What Nursing Can Mean--New Followers Re-post

An Article from the Nursing Center--Nurse Staffing and Inpatient Hospital Mortality

SPECIAL ARTICLE

Jack Needleman, Ph.D., Peter Buerhaus, Ph.D., R.N., V. Shane Pankratz, Ph.D., Cynthia L. Leibson, Ph.D., Susanna R. Stevens, M.S., and Marcelline Harris, Ph.D., R.N.

N Engl J Med 2011; 364:1037-1045March 17, 2011

Nurse Staffing and Inpatient Hospital Mortality

BACKGROUND

Cross-sectional studies of hospital-level administrative data have shown an association between lower levels of staffing of registered nurses (RNs) and increased patient mortality. However, such studies have been criticized because they have not shown a direct link between the level of staffing and individual patient experiences and have not included sufficient statistical controls.

RESULTS

Staffing by RNs was within 8 hours of the target level for 84% of shifts, and patient turnover was within 1 SD of the day-shift mean for 93% of shifts. Overall mortality was 61% of the expected rate for similar patients on the basis of modified diagnosis-related groups. There was a significant association between increased mortality and increased exposure to unit shifts during which staffing by RNs was 8 hours or more below the target level (hazard ratio per shift 8 hours or more below target, 1.02; 95% confidence interval [CI], 1.01 to 1.03; P<0.001). The association between increased mortality and high patient turnover was also significant (hazard ratio per high-turnover shift, 1.04; 95% CI, 1.02 to 1.06; P<0.001).

CONCLUSIONS

In this retrospective observational study, staffing of RNs below target levels was associated with increased mortality, which reinforces the need to match staffing with patients' needs for nursing care. (Funded by the Agency for Healthcare Research and Quality.)

Is this a surprise for anyone? Really?

I have read many studies that show a correlation between proper staffing an many sentinel events, i.e., not only patient mortality, but, medical errors, patient falls, pressure ulcers, and increase in infections as well.

And, OOPS..by the way, these studies have also shown that properstaffing also improves nurse satisfaction and decreases turnover rates...

My oh My, what a revelation and a shame that such a study is needed.

Re Post...From the early days

Here's a question:

How many nurses believe that point-of-care testing should benefit the staff that draws the blood, runs the tests and trouble-shoots the machinery???

I vote for Nursing Revenue from POC testing.

What do you want from NURSES of the FUTURE?

Do you want sheep? Followers who never question? Never Wonder?

Why Oh Why are hospitals going crazy about No Wait ER's? It is an EMERGENCY ROOM. NOT a doctor's office, NOT a clinic. ARRRGGGHHHHH.....IN Emergency Rooms, emergencies happen...Oh My!
And that now emergent hangnail may actually have to wait, and why would it be encouraged to STRAIGHT Back complaints that are in No Way an emergency?????

NO Wait ER's validate using the ER as a clinic or doctor's office. Validate stupidity and a waste of resources.
Many of these people should be #1 managing their symptoms at home, #2 using community resources including their local pharmacy for meds to treat nausea, vomiting  and diarrhea, fever, cough and flu symptoms, all of the basics covered in the local pharmacy aisles (OOPs, you may have to pay for that, OH and pregnancy tests can be done at the dollar store), and #3 go to your family doctor or clinic, (yes you may have to wait but that does not make the ER the appropriate place for your problem). And yes you are expected to pay for your ER visit too, though tooooooo many come in with NO intention of paying.

This is an area that all of these wonderful administrators and politicians need to focus their healthcare reform:

1) Personal responsibility for healthcare choices: you must live life to the fullest, but stop expecting people to cleanup after you, if you smoke accept the consequences, if your choose to drink to excess, do not expect a liver transplant, be compliant with your healthcare or have your palliative care plans in place.

2) Public education regarding use of the ER, hospitals, doctors offices, clinics, etc.: i.e. you can throw up more than once without running to the ER, unless its a bucket of blood. That may be impressive. And wait more than a half-hour after throwing up ONCE to call Rescue to take you to the ER. And when you call rescue, have a way to get home, your transportation is YOUR responsibility.

3) Community resources need to be expanded to 24/7 clinics with a pharmacy when overcrowded doctors offices are not available or cannot keep up, they should also be taking extra patients instead of sending everyone to the ER. Pain management centers should also be available 24/7 also with contracts that must be honored.

4) Public education of the proper use of Fire/Rescue. Do Not call them for non-emergent situations while your family that could have brought you in beats you to the ER.

5) Here is a BIG ONE Politicians: Prisoners, especially death-row inmates, have lost their rights to vote, yet they seem to have access to the best education and the best of healthcare. This is wrong when, today, people in the community who contribute and work hard can hardly afford to provide healthcare for themselves. People on death-row should have DNR on their healthcare records and never, NEVER get a transplant...LUDICROUS. Treat the active community first you could probably set up accounts from all the free stuff for prisoners...Dialysis for child molesters and rapists...Really??? Why not let nature take its course in all of these instances. Instead, because payment is fast and certain, doctors jump at treating these UN-Fine people over people who actually contribute to society.

What Nursing Can Mean--New Followers Re-post

Health Care for the Future of the Aging Population-4

A plan for adding alternative therapies to the comfort measures in place for patients in EOL situations will provide greater options in providing care. The complementary treatments such as music therapy, aromatherapy, massage, and healing touch provide significant levels of comfort. The therapies soothe patients in terminal care conditions, stimulating fond memories through scents and music and promoting pain relief via massage and healing touch. A strength is that both aromatherapy and music therapy can be provided for minimal cost expenditures. Providing both of these touch therapies could be accomplished for low to moderate financial requirements. Healing touch can be an option for patients during any bathing, turning, or moving procedures. Aromatherapy and music can be supplied to the patients at regular intervals around the clock. Massage therapy can be incorporated into the physical therapy regime for EOL patients and healing touch can be taught to the nursing care providers at all levels. An additional strength is that none of the treatments have significant risks nor will the therapies interfere with intensive care unit functions, care provision, or equipment, the staff may also benefit from the comfort provided.

Some weaknesses of the plan will include resistance and opposition by staff members to an increase in the workload if the plan does not incorporate the time required by the touch therapies. Aromatherapy and music therapy should not increase work requirements as long as the supplies are available. Another weakness may be in the lack of understanding by patients, families, and staff of the benefits of these treatments. Seeing them as giving up or encouraging death will be some views of the therapies and palliative care that will need to be addressed. Educational programs will be one of the significant costs to implementing the plan.

Opportunities of the strategic plan to implement complementary therapy into palliative care programs of ICU’s include the chance to educate the healthcare providers, public, insurance providers, and the community as a whole. The education should include not only responsible decision making for EOL health conditions but being able to choose the comfort measures desired when a terminal situation arises. Preparedness is a better measure for the increasingly sick population that will be seen in the coming years. Implementing these simple and noninvasive alternative measures into the comfort care of the dying will open the doors to integrating other complementary therapies into more healthcare situations. Here will be a chance to educate administrators and upper management about alternative treatments that often are paid for out of pocket by clients and that patients seeking these therapies will provide revenue to the facility.

What Nursing Can Mean--New Followers Re-post

Did U Ever Feel?--5

Just a thought,

That you just want to laugh out loud at all the people who come in the ER and say they are going to sue (i.e., you, the doctor, the hospital), somebody. More often than not it is the baker act who never takes drugs and only had two beers (odds on a positive urine drug screen), or the drug seeker who only dilaudid works for, or the entitled toothache , chronic back pain, or hangnail, who believes they are the most important person in the ER and should never have to wait.

One thing I have learned over the decades that I have been a nurse and the work I have done as a legal nurse consultant, is:

1) Damages have to occur for there to be a legal case

2) I have yet to see chronic pain or waiting actually kill anybody or cause damages (When I have to Yell clear in such a case, I may rethink the issue, at least after the 2nd time)

3) No one has ever had just two beers when they come into the ER, and only the truly psychotic, some diabetics or very critical head bleeds end up baker acted and have clean urine.

4) When the patient has an allergy list a mile long mostly consisting of pain medications except dilaudid, then they may really only need time and therapy.

5) When the lawyer on speed dial, bet even the lawyer doesn't answer that phone call...

The best and most true scenario of way too many ER Patients. Usually not even faking a seizure, but some complaint, to encourage the delivery of some narcotic or benzos...

http://www.youtube.com/watch?v=_m64cy1MMPg

From the ANA Smartbrief--Interesting Articles

Child psychiatric visits to EDs are becoming more prevalent
A study found that the prevalence of psychiatric visits by children to emergency departments grew from 2.4% in 1999 to 3% in 2007. Children who are underinsured accounted for 54% of such ED visits in 2007, an increase from 46% in 1999, researchers said. The findings, which were presented at the American Academy of Pediatrics National Conference and Exhibition in Boston on Oct. 14, were based on ED data from the National Hospital Ambulatory Medical Care Survey. Nurse.com (10/15)


Survey finds need for more health care workers to get flu shots
The CDC is asking health care administrators to make influenza vaccination accessible to health care workers to improve patient safety. A survey of 1,931 medical personnel found that only 63.5% were vaccinated for the 2010-2011 flu season. The flu vaccine strains for the 2011-2012 season did not change from those of the previous season, but the agency recommends annual vaccination even for individuals vaccinated last season. ClinicalAdvisor.com (10/15)


CDC: Heart disease rates in the U.S. decline
A national telephone survey in the CDC's Morbidity and Mortality Weekly Report revealed that the prevalence of coronary heart disease dropped from 6.7% in 2006 to 6% in 2010. The decline was consistent with a drop in the number of people at high risk for heart disease, including smokers and people with uncontrolled LDL cholesterol or high blood pressure, lead author Dr. Jing Fang said. CNN/The Chart blog (10/13)


Here is One we can all LOVE:


Chocolate cuts risk of stroke in women, researchers find
A Swedish study found that women who had the highest chocolate consumption, an average of about 2.3 ounces per week, had a 20% reduced stroke risk. Although the study failed to prove a cause-and-effect link between chocolate and stroke, cardiologist Nieca Goldberg said, "Chocolate does have antioxidants, and antioxidants are beneficial for your health." The findings, which were based on the diet and lifestyle of more than 33,000 women ages 49 to 83, appear in the Journal of the American College of Cardiology. USA TODAY/HealthDay News (10/10)


Septicemia the most costly condition in U.S. hospitals, AHRQ finds
The overall cost of septicemia treatment in U.S. hospitals reached almost $15.4 billion in 2009, the highest for any condition that year, according to a report released by the Agency for Healthcare and Quality. The number of hospitalizations for septicemia more than doubled between 2000 and 2009. Nurse.com (10/9)

From the ANA Smartbrief--Interesting Articles

Yeah---


Chocolate is linked to lower heart disease risk, study shows
An analysis in the British Medical Journal of seven studies that included 100,000 people found the highest levels of chocolate consumption were tied to a 37% lower risk of cardiovascular disease and a 29% lower risk of stroke compared with the lowest levels of consumption. However, the data did not differentiate between dark or milk chocolate, and any benefits could be outweighed by the high fat and sugar content of the candy, the researchers said at the European Society of Cardiology meeting. Reuters (8/29)


ANA formally recognizes emergency nursing scope, standards
The ANA has formally recognized emergency nursing as a specialty and has accepted the field's scope and standards of practice, as defined by the Emergency Nurses Association. "The criteria for attaining specialty status are rigorous, so the recognition of emergency nursing as a specialty is a significant achievement," said ANA President Karen Daley. Nurse.com (8/23)


Calif. hospitals reduce HAIs, saving an estimated 800 lives
Midway through a three-year initiative to reduce hospital-acquired infections at 160 California hospitals, officials say ventilator-associated pneumonia cases are down 41%, catheter-related urinary tract infections fell 24% last year and blood poisoning dropped 11%, saving $11 million overall. Some 800 lives have been saved because of the program, and hospital leaders say the strategy for success is simply adhering to basic staff and patient hygiene protocols, eliminating unnecessary procedures, using safety checklists, and documenting each step. Los Angeles Times (8/23)


T3 program keeps chronically ill homeless out of ED
The Sacramento clinic called the Effort partnered with Sutter Medical Center to create the T3 program - standing for triage, transport and treatment - which gives homeless people with nonemergency or chronic disease a place to stay and receive treatment so they do not end up in a hospital emergency department. By helping patients like Steven Macko, who has Crohn's disease, manage their illnesses, the T3 program has reduced ED visits at Sutter by 65% and saved $2.3 million in costs, becoming a model for other health care facilities to follow. HealthyCal.org (8/23)


Study finds few emergencies in requests for follow-up care at ED
A study of 6,675 trauma patients treated at the Johns Hopkins Hospital found that almost 90% of those who returned for follow-up care at the emergency department didn't qualify for readmission, suggesting their needs could have been addressed at outpatient clinics. Reporting in the Annals of Emergency Medicine, researchers said the odds of unnecessary visits to EDs were 60% higher among Medicaid- or Medicare-insured and uninsured patients compared with privately insured patients. HealthDay News (8/29)

What Nursing Can Mean--New Followers Re-post

Nurses need to Take Care of Nurses-6

A Nurses View of the Shortage…

As a nurse of over 20 years, there have been many changes.

Nursing continues to be a fulfilling and rewarding profession and one that’s easy to love after all of this time. Taking care of my patients and their families, making them feel better and helping them through the illnesses and life threatening diseases that often bring them to the hospital makes coming into work every day worth it. Their care often includes making snap-decisions that will help save their lives and being proficient in medications and life-saving equipment is only part of why experienced nurses are important. Sometimes the care also includes helping them on their journey to a better place, to “go gently into the night”. There are so many parts of what it takes to make the caring, supportive and knowledgeable nurse.

The decades have continually increased nursing responsibilities, experience and education. Along with this there has been very little compensation, respect or appreciation in a profession that is facing a severe shortage. Understaffing continues to be looked as a “just deal with it” issue, and when concerns arise that patient safety is compromised, many are told, “if you don’t like it you can leave”. More and more responsibility and patient load is added to nurses’ shoulders, and they can barely manage the care they have to give, much less the care they want to give. That extra TLC that can be given when time allows, often when the nurse may not have even had a chance to grab something to eat or drink, or make it to the bathroom, when all shift you have been wishing for a leg bag, is often put on hold for the next crisis taking precedence.

Well, nurses have been leaving for years, and can now leave easier than ever.

What Nursing Can Mean--New Followers Re-post

Health Care for the Future of the Aging Population-4

A plan for adding alternative therapies to the comfort measures in place for patients in EOL situations will provide greater options in providing care. The complementary treatments such as music therapy, aromatherapy, massage, and healing touch provide significant levels of comfort. The therapies soothe patients in terminal care conditions, stimulating fond memories through scents and music and promoting pain relief via massage and healing touch. A strength is that both aromatherapy and music therapy can be provided for minimal cost expenditures. Providing both of these touch therapies could be accomplished for low to moderate financial requirements. Healing touch can be an option for patients during any bathing, turning, or moving procedures. Aromatherapy and music can be supplied to the patients at regular intervals around the clock. Massage therapy can be incorporated into the physical therapy regime for EOL patients and healing touch can be taught to the nursing care providers at all levels. An additional strength is that none of the treatments have significant risks nor will the therapies interfere with intensive care unit functions, care provision, or equipment, the staff may also benefit from the comfort provided.

Some weaknesses of the plan will include resistance and opposition by staff members to an increase in the workload if the plan does not incorporate the time required by the touch therapies. Aromatherapy and music therapy should not increase work requirements as long as the supplies are available. Another weakness may be in the lack of understanding by patients, families, and staff of the benefits of these treatments. Seeing them as giving up or encouraging death will be some views of the therapies and palliative care that will need to be addressed. Educational programs will be one of the significant costs to implementing the plan.

Opportunities of the strategic plan to implement complementary therapy into palliative care programs of ICU’s include the chance to educate the healthcare providers, public, insurance providers, and the community as a whole. The education should include not only responsible decision making for EOL health conditions but being able to choose the comfort measures desired when a terminal situation arises. Preparedness is a better measure for the increasingly sick population that will be seen in the coming years. Implementing these simple and noninvasive alternative measures into the comfort care of the dying will open the doors to integrating other complementary therapies into more healthcare situations. Here will be a chance to educate administrators and upper management about alternative treatments that often are paid for out of pocket by clients and that patients seeking these therapies will provide revenue to the facility.

From the ANA Smartbrief--Interesting Articles

Robust job growth is forecast for nursing through 2018
Driven in part by the increasing focus on wellness and preventive medicine, experts project that registered nursing will have above-average growth of 22% through 2018. "It's a perennial profession. We're always going to have people with health care needs, and now nurses aren't just caring for sick people, but well people, too," said Katie Brewer, senior policy analyst for the ANA. Las Vegas Review-Journal (8/7)


But will there be enough nurse to fill the gaps that will be left by retiring professionals?


Nurses are key players in distance caregiving, experts say
Researchers said that distance caregivers -- expected to total 14 million by next year -- suffer emotional dilemmas regarding the right time to visit or call their family members and uncertainty about what is happening with them, among other findings. In the study published in the Oncology Nursing Forum, they said nurses have the ability to ease caregivers' emotional distress. "The nurse is the health care team member most likely to have an impact on distance caregiver distress by providing education tools and support," the researchers wrote Nurse.com (8/9)


States' average health insurance premiums range from $136 to $400
The average national health insurance premium is $215 a month, with rates varying from state to state, a Kaiser Family Foundation report found. The highest and lowest state averages were $400 in Massachusetts and Vermont and $136 in Alabama. However, the averages do not reflect the costs adults see when shopping for themselves, since they include prices for children, who are less expensive to cover. Kaiser Health News/Capsules blog (8/9)


Study finds no link between ED crowding, speed of heart attack care
Researchers wrote in the Annals of Emergency Medicine that the level of crowding in one Illinois emergency department didn't have a negative effect on how long it took heart attack victims to get emergency angioplasty. The average time from arrival to surgery was 65 minutes and whether the ED was crowded did not appear to affect the timing. However, arriving weekdays from 6 a.m. to 6 p.m. when the angioplasty team was at the hospital did make for a faster average treatment start. Reuters (8/11)


Nurses are on front line of hospice, palliative care innovation
Nurses are adopting innovative ways to provide hospice care services as well as guide the families of patients. For instance, Dawna White has introduced a website aimed at educating the public about hospice, while Bristol Hospice CEO Christie Franklin has developed special programs to better serve veterans as well as patients with dementia and kidney disease. Nurses are vital in providing palliative care, especially for patients who don't want to have hospice care. "Nurses can educate the public, because there is a large percentage of patients who could benefit from palliative care. We can help patients make educated decisions," said nurse Linda Fraser. NurseZone.com (8/17)

What Nursing Can Mean--New Followers Re-post

Nurses need to Take Care of Nurses-5

Nurse accountability is integral to professional nursing. Every nurse should know that with every decision and action made she/he is the one who is ultimately responsible for the patient outcomes related to those decisions and actions. Patient safety and well-being; optimization of their health and enabling the patients return to a normal functioning status should be inherent to any plans or procedures performed. Autonomy requires exercising informed judgment and competence that generally only comes with experience and time. A part of that use of autonomy is knowing when to call for help and/or call the doctor, especially, if the avenues of choices from standard orders have been exhausted. So many decisions and actions that every nurse performs on a daily if not hourly basis. Each time the patient's welfare is being considered.

This is just another reason that NURSES NEED their own ADVOCATES... 

Patient's have the whole alphabet in advocates and they BEGIN with Nurses...

Nurses should be advocating for themselves as well and be involved in all decisions regarding how they practice. Whether it is in their workplace and more importantly in the political arena...Get Involved...

From the ANA Smartbrief--Interesting Articles

Review: APRNs, doctors achieve comparable health outcomes
A review of 69 published studies indicates that advanced practice nurses, such as nurse practitioners, reach care outcomes equal to or better than those of physicians. The study "reinforces that APRNs provide effective, high-quality patient care and play an important role in improving the quality of care in the United States," researchers wrote in Nursing Economics. Nurse.com (7/28)


Families see hospice care as beneficial, but timing is crucial
Families of nursing home patients with dementia who received hospice care were at least 49% less likely than families of those who didn't have hospice care to say their needs and concerns regarding quality of care, pain management and emotional support for loved ones were unmet, according to a study in the Journal of the American Geriatrics Society. Researchers noted that families of patients who were given hospice care "too late" became more concerned about care and support and felt worse off than those whose loved ones didn't get hospice care at all. Nurse.com (7/31)


Why the lack of nursing IT funds is "a missed opportunity"
The HHS is providing $71.3 million to broaden nursing education, but Bonnie Westra of the Alliance of Nursing Informatics and the University of Minnesota's Center for Nursing Informatics said the lack of federal funds to train nurses in health IT is "a missed opportunity." The government should not shortchange "the need to educate nurses in advanced informatics positions, given the investment that HHS is making in health IT," she said. InformationWeek


Patients' perceptions don't always reflect quality of hospital care
An analysis of Medicare data conducted by USA TODAY found that more than 120 hospitals that received high ratings from patients also had high rates of death from heart attack, heart failure or pneumonia. This finding sheds light on the differences between patients' perceptions and more objective measures of quality of care, according to experts. USA TODAY (8/5)


Health care industry hired 31,300 in July
Data from the Bureau of Labor Statistics showed the health care industry gained 31,300 new jobs in July, with hospitals hiring 14,000 employees, doctor's offices hiring 6,300 and home health care services hiring 3,100. According to the report, nursing and residential care facilities had 3,200 additional staff, but at nursing homes alone 500 jobs were lost. The total gain was higher than the pre-recession monthly average of 2007. The Wall Street Journal (tiered subscription model)/Health Blog (8/5)

What Nursing Can Mean--New Followers Re-post

Nurses need to Take Care of Nurses-4

To improve political activism in nursing workforce conditions and practice issues, nurses need to be involved and aware. All levels of nursing should be involved in this process; student nurses, licensed practical nurses, registered nurses and advanced practitioners. From contact with the department of health, just in the Jacksonville area alone, the number of nurses, totals over 14,700 nursing professionals. This could be a powerful tool for improving working conditions and protecting professional practice if even a portion of these nurses become more involved and today much of this can be done through the point-and-click method.

When politicians make decisions about how nurses practice and the situations they work in, the time is now to be more aware and involved in the politics of nursing. Politicians should be educated by nurses about nursing issues.

The main feeling that many government representatives have about nurses, is that they are not organized, and that being organized is the best way to get your interests heard.

Many legislators have regular delegation meetings that often address issues and particular groups; this is one option for nurse involvement.

Helping legislators with their campaign is a good way to stimulate interest in sensitive and important nursing issues and does not require money. Congressional representative Patterson said “sweat equity” is as much or more valuable. Walking neighborhoods for a representative that is willing to listen and possibly help nurses with an issue important to you, time allowing, is an easy chore. Other options include steps as simple as stuffing envelopes or putting a sign in the yard, which he said, is often hard to get people to do.

Have well-spoken representatives (Nurses) are needed to speak in committee hearings in Tallahassee

Summertime is the key time to present issues of concern to legislators; they have recently completed the sessions for the year and are back in their home districts. This is the time to present new issues.

Know your legislators; their past successes and failures in healthcare issues, the issues they have supported or been against in the past, and know when key committee hearings are taking place.