length of nursing shifts at your organization? Have you ever noticed a correlation between the length of a shift and nursing fatigue? Does your organization have any policies in place to address these issues? Share your thoughts in the comments section!

Emergency preparation in the face of a hurricane

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

The anticipated impact of Hurricane Sandy undoubtedly led many hospitals on the east coast to reevaluate their emergency preparations, and now that the storm has hit, facilities will keep patient safety a priority in the aftermath. It is no small feat to assess the risks associated with a major natural disaster, from loss of power to compromised infrastructures and depletion of essential supplies. In addition to keeping existing patients safe, hospitals must also consider the possibility of an influx of new patients if the storm wreaks havoc elsewhere in the community. It is one thing to have disaster recovery plans sitting in a file somewhere, but another thing entirely to put those plans into action.

Healthcare Finance News highlighted the extensive preparations undertaken by Hackensack University Medical Center (Hackensack, N.J.) in advance of Hurricane Sandy’s arrival, noting that the hospital stockpiled medical supplies and medications, increased food and water supplies, and backed up essential equipment by generator. The hospital also deployed mobile satellite emergency vehicles to service the community. Each vehicle contains seven critical care beds with monitor-defibrillator capability, a portable digital X-ray unit, telemedicine capability, and a full functional mobile emergency department consisting of physicians, nurses, and operations personnel.  As demonstrated in Hackensack’s preparations, even the smallest details must be considered to ensure patient safety in the event of an emergency.

Sometimes even the best preparations can’t match the power of a natural disaster, and a hospital is forced to evacuate, as was the case with NYU Langone Medical Center in New York City. Although emergency generators kicked in, 90% of the hospital’s power went out and the hospital’s basement and lower floors filled with more than 10 feet of water. Approximately 1,000 physicians, nurses, residents, and medical students worked alongside firefighters and police officers to evacuate patients by the light of flashlights. Nurses carried several newborns down nine flights of stairs while performing manual respiration, since the respirators the newborns were on had stopped working in the power outage.

Hopefully the extensive preparations that many hospitals took will prove successful in the face of Hurricane Sandy. Even without the threat of a monster storm, hospitals are wise to review emergency plans and perform risk assessments on a regular basis; patients’ lives depend upon it.

Are you aware of your organization’s emergency procedures? How often do you review those procedures? Share your thoughts in the comments section.

Template for NPD administrative reports

Editor’s note: This feature is written by nursing professional development expert Adrianne E. Avillion, DEd, RN. Each week, Adrianne writes about an important issue in the area of professional development or answers questions for readers of the e-newsletter Staff Development Weekly.

Template for NPD administrative reports

We’ve been talking about evidence-based monitoring for nursing professional development (NPD) departments. How you present your evidence is critical. Whether you present your findings in writing or verbally you need to be concise and make an impact. All of us receive more than enough materials to read. We don’t have time (nor will our colleagues take the time) to read lengthy documents. The same concept goes for verbal presentations. How many times have we squirmed and kept glancing at our watches in meetings as a colleague makes what seems to be an endless report that could have been presented in a few choice sentences?

You need to use some type of template that summarizes your key findings. Using a template will also help keep all members of the NPD department “on track” when presenting information during department staff meetings. Here is an example of such a template.

Using this type of format allows you to quickly show not only how and why you made programming decisions based on available evidence but the positive impact education had on a specific patient outcome. There is no guess-work. All comments are “backed up” by evidence.

Editor’s note: Want to receive articles like this in your inbox each week? Subscribe to Staff Development Weekly!

Zombies, witches, and nurses?

As the end of October quickly approaches, children and adults alike are finalizing their choices for Halloween costumes, and it is highly likely that some variety of nurse costume will be among the options. The “naughty nurse” is an image that pervades our culture, and unfortunately detracts from the many positive images that nursing professionals strive to uphold.  According to an article in the Los Angeles Times, nurses are tied with ghosts at number eight in a list of the 10 most popular Halloween costumes. Why does the nurse costume remain a popular option year after year?

Halloween costumes run the gamut from scary to silly, as the article in the L.A. Times shows. Traditional costumes such as witches and vampires are joined by superheroes, princesses, and politicians. The holiday marks an occasion to become something or someone else for an evening, and of course it is all in good fun, but the trend towards the “sexy” or “naughty” nurse belittles the profession and in many ways mocks the work that nurses do each day. People who dress up as an Olympic athlete are typically showing their admiration of that athlete’s achievements; people who dress up as a naughty nurse are typically displaying a lack of originality.

Do you feel that the “naughty nurse” costume perpetuates a bad image for nurses? Share your thoughts in our comments section?

When disrespect becomes a safety issue

A dysfunctional culture rooted in widespread disrespect is a significant barrier to patient safety, and affects everyone in a healthcare organization, according to a pair of papers published in the journal Academic Medicine earlier this year. The papers’ authors identified six broad categories of disrespectful behavior, including degrading treatment of nurses, residents, and students, passive-aggressive behavior, and dismissive treatment of patients. Other behaviors included disrespect for system-wide policies and processes, disruptive behavior, and passive disrespect. The authors concluded that such behavior prohibits teamwork and undermines morale, which in turn threatens patient safety.

Most, if not all, organizations have at least one practitioner who seems intent on making everyone else miserable. While these disruptive practitioners may only be a small percent of the people working in a hospital or other healthcare facility, their behaviors and the influence of their attitudes can have much larger implications, as the authors of the papers point out. Nurses are particularly at risk for taking the brunt of a physician’s abuse; in several recent studies, more than 90% of nurses reported experiencing verbal abuse.

The second of the two papers focuses on creating a culture of respect. The paper’s authors call on an organizations leader, specifically the CEO, to initiate changes within an organization. However, anyone in a leadership position could address the need for change and begin working towards a cultural shift. The paper recommends five major tasks: motivate and inspire, establish preconditions for a culture of respect, lead the establishment of policies regarding disrespectful behavior, facilitate frontline worker engagement, and create a learning environment for resident and students. By recognizing that there is an issue with disruptive behavior and taking steps to eliminate those behaviors from your organization, you can begin to move towards a culture that is respectful and safe.

How has your organization addressed disruptive behavior in the past? Leave a comment and let us know!