Nursefriendly.com: unsafe staffing levels

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Wednesday, May 11, 2011

ANA GOVA (nursingworld) on Twitter

ANA GOVA

@nursingworld

ANA Gov't Affairs is leading the fight for nurses on Capitol Hill. Follow us as we make sure that the issues facing nurses & their patients are front & center.

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nursingworld ANA GOVA

Thx @RepMcCarthyNY for supporting HR 876: Registered Nurse Safe Staffing Act of 2011! www.safestaffingsaveslives.org #nationalnursesweek

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connecticutjoe Rep. Joe Courtney

by nursingworld

Great news! Aetna announced rate CUTS for health insurance due to new consumer protections in #HCR law. http://bit.ly/jgrAtf #ctpolitics

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AmerPsychNurses APNA

by nursingworld

International Nurses’ Day, New Zealand style! nzdoctor.co.nz/un-doctored/20…

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mnt_medicare MNT Medicare News

by nursingworld

HHS Offers New Tools To Help States Lower Medicaid Costs, Provide Better Care http://mnt.to/3VJx #medicare

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Monday, March 21, 2011

When Nurse Staffing Drops, Mortality Rates Rise: Study

When nurse staffing levels fell below target levels in a large hospital, more patients died, a new study discovered.

The finding may provide guidance in an era of nursing shortages and cost-cutting, in that the focus should shift from cost to patient safety, said the authors of the research, appearing in the March 17 issue of the New England Journal of Medicine.

"Hospitals need to know what their nursing needs are for their patients, and they need to bring staffing into line," said study senior author Jack Needleman, a professor of health services at the School of Public Health of the University of California Los Angeles.

"Patients are entitled to be safe in the hospital and to have care delivered reliably and to have nurses with enough time to make sure they aren't developing avoidable complications with permanent consequences," Needleman said.

via businessweek.com

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Saturday, March 19, 2011

101 Blog Posts Every New Nurse Should Read Nurse Practitioner Schools

Nursing requires almost superhuman strength, stamina, and compassion. And due to its nature, none involved in the profession practice in a vacuum. Both students and recent graduates preparing to enter into their studies or career should look to the experiences of their predecessors for information and inspiration. Some have plenty to say about the profession and their particular specializations. Others prefer discussing the education and exams that lead into a nursing career. And still others take to activism and patient advocacy to ensure the needs of the community and their patients are met. All of them have valuable perspectives to offer those starting to dip their comfortable shoe-clad toes into the field.

1. “Uh oh” at code blog

One nurse shares her very first professional experience after graduating, which involves how she dealt with a patient’s relentless requests for excessive pain medication. Those new to nursing ought to ponder over the myriad different patients they will encounter in their careers.

2. “Flight Nurse: A Life of Training and Trauma” at CRZEGRL, FLIGHT NURSE

This guest post by John C. Lee, Jr., SRN reflects upon the responsibilities and experiences of working as a nurse on Lifeflight helicopters. It is one possible career path for nursing students and recent graduates to consider.

3. “The Travel Nursing Cost of Living Calculator” at TravelNursingBlogs.com

All careers – not just nurses – can benefit from this extremely valuable tool, which helps people understand how much they need to make in order to maintain a certain standard of living when transitioning from one city to another.

via nursepractitionerschools.org

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Thursday, March 17, 2011

The #1 stressful thing about being a nurse, Scrubsmag.com

So, we all know there are a million things that ‘stress’ us out during our shifts. Do I really need to list them? Here are just a few that come to mind:
Causes of Stress
Inadequate staffing
Nurse-to-staff ratio overload (does the word unsafe come to mind)
Lack of teamwork
Lack of effective and fair management
Coworker strain
Paperwork
Endless charting – repeating information on multiple forms
Miscommunication or the lack of communication
Census overload and strain (revolving door of admissions and discharges)
No time to even use the bathroom

via scrubsmag.com

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Wednesday, March 16, 2011

Don't bring stress home with you, Scrubsmag.com

As a nurse, I don’t think we will ever be able to eliminate stress. I think a certain amount of stress is expected in our line of work. I mean, let’s get real. We’re in the business of saving, and improving the quality of lives here. Stress is just part of the game.
But, just like an athlete playing a ‘game’, we need to leave it all on the field. Yeah, it’s a loose analogy, but it goes a long way. Athletes leave it all on the field and we nurses should leave it all at work.
Bringing stress-related issues home with you just compounds the original problem(s). We have a tendency to take that high-octane paced environment and just keep on driving until we drive it on home. Then you’re ‘wired for sound’ for your significant other or family member. You end up being unpleasant and short-fused with persons who really have nothing to do with your stress. Yet, these are the people that usually have to figure out how to deal with it? So then your level of stress gets even higher since you have no solution.

via scrubsmag.com

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Friday, March 11, 2011

Safe Staffing Saves Lives - ANA's National Campaign to Solve the Nurse Staffing Crisis

Nurses everywhere rank staffing as their biggest problem. Research shows it is a problem – for patients: Insufficient nurse staffing is linked with poorer patient outcomes, lengthened hospital stays and increased chance of patient death.

ANA’s Solution to Staffing

ANA advocates solving the problem by requiring hospitals to set nurse staffing plans for each hospital unit based on changing conditions:

Patient acuity (severity of illness)

Patient numbers

Nurse skills and experience

Support staff

Technology

via safestaffingsaveslives.org.

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Monday, February 21, 2011

Are 12-hour shifts safe? Donna Cardillo, MA, RN - American Nurse Today

Are 12-hour shifts safe?

Donna Cardillo, MA, RN

12-hour shifts have become the norm in hospitals and most nurses love them. One can work 3 days and have 4 days off, there is one less major shift change to contend with, and patients have fewer names and faces to get acclimated to in a 24-hour period. It all makes sense on the surface.

But is working 12 consecutive hours in a fast-paced, high stress, physically and mentally demanding environment a good idea? Does it support the clear judgment, quick thinking and reflexes, and life and death decisions that we must make in the acute care setting?

I know a few nurses who do three 12-hour shifts a week, at least two of the shifts on two consecutive days. Some nurses do three consecutive 12s. Factor in commuting time, shift transition (it can sometimes take 1-2 extra hours to actually finish up), time to get ready for work—never mind making time (if at all) for family or self and they’re lucky to get 5-6 hours of sleep if that. Compound that with the fact that many nurses no longer take meal breaks or even short breaks during their shift to rest and refresh because they believe they don’t have the time or they don’t make the time. This is a recipe for disaster.

via americannursetoday.com

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Thursday, January 13, 2011

CMS 30-minute rule for drug administration needs revision, ISMP.org

In our June 17, 2010 newsletter, we covered a precarious topic best known as the “30-minute rule”—a requirement in the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation Interpretive Guidelines to administer scheduled medications within 30 minutes before or after the scheduled time (see pages 174-175 at: www.cms.gov/manuals/Downloads/som107ap_a_hospitals.pdf). In our July 2010 nursing newsletter, Nurse Advise-ERR, we asked frontline nurses who are most directly affected by the 30-minute rule to weigh in on the issue by completing a short survey. And WOW, did they ever! More than 17,500 nurses responded to our survey, providing more than 8,000 additional comments (see Table 1 on page 2 of the PDF version of the newsletter), making it very clear that the issue is of great significance to nurses.
Respondent profile and compliance rates
Almost half of the responding nurses work on medical/surgical units, and the other half work in critical care, telemetry, or specialty inpatient units. Most nurses feel that the 30-minute rule is unsafe, unrealistic, impractical, and virtually impossible to follow. Approximately three out of four respondents (70%) told us their organization enforces such a policy. Of these nurses, only five of every 100 (5%) were always able to comply with the policy, while more than half (59%) were infrequently or only sometimes compliant (see Graph 1 on page 6 of the PDF version of the newsletter). Why nurses find it difficult to comply with the 30-minute rule was expressed by many (see Table 2 on page 3 of the PDF version of the newsletter), including a nurse who sent a pragmatic yet eloquent account of a Day in the Life of a Nurse (see Sidebar that follows this article).

via ismp.org

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Thursday, November 18, 2010

Mass. aims to cut drug overuse for dementia - The Boston Globe

State regulators and the Massachusetts nursing home industry are launching a campaign today to reduce the inappropriate use of antipsychotic medications for residents with dementia — a practice that endangers lives and is more common here than in most other states.

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During the next year, a team of specialists will identify nursing homes with successful methods for avoiding overuse of antipsychotics and determine which homes need help cutting back. Nursing home staff will be taught how to deal with aggressive and difficult behaviors, often displayed by dementia patients, without resorting to antipsychotics to sedate them.
In 2009, 22 percent of Massachusetts nursing home residents who received antipsychotic medications did not have a diagnosis for which the drugs were recommended — the 12th highest rate of inappropriate antipsychotic use in the nation, the Globe re ported earlier this year.
Twice in the past five years, federal regulators have issued nationwide alerts about troubling and sometimes fatal side effects when antipsychotics are taken by people with dementia, often Alzheimer’s patients.
Specialists say that understaffing sometimes prompts overuse of these medications to help control dementia patients’ behavior, but that inappropriate use can also be traced to lack of training in alternative approaches.
“There is a knowledge gap between the front-line workers — the nurses — and the black-box warnings on these medications,’’ said Laurie Herndon, a geriatric nurse practitioner who is leading the initiative for Massachusetts Senior Care, the trade group representing the state’s 430 nursing homes. A black-box warning is the most serious type of caution used in prescription drug labeling.
“We wanted to avoid talking at them, and instead provide educational material they can use,’’ Herndon said.
Campaign details will be unveiled at the association’s annual meeting today in Worcester, which is expected to draw about 900 people.
Alice Bonner, the state’s top nursing home regulator, said she appointed a task force to study the overuse of antipsychotics in nursing homes and develop alternative approaches after the Globe highlighted the problem in Massachusetts earlier this year. The task force includes nursing home physicians, nurses, social workers, and pharmacists, along with elder advocates, researchers, and state surveyors who monitor the quality of the facilities.
Bonner, director of the Bureau of Health Care Safety and Quality in the Department of Public Health, said the state, given its budget problems, does not have new resources to devote to the campaign, but is working with legislators and the Patrick administration to get new funding in the next state budget. The trade association intends to apply for grants from nonprofit groups to fund the initiative.
“No one is going to plunk a whole lot of money in our laps,’’ Herndon said, “but that shouldn’t stop us.’’

Bonner said that the task force has already identified low-cost approaches used by some nursing homes. One approach involves more careful screening of patients when they are admitted, which includes gathering more detailed information from families about the patient’s personality before the onset of illness. This, Bonner said, helps staffers tailor care and activities to each patient.
“They get a good sense of who a person was before they began to suffer with dementia, what kinds of things they like to do, and what kinds of things their family can tell us makes them calm or gets them engaged,’’ Bonner said.
“When you see a nursing home with a low rate of antipsychotics, very often you will see these programs,’’ she said.
Bonner also said that nursing homes that give workers consistent schedules that allow them to work with the same patients have also been successful.
“That helps reduce difficult behaviors with patients with dementia because staff knows the patients so well, they pick up on early signs of trouble and prevent a catastrophic event, so they can intervene early,’’ she said. Consistent schedules have the side benefit of helping nursing homes retain their workers longer, Bonner said. “Once this is in place, it turns out it is less expensive because staff turnover is expensive,’’ she said.
The education campaign will draw on the work of Dr. Susan Wehry, a geriatric psychiatrist and associate professor of psychiatry at the University of Vermont College of Medicine. Wehry recently concluded an intensive, nine-month pilot project in four Vermont nursing homes that taught all staffers, from housekeepers to medical directors, alternative approaches, such as using music and massage, to manage difficult patient behaviors.
The program, she said, helped identify which alternatives work, which don’t, and how challenging the mission can be.
Wehry is still analyzing the results but said preliminary findings showed that in one of the homes where the administrator made all of the training sessions mandatory for staff, antipsychotic use was dramatically reduced. A third of the patients with dementia had been prescribed antipsychotics before the program, and not one was on them by the end, she said.
“They were much improved in terms of staff-resident interactions and level of alertness,’’ Wehry said. “And they looked happier.’’
Data from another home that did not make all of the training mandatory showed no change in the number of dementia patients given the medications. Wehry said a more troubling trend also emerged there — one of the physicians switched from giving antipsychotics to prescribing antianxiety medications.
“If all we do is shift the burden, then all we have done is create a different set of problems,’’ Wehry said. “Our goal is not to just reduce our reliance on antipsychotics, but to change [patient] behaviors.’’
Kay Lazar can be reached at klazar@globe.com

via boston.com

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Wednesday, May 11, 2011

ANA GOVA (nursingworld) on Twitter

ANA GOVA

Monday, March 21, 2011

When Nurse Staffing Drops, Mortality Rates Rise: Study

Saturday, March 19, 2011

101 Blog Posts Every New Nurse Should Read Nurse Practitioner Schools

Thursday, March 17, 2011

The #1 stressful thing about being a nurse, Scrubsmag.com

Wednesday, March 16, 2011

Don't bring stress home with you, Scrubsmag.com

Friday, March 11, 2011

Safe Staffing Saves Lives - ANA's National Campaign to Solve the Nurse Staffing Crisis

Monday, February 21, 2011

Are 12-hour shifts safe? Donna Cardillo, MA, RN - American Nurse Today

Thursday, January 13, 2011

CMS 30-minute rule for drug administration needs revision, ISMP.org

Thursday, November 18, 2010

Mass. aims to cut drug overuse for dementia - The Boston Globe

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