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Creating a transgender-friendly healthcare environment starts with nurses

Nurses are often the face of their hospital; they are typically the first staff member to interact with the patient, and nurses are integral to providing a positive patient experience. In the ever-shifting landscape of culture, healthcare providers need to avoid discrimination and work to make sure patients feel at ease. While we have many resources that address cross-cultural competency (like this article from our Strategies for Nurse Manager’s reading room or the Health and Human Services’ guide), the medical community is just beginning to address how to effectively treat transgender patients. The Association of American Medical Colleges (AAMC) recently released treatment guidelines for transgender patients, and it is vital that nursing staffs help battle unconscious bias and create a safe climate for all of their patients.

In 2010, Lambda Legal found that a staggering 70 percent of transgender people had experienced discrimination in a hospital setting, and a 2011 study by the National Center for Transgender Equality and the National LGBTQ Task Force reported that 19 percent of patients were denied healthcare because of their status (via the New York Times). Because of this, 28 percent of the respondents have postponed medical care when sick and 33 percent don’t pursue preventive care because of their past experiences with medical professionals.

Better nurse education would be a great start to counteract this trend of discrimination and improve the climate for transgender patients; and when it comes to educating your staff, a little can go a long way. Part of the problem is treatment knowledge, but many of the issues could be solved with improved sensitivity training. Basic language education, such as what pronouns to use and asking the patient how they’d like to be addressed, can make a transgender patient feel at ease. Adding a gender and preferred name component to medical records and ensuring that they are up to date can greatly improve the consistency and quality of care as well.

Janis Booth, RN, shares a great example of how hospital staff can help a transgender person feel at ease from one of her readers:

“My new doctor saw my list of meds and knew immediately and opened with, ‘You look great…how long ago did you begin your transition?’ Put me right at ease, immediately, even though my name change had not caught up with their record keeping. I presented new IDs and they updated my info.”

Small things like asking the right questions in a gentle way can open up the patient and make them more comfortable, which will make your job much easier as well. Nurses get to set the tone of the patient’s experience, so properly training your staff on gender issues can make all the difference for a transgender patient in need.

Here are some great training resources on the topic:

  • You can download the full AAMC guide here.
  • WBUR has a list of tips to get you started.
  • Janis Booth’s full article has a lot of great information as well.
  • TransRecord and RAD Remedy are sites dedicated to gathering and sharing data on trans-friendly providers.

Ben Franklin’s advice to nurse preceptors

Tell me and I forget.
Teach me and I remember.
Involve me and I learn.

How do you provide preceptees with constructive advice Ben Franklin2
or feedback? Do you tell them what they did wrong and spell out how to correct it? Or do you encourage them to use critical-thinking skills to truly ingrain a personal understanding of ways to improve their practice?

Look at these two approaches to feedback, and see which you think would be more effective. (More examples excerpted from The Preceptor Program Builder can be found in the Reading Room.)

The preceptor observes the preceptee greeting the manager correctly, giving her name, and stating that she is a preceptee. However, she was not wearing her name tag.

Evaluative feedback
Your name tag is missing, and the manager
won’t like it!

Descriptive feedback
You greeted the manager according to the facility protocol.
Can you think of anything that would help your manager remember you?

The descriptive feedback encourages the preceptee to use critical thinking, which illustrates Ben Franklin’s timeless recommendation to “involve me, and I learn.”

If you would like to share “aha” moments and techniques for constructive feedback, please feel free to comment below…

Budget Item: Skis and Snowshoes for Nurses?

RN SkierThe New England winter of 2015 has made headlines across the country. According to The Boston Globe, some hospitals had to rely on the Boston police to deliver essential staff members to work, and taxis to take patients home.

The Globe also reported that “some managers at Mass. General went door-to-door on their drive into the city, picking up as many colleagues as their cars could handle, and other staffers slept overnight on mattresses in the hospital’s conference rooms because they worried they wouldn’t make it back in Tuesday.” And Boston Medical Center’s spokeswoman Ellen Slingsby reported “numerous staff members who have walked considerable distances or even skied into work in order to be here for our patients.”

Which brings me to the title of this blog. Somewhere in next year’s operational budget, nurse managers in the snowier states should consider adding funding for skis and snowshoes for staff.

The ROI is clear: Better staffing during blizzards and a healthier, more athletic staff.

Review finds quality of NP care equal to physician care

Care provided by nurse practitioners (NP) is comparable to care provided by physicians in terms of patient satisfaction, prescribing accuracy, preventative education, and time spent with patients, according to a literature review conducted by the National Governors Association. The group examined 22 articles and studies regarding scope-of-practice for NPs.

The review found that NPs could successfully manage chronic conditions such as hypertension, diabetes, and obesity, and rated favorably in gaining patients’ compliance with recommendations and reductions in blood pressure and blood sugar. The report notes that patients often stated a preference for a care from a physician when it came to medical aspects, but had no preference with regards to nonmedical aspects of care.

NPs are currently allowed to practice and prescribe independently in 16 states and the District of Columbia, while NPs in the remaining 34 states must have some level of physician involvement in order to practice. The authors of the report note that expanding scope-of-practice laws for NPs could help states meet the increasing demands for primary care services. The debate over whether or not NPs should be allowed to practice independently has been ongoing for several years, with many physicians groups opposing NP independence. However, those states and healthcare systems that have expanded the role of NPs have reported positive results, according to the report.

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?

Medicare performance penalties and incentives are in effect

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

As of October 1, two provisions of the Patient Protection and Affordable Care Act will impact Medicare payments at hospitals across the country.  The Act calls for a 1% cut of Medicare payments across all eligible hospitals. The $963 million expected to result from those cuts will be placed in a fund for redistribution among hospitals that scored well over the course of a performance period that ended last June. Hospitals’ scores are based on patient satisfaction surveys and adherence to 12 quality measures.

The Centers for Medicare & Medicaid Services predicts that approximately 40% of the hospitals will receive their 1% share of the pooled money, plus additional funding, while another 500 hospitals will received their 1% share back, without additional money. Approximately 1,377 lower performing hospitals will receive less than their 1% pool funds back.

As the payment adjustments begin to impact hospitals’ finances and the penalties increase in the coming years, it will be interesting to see how these organizations react to the incentives. The intended goal, of course, is to improve quality across the board, but how different hospitals will accomplish that goal remains to be seen.


The practitioner will see you now: Physicians oppose independent nurse practitioners

The debate about who is qualified to provide primary care rages on this week, following the release of the report Primary Care for the 21st Century: Ensuring a Quality, Physician-led Team for Every Patient  from the American Academy of Family Physicians (AAFP).  In the document, the AAFP advocates for a team-based approach to primary care–in which a physician leads a groups of nurses, nurse practitioners (NP), physician assistants (PA), and other healthcare professionals to provide comprehensive and high quality care –while criticizing proposals to allow NPs to practice independently.

A national shortage of primary care physicians has led to efforts to substitute independently practicing NPs for physicians, but the AAFP points out that NPs “do not have the substance of doctor training or the length of clinical experience required to be doctors.” While it is an inarguable fact that physicians receive several years of training and clinical experience beyond that of NPs, the debate centers more around whether NPs and PAs can provide the necessary healthcare services that patients require while maintaining a high quality of care, without the direct supervision of or collaboration with a physician.  Some states, such as Massachusetts, have already granted a greater degree of independence to advanced practice professionals.

While the AAFP’s argument for solving the primary care gap by instituting ideal ratios of NPs to physicians is compelling, and the model of physician-led healthcare teams does hold promise for improving the healthcare system, the report nonetheless seems to fan the flames when it comes to practitioner qualifications. NPs are referred to as “less-qualified health professionals” and “lesser-trained professionals” who are able to handle only patients with “basic,” “straightforward,” and
“uncomplicated” conditions. The language of the report does not seem to give NPs much credit when it comes to their training and education.

While the AAFP rules out the idea that two models of healthcare–physician-led teams and independently practicing NPs–could coexist harmoniously, one has to wonder whether ultimately the patient should be allowed to decide which model best meets his or her needs. Shouldn’t patients be trusted to make informed decisions about their healthcare? If a patient is aware of the amount of training an NP has received, is aware that it does not equal that of a primary care physician, and is comfortable with that concept, why shouldn’t a patient be able to seek those (potentially more convenient) services rather than hunt for a physician-led team model? The issue is complex, but a solution that allows all Americans to receive quality healthcare must be reached.

What are your thoughts on the AAFP report, and the debate about granting NPs autonomy? Share your comments with us!

Discrimination settlement reveals underlying diversity issues

Earlier this week, a language discrimination settlement–thought to be the largest of its kind in the healthcare industry–awarded $975,000 to immigrant Filipino healthcare workers in California who claimed they endured “harassment and humiliation” from coworkers and management, according to a recent article in the Los Angeles Times.  Nurses involved in the case, which was filed in 2010 against Delano Regional Medical Center in Kern County, Calif., alleged that the hospital forbade them from speaking any language other than English in public spaces such as hallways and break rooms. The nurses also reported being followed by other employees, who would harass them and mock their accents.  One employee claimed that a former hospital executive threatened the nurses with suspension or termination if they were caught speaking their native language.

According to the Los Angeles Times article, Delano Regional Medical Center employs healthcare workers who speak several other languages, including Spanish, Hindi, and Bengali, yet singled out Filipino employees. The terms of the settlement require the hospital to conduct anti-discrimination training and to enforce reporting and handling of discrimination complaints, which will be reviewed by an outside monitor. The hospital denies the claims and stated that it settled the lawsuit to avoid wasting financial resources.

Just a few weeks ago, The Leaders’ Lounge reported on an initiative at George Washington University to attract a more diverse group of students to the nursing profession. We followed up with a poll on StrategiesforNurseManagers.com asking readers how diverse they consider their organizations. Of those who responded, 34% said their staff is not very diverse and 40% replied that their staff is somewhat diverse.  Only 26% of respondents consider their staff to be very diverse.

It seems that establishing a staff that reflects the diverse patient population is an issue that many organizations face, and the lawsuit in California shows that it is not enough to simply attract nurses from different ethnic and economic backgrounds. Employees and leaders alike must receive diversity training, and issues of discrimination / harassment should not be tolerated. A workforce that is divided by prejudice and hostility is a workforce that fails to work together to meet goals for patient safety and high quality healthcare.

Do as I say, and as I do: Setting a healthy example for patients

More than one-third of U.S. adults are obese, according to the Centers for Disease Control and Prevention, and many speculate that percentage will continue growing in the coming years. With so many health issues linked to being overweight or obese, it is in the best interest of patients to listen to their healthcare professionals’ advice and move toward a healthier lifestyle and a lower weight. But what happens when physicians, nurses, and other healthcare professionals are the ones with the extra pounds?

Two students from Johns Hopkins School of Medicine asked this question, and responded by establishing The Patient Promise, an initiative aimed at addressing clinician health and encouraging physicians and other healthcare professionals to adopt the healthier habits they prescribe to their patients. The initiative’s website cited data that found 63% of physicians and 55% of nurses were overweight or obese, and pointed to additional research that showed physicians who live healthier lifestyles and are at healthier weights are more likely to address weight issues with their patients. Within a few weeks of launching The Patient Promise, 300 healthcare professionals and medical students across the country had signed the pledge to show their support.

Earlier this year, we posted on the blog about a study from the University of Maryland that examined the impacts of job stress and irregular work hours on nurses’ weight. The obesity issue, and more broadly the issue of leading a healthy lifestyle, is one that needs to be addressed, and projects like The Patient Promise are steps in the right direction. As the Patient Promise website says, “Hippocrates, not hypocrisy.” Nurses and physicians have the opportunity to lead by example and make a positive change in both their own lives and the lives of their patients; it is an opportunity that should not be wasted.

Leave a comment and let us know about any initiatives your organization has in place or is considering for promoting a healthier lifestyle among your nurses and physicians.

Patient experience undefined, but a top priority

A new study by the Beryl Institute, an organization that promotes better patient experiences within the healthcare system, finds that although patient experience is among the top three priorities for hospital executives, patient experience itself is still largely undefined.

The study surveyed more than 790 hospital executives and found that patient experience/patient satisfaction was ranked number two at 21%. Quality/patient safety (31%) was the number one priority, and cost reduction was ranked number three at 9%.

Despite its importance, the majority of hospital executives (73 percent) surveyed said they do not have a formal definition for patient experience. As a result, they are purposefully addressing the issue by examining the state of the patient experience in the nation’s hospitals and identifying the greatest roadblocks to implementing change, with the top three priorities being noise reduction, discharge process and instructions, and patient rounding.

Despite the challenges around the issue of patient experience, nearly 61% felt positive or very positive about their progress in addressing the issue. Forty-two percent of respondents said the most common structure for improving patient experience is a small committee that meets at their facility on a monthly basis.

Hospitals are also turning towards interactive technology to communicate with patients, according to the Beryl Institute’s latest white paper. A study based on six hospitals using technology from San Diego-based Skylight Healthcare Systems, and using scores from industry-standard Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS), showed that patient interactive systems has increased patient satisfaction scores by about 10%. Hospital educational materials and courses have increased patient satisfaction by as much as 42%.

Click here to visit the Beryl Institute website and read more information on the patient experience.

Source: Healthcare Finance News