Nursing Science, Evidence, and Policy Recommendations for Creating a Culture of Health in Home Care

(NewsWise) Due to the Affordable Care Act, hospitals are seeking ways to reduce re-admissions. Referrals to home health agencies could be a solution; yet there is wide variation in home health agencies’ ability to keep patients safely in their homes, and out of the hospital.

In the largest study of its kind, a University of Pennsylvania School of Nursing (Penn Nursing) investigation shows that home health agencies providing organizational support to their nurses get better outcomes. The best outcomes for patients, including fewest hospitalizations and transfers to nursing homes, are achieved by home health agencies that provide supportive work environments, enabling nurses to focus on patient care.

The study, “Home Health Agency Work Environments and Hospitalizations,” is published in the October issue of the leading scientific journal Medical Care. Home health is one of the nation’s fastest-growing healthcare sectors serving approximately 4.5 million patients annually. The study of 118 Medicare-certified home health agencies in 3 states investigated rates of hospitalizations and success in maintaining patients in community living arrangements.

The study’s findings are especially important as the home health industry absorbs a 14% cut in Medicare payments (3.5% for each year 2014-2017). Designed to correct overpayment, the cut is so large that the Center for Medicare and Medicaid (CMS) has calculated it will leave 40 percent of home health providers operating at a net loss by 2017. Home health agencies that reduce costs through increasing nurse workloads may be diminishing the quality of patient care.

According to the lead author, Dr. Olga Jarrín of Penn Nursing’s Center for Health Outcomes and Policy Research, “Home health care nursing is meant to help patients recover from illness and safely remain in their homes, but home care nurses are often so burdened with non-care responsibilities that patients and their families fail to receive the help they need. Home health agencies should be incentivized to enable nurses to practice to the highest level of their training and maximize time with patients, thus optimizing patient outcomes and reducing unnecessary use of expensive hospital and institutional care.”

The study received funding from the National Institute of Nursing Research (NINR), part of the National Institutes of Health, and the Agency for Healthcare Research and Quality (AHRQ).

This study establishes a mechanism for why some home health agencies have better outcomes, and is relevant to hospital and home health administrators, as well as policy makers.

The full paper can be accessed free by using the link below:

http://journals.lww.com/lww-medicalcare/Fulltext/2014/10000/Home_Health_Agency_Work_Environments_and.4.aspx

Growing RMU nursing school poised for expansion

(TribLive) Phyllis Wolfe McDonough knew she could elevate her work as a nurse practitioner with a doctorate, but it took a postcard from a Pennsylvania university she had never heard of in 2007 for her to begin her long-distance journey.

Today the 66-year-old Long Island woman, who flew to Pittsburgh six times in two years to study at Robert Morris University’s Moon campus, is among dozens of nurse practitioners who have graduated from the university’s distance-learning doctoral program.

The nation’s growing demand for nurses and the increased earning potential for nurses with advanced educations — nurse practitioners earn median salaries of $90,000 a year with master’s degrees — are fueling a boom in applications at some Western Pennsylvania nursing schools.

Enrollment in RMU’s nursing and health sciences program, which began with 18 students in 2003, grew to 793 this year. On Friday, RMU officials broke ground on a $12 million, 30,000-square-foot facility to house the program that now offers bachelor’s, master’s and doctoral programs, including wholly online degree and certificate programs.

“The School of Nursing and Health Sciences has been one of the great success stories in RMU’s recent history. In a relatively short period of time, the school has established itself as a leader in health care education and medical simulation, clinical research and community service on a global scale,” RMU President Gregory G. Dell’Omo said.

At least part of that success may be timing. The school’s nursing program began as demand for highly trained nurses was exploding.

According to the Bureau of Labor Statistics, the nation will need 1.1 million more nurses by 2020 to meet the demands of an aging population. In Allegheny County, where there are about 19,500 registered nursing jobs, the Three Rivers Workforce Investment Board estimates there are about 630 new openings for nurses a year. Demand is expected to grow 12 percent in the next decade.

Nearby universities also have been adapting to the changing demands of a growing marketplace.

Enrollment at Duquesne University’s School of Nursing increased by 32 percent in the past two years. Most of that growth occurred in a new program that allowed college graduates with other degrees to earn a nursing degree in an intense yearlong program, said Mary Ellen Glasgow, dean of the School of Nursing at the university.

At the University of Pittsburgh, 1,632 students — an increase of 44 percent during the past three years — applied to its undergraduate nursing program, which caps enrollment at 110. At the graduate level, Pitt’s doctorate of nursing practice, which enrolled eight students in 2006-07, had 189 this year, said Sandra Engberg, associate dean for graduate and clinical education at the School of Nursing.

The demand for additional nursing credentials has grown as many hospitals and health care providers, which once jumped to hire registered nurses with associate degrees or diplomas, are seeking RNs with bachelor’s degrees.

A 2010 Institute of Medicine Study that documented stronger patient outcomes with college-educated nurses called for increasing the percentage of registered nurses with bachelor’s degrees to 80 percent from 55 percent and doubling the number of nurses with doctoral degrees.

Valerie Howard, dean of Robert Morris’ School of Nursing and Health Sciences, said RMU scrambled to heed that call. In addition to traditional four-year nursing degrees, it established a program for registered nurses to earn master’s and bachelor’s degrees in two years.

In 2008, RMU started a two-year hybrid curriculum that allowed working nurse practitioners such as McDonough, who had a master’s degree, to earn doctorates in a program that requires them to spend one week on campus during each of six 15-week semesters.

“We are small. We are innovative,” Howard said. “We have the ability to move and respond to what is happening in health care.”

Howard said 95 to 99 percent of the school’s recent graduates are working, and about 80 percent stayed in the Pittsburgh area.

 

Quincy, Mass. nurse who helped at finish line describes year of guilt, anxiety, pride

(The Enterprise) Bill Dockham was so close to the first explosion that the medical tent shook around him.

With no windows to look through, Dockham had to watch on a small television as chaos suddenly broke out a few dozen feet from where he stood near the Boston Marathon finish line. Moments later, the first victims started coming in.

[Read more...]

Longer Nurse Tenure on Hospital Units Leads to Higher-Quality Care

(Columbia University Medical Center) When it comes to the cost and quality of hospital care, nurse tenure and teamwork matters. Patients get the best care when they are treated in units that are staffed by nurses who have extensive experience in their current job, according to a study from researchers at Columbia University School of Nursing and Columbia Business School. The study was published in the current issue of the American Economics Journal: Applied Economics. [Read more...]

Congratulations Jill Keeney!

Congratulations to winnerJill Keeney, who is a junior nursing major (RN, BSN) at Temple University in Philadelphia, Pennsylvania. Jill has completed several different clinical rotations in hospitals all over the Philadelphia area.  Jill is looking forward to graduating and becoming an RN in 2015!

Jill is the winner of a brand new 3M Littmann Master Cardiology Stethoscope from our 2013 SNAP drawing! 

Newly licensed RNs report having fewer job opportunities

(Nurse.com) Compared with six years ago, newly licensed RNs have greater job commitment but are more likely to work part-time, and to report that they had fewer job opportunities, according to a study. [Read more...]

Should a nurse be your family doctor?

(MetroNews)  A legislative audit recommends that advanced practice registered nurses in West Virginia be allowed to expand the scope of their care, but the recommendations do not go as far as the APRNs want.

Legislative Auditor Aaron Allred’s report suggests that further empowering APRNs to provide more primary care would help address the doctor shortage in West Virginia.  However, Allred stopped short of suggesting the nurses could operate independent of physicians. [Read more...]

Beating the burnout: Nurses struggle with physical, mental and emotional exhaustion at work

(Holland Sentinel) As educators, caretakers and lifelines, nurses take on several roles as they routinely care for patients day in and day out.

And for some, the strains of the job can eventually lead to physical, mental and emotional exhaustion, otherwise known as burnout.

“It’s really stressful,” Dawn Kettinger, spokeswoman for the Michigan Nurses Association, said. “You’re taking care of six people when you should take care of four.”

That was the case for Debra Nault.

Nault worked as an obstetrics nurse and midwife for almost 25 years at Sparrow Hospital in Lansing. It was a job she loved, but what ultimately did her in, she said, was the cultural change at work. An unnecessary increase in cesarean deliveries and medically induced labor began to make OB nursing feel like assembly line work, she said.

Nault also felt like she was losing control of her schedule, assignments and workload. As a charge nurse, she had the added responsibility of caring for patients while also running the unit.

“(Burnout) caused nearly constant frustration and sometimes guilt.

When you’re on the front lines and know what’s needed to provide quality care but do not have the resources of support, it’s very irritating. Your frustration and bad attitude can spill over to your performance and interactions.”

Nault’s experience is not rare. Nurse burnout is affecting the health care system and causing high rates of turnover in the field.

Although colleges and universities in West Michigan are generating 745 new registered nurses annually, the influx still falls short of the projected annual demand by more than 100, according to Grand Valley State University’s report “Health Check: Analyzing Trends in West Michigan 2014.”

Employment of registered nurses in Michigan is projected to grow 19 percent from 2010 to 2020.

But who will fill those jobs? According to a 2013 survey by the Michigan Center for Nursing, 42 percent of all active RNs say they plan to practice nursing for only one to 10 more years.

It’s an issue that affects everyone, Kettinger said. “More nurses are retiring earlier, and that’s a real concern for all of us in the public. We want those experienced nurses to stay on and provide quality, safe care.”

Burnout can be caused by several factors, including lack of social support, inability to control one’s work schedule or assignments, a chaotic or monotonous job and work-life imbalance. But Kettinger said short staffing is often the primary contributor.

As hospitals try to cut costs, that tactic backfires and becomes a patient safety issue.

“You’re running around taking care of people’s needs,” Kettinger said. “People describe going home at night and thinking, ‘What did I forget?’”

According to the Michigan Nurses Association, short staffing is connected to higher infection rates, higher preventable falls and higher death rates.

Similar to burnout is the issue of compassion fatigue, the emotional strain of dealing with traumatic and difficult situations on a daily basis.

The two are very connected, said Shari Schwanzl, vice president of operations and nursing for Helen DeVos Children’s Hospital.

It’s a lot like post-traumatic stress disorder. Your response to these emotional things becomes normal, and it shouldn’t be.”

One way hospitals can keep compassion fatigue from setting in, Schwanzl said, is to make sure employee assistance programs are in place. The teams should come in 24-48 hours after a traumatic situation to help employees debrief and deal with the experience.

If that kind of debriefing isn’t in place, then there’s a cumulative effect, Schwanzl said, and staff can burn out very quickly.

The pace of the job is fast and furious, Schwanzl said, and because of that, nurses need to be reminded and encouraged to find time to decompress, sleep enough at night, eat regularly and exercise.

“Our leadership responsibility is to remind people this is tough stuff but you can do a better job when you’re in a better place.”

Kettinger and Nault agree burnout has probably worsened, as the workload of the average nurse is greater today than it was 10 or 15 years ago because of more technology, documentation, electronic medical records and added nursing responsibilities.

In order to reduce burnout, the Michigan Nurses Association is hoping for the passage of a state law that would require hospitals to provide minimum nurse staffing at all times. State Rep. Jon Switalski and state Sen. Rebekah Warren have introduced two bills to address that concern.

Currently, both are waiting to be taken up by legislative committees.

If passed, Kettinger said, the bills would keep nurses from working 15- to 18-hour shifts and reaching the point of exhaustion and eventual burnout.

“In a way, it’s a broad issue with lots of subpoints, but in another way it’s very simple — nursing is a hard job, and nurses need support,” Kettinger said. “They have a legal and ethical and moral obligation to provide safe, quality care every time.”

Men proud to take place in nursing field

(News Leader) Joe Long first thought of becoming a nurse when his wife was hospitalized for a week during her pregnancy with their second child.

He now works at Mercy Hospital Springfield, taking care of patients in the intensive care unit.

“Nursing is manly,” Long said. “It’s not just for women.”

About 6.6 percent of nurses nationwide are male, according to the American Association of Colleges of Nursing. In Springfield, about 7.3 percent of nurses at CoxHealth are male. At Mercy, about 11.4 percent of the nurses are male.

The American Assembly of Men in Nursing was formed in 1971 in Michigan to provide support for male nurses. An Ozarks chapter is being started. There are also chapters in St. Louis and Kansas City. The organization also is open to women.

“It’s a very female-oriented world and we’re OK with that, but men still need to socialize,” said Paul Pope, the chapter president and a nursing instructor at Southwest Baptist University.

The executive director of nursing at Mercy Hospital Springfield is a male nurse, Kurtis Abbey.

Nurses like him have faced some of the obstacles that women entering predominantly male fields have faced. There have been lawsuits and complaints about isolation.

Rick Leroux, a nursing instructor at Southwest Baptist, got into nursing with the encouragement of his aunt. He learned how to make chitchat with children and to be absolutely honest about whether a medical procedure would hurt.

He treasures moments such as an encounter with the adult daughter of a man he had cared for who had a heart attack. She hugged Leroux and thanked him.

“Those are the moments we live for,” Leroux said.

Female employees at Mercy said they appreciate male nurses when it comes to lifting patients. They also value other qualities such as help in dealing with sometimes-disruptive families.

“We have a lot of difficult patients,” said Becky Pierce, who has worked at Mercy for about 40 years. “For each difficult patient, you have family members who sometimes need the physical presence of a man.”

Dr. Tobey Cronnell said male nurses tend to be more supportive of female doctors.

“I particularly enjoy working with male nurses as a female physician,” Cronnell said.

Long recently tended to John Goar, 73, who was admitted to Mercy Hospital Springfield after having trouble breathing.

Long gave him insulin and some other medication and then told Goar that his relatives were on their way to visit.

“He’s as good as a woman,” Goar said.

Long left Goar’s room. He was about halfway through his 12-hour shift. He doesn’t miss his previous career as a loan officer for a mortgage company.

“It’s the first time I have a job where I actually look forward to going to work,” he said.

 

From nurses and students, a new assault on inequality

(Hays Post) From the White House to the Vatican, everyone these days seems to be talking about income inequality. But our politics hasn’t kept up. Concrete proposals that could actually narrow the gap between the rich and the rest of us haven’t yet moved onto our public policy center stage. [Read more...]

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