Monthly Archives: December 2015

More Nurses = Better Survival

As if it isn’t bad enough to be in the hospital, some patients suffer an in-hospital cardiac arrest (IHCA)! Along with C difficile, MRSA and other nosocomial scourges, IHCA can occur for a variety of reasons. Survival is surely desired by both the patient and the hospital. As it turns out, the best way to increase the odds of patient survival is by increasing the number of nurses available to care for them, and making sure the nurses are well treated. So says the Physician’s Briefing in an article released yesterday. Here’s the link:

http://www.physiciansbriefing.com/Article.asp?AID=706195

So WHY are hospitals trying to reduce their nursing staffs and reduce their pay and benefits? It’s counter-productive! Nurses, get on your computers and spread the word: the best chance a person will ever have to survive a hospital is to go to one with an above-average number of nurses to patients and one that pays and treats their nurses well.

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You’re Terminated…

My dear friend let me know that she had received her official letter of termination yesterday, along with all of the other #Michigan68. Luckily she has already been contacted by a recruiter for a wonderful facility which is seeking Magnet status. Magnet status is an award given by the American Nurses Credentialing Center (ANCC) to hospitals that satisfy a set of criteria designed to measure the strength and quality of their nursing. Perhaps they know something that Providence/Providence Park does not know which is mainly recruitment and retention of nurses is paramount for achieving excellent quality of care and outcomes. This is supported by a June, 2015 study which found that patients are less likely to die (!) postoperatively in Magnet facilities both in uncomplicated and complicated recoveries.  According to the authors of this peer-reviewed study, this is because they have, “improved organizational hierarchy, nurse empowerment, measure and benchmark quality indicators and have more satisfied nursing staff” (Punke, 2015).

A sad state of affairs for these nurses during the holiday season, knowing that the new year brings unemployment and insecurity rather than health and wealth. The complete update can be found here:

https://www.gofundme.com/8acbtzfw?utm_source=internal&utm_medium=email&utm_content=cta_button&utm_campaign=upd_n

What a crappy thing to do a week before Christmas. It seems the Providence health system just doesn’t understand the worth of its nursing staff nor the difficulty it will have in replacing a large number of CRNAs who are now being actively recruited by other organizations. How can they be so Donald Trumpish about the whole thing? Bizarre.

The only good news is that the donations keep pouring in to the GoFundMe website. Perhaps we should start a separate one for Christmas presents for their children?

Please keep the word going out about this truly repugnant situation and the bravery of the #Michigan68. Happy holidays…

Reference

Punke, H. (2015). Do Magnet hospitals have better patient outcomes?.Beckershospitalreview.com. Retrieved 19 December 2015, from http://www.beckershospitalreview.com/quality/do-magnet-hospitals-have-better-patient-outcomes.htm

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Take the Pledge: Nurses Unite

How exciting it was to look at what’s happening with the blog today and see that it was read by someone in India. Looking at a map of the earth, it is unbelievably far away! And yet, the internet facilitates communication between nurses in all countries and cultures.

However, nurses do not always feel empowered or able to share their perspectives. There is a way for us all to work together toward achieving the vision of a healthy world – the Nightingale Initiative for Global Health (NIGH).

We have seen the power of a few dedicated nurses work to galvanize an entire community of CRNAs worldwide! We must use this experience to explore the way in which we can impact our personal practice, and bring our voices to the public in a powerful way. That is why I am urging you to take a look at the NIGH website and explore what is there for you. Here it is:

http://www.nighvision.net/

Take the pledge, join together with nurses around the world in advocating for a better world for our children and grandchildren. Their future depends upon it.

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Don’t Muzzle the #Michigan68 !

Thoughts of holidays and good will toward men lead me to believe that the #Michigan68 would be successful this week in negotiating a reasonable contract with the ostensible new employer PSJ and Providence/Providence Park administrators. Not so.

It is disappointing to report that a fair and just contract was not able to be reached, and the CRNAs have pledged to keep working for the hospital system until a new vendor/contractor can be found who will negotiate with them in good faith. They are upholding the standards of nursing by caring for their patients in a professional, safe, and dedicated manner. Their fate, however, is still in peril.

Even more so now that they are individually and collectively being threatened with lawsuits MERELY FOR TELLING THE TRUTH. Well I am telling it as loud as I can, and hope you will pass this along and do the same. We MUST INSIST on ethical and equitable treatment as medical professionals, just as we provide the same care for our patients. Nurses are the largest constituent of the health care work force and need to advocate for ourselves, our profession, and our patients. Please do all you can to spread the word and support the #Michigan68

The story directly from where it’s happening can be found here:

https://www.gofundme.com/8acbtzfw?utm_source=internal&utm_medium=email&utm_content=cta_button&utm_campaign=upd_n

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Update on the Michigan 68

Representatives from the #Michigan68 met with the hospital today (which had previously stated that such a meeting was out of the question), raised their concerns and earned some concessions. They have far exceeded their fundraising goals,and will be bringing the contract updates to the group as a whole in the next few days. Support has poured in from many, many sources, and nursing has come together to take a STAND. Read more about it here:

https://www.gofundme.com/8acbtzfw?utm_source=internal&utm_medium=email&utm_content=cta_button&utm_campaign=upd_n

I promise to keep updating the blog with news from all sectors of nursing and would be happy to present issues that readers bring forward for greater exposure. Thank you for reading and keeping nursing strong in the blogosphere, the social media world, and the “real” world.

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…and the Good News re: The Michigan 68

More press coverage, and perspectives today from Michigan. In sum, the word is OUT and it is unfavorable to the hospital and potential employer. A meeting is scheduled, without need for attorneys, and the parties will have the opportunity to hash things out face to face. Read the whole scoop here:

http://www.crainsdetroit.com/article/20151207/NEWS/151209860/st-john-providence-to-meet-wednesday-with-nurse-anesthetists-facing

Still standing strong, the #Michigan68 are making nursing history.

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Spending Healthcare $ – Who Profits?

According to a recent Bloomberg Business report (12/02/2015), healthcare spending is up. The greatest area of increase is in retail prescription drugs, driven by “Hepatitis C pills”.  Spending of dollars on hospitals increased 4.1% from 2013, and physician and other clinical services increased 4.6%. The whopper is in the area of administrative costs for private health insurance, which rose 12.4%. This includes things such as taxes and profits.

With hospitals and doctors crying about reduced reimbursement, the private insurance companies are staying strangely quiet about the impositions placed upon them by the Affordable Care Act (ACA). Probably, because they knew that a huge new market would result in greater profits for those at the top of their administrative structure.

Health care reform efforts need to tackle the next elephant in the living room – prescription drug costs. Interestingly, non-prescription supplements (vitamins, etc.)  are much less expensive in the US than in Europe, but the converse is true for prescriptions. There is much work to be done yet.

You can read the Bloomberg article here:

http://www.bloomberg.com/news/articles/2015-12-02/u-s-health-spending-up-most-since-07-fueled-by-obamacare

 

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The Nurse is Mightier than the Purse

Good news from the #Michigan68 – The hospital and anesthesia group have invited them to a meeting next week and opened the possibility up for discussion of their concerns.

Perhaps the hospital is realizing what they will lose, in addition to 68 dedicated, professional CRNAs. The ANA’s commissioned study on Nurse Staffing found:

In addition to significant patient care consequences, increased nurse turnover contributes to waste of healthcare dollars. A number of national studies have estimated that the average cost of replacing an RN ranges from $22,000 to over $64,000. These figures include termination costs; costs of unfilled positions; advertising and recruiting costs; new
staff hiring costs; and new staff training and orientation costs. In aggregate, the average hospital is estimated to lose about $300,000 per year for each percentage point of annual nurse turnover.As the average hospital RN turnover rate is 16.4%, hospitals will pay nearly $5 million dollars per year in costs associated with nurse turnover (ANA, 2015).

Figuring conservatively, that puts the cost of replacing all 68 CRNAs at $1,496,000 (22K X 68)  or a million five. A million and a half dollars. One point five million dollars. We are talking bank here. Should the proposed new contract save the hospital less than a million and a half dollars, they may well want to reconsider.

At any rate, the strength of the 68, the backing of the nursing community and the power of public perception has moved the mountain and the nurses will get an opportunity to negotiate after all. Thank you all for your part in this! Keep the faith.

Resources

American Nurses Association. (2015). New American Nurses Association Resource Helps RNs Make the Case for Optimal Nurse Staffing (11/23/15) . Retrieved 6 December 2015, from http://nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2015-NR/New-ANA-Resource-for-Optimal-Nurse-Staffing.html

Click to access Nursess-Role-in-Ethics-and-Human-Rights.pdf

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Empowering Nurses = Patient Safety

The #Michigan68 have cited declining reimbursements among the factors that led to their disgraceful firing. The ANA, in a White Paper released in September , 2015 detailed several reasons for such actions. They found:

The influx of new patients covered under the Affordable Care Act (ACA) and the growing elderly population are bringing additional cost-containment pressures to the U.S. healthcare system. These changes are also changing the nature and complexity of nursing care. Reducing professional nurse labor hours and their associated costs may be viewed as a potential cost-containment measure for hospitals. However, this strategy has a negative impact on safety for both the patient and the nurse, and ultimately leads to an increase in the cost of care.

Yes, you read it here ! An INCREASE is the cost of care. What can we do to fight this? Rely upon the Institute of Medicine’s recommendations and findings such as:

The 2001 IOM report, Crossing the Quality Chasm, stated that “fundamental changes are needed in the organization and delivery of health care in the United States.”5 Specific to nursing, The influx of new patients covered under the Affordable Care Act (ACA) and the growing elderly population are bringing additional cost-containment pressures to the U.S. healthcare system. These changes are also changing the nature and complexity of nursing care. Reducing professional nurse labor hours and their associated costs may be viewed as a potential cost-containment measure for hospitals. However, this strategy has a negative impact on safety for both the patient and the nurse, and ultimately leads to an increase in the cost of care. Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes 7 even sources that were once equivocal have come to this point of view. In 1996, IOM concluded that the evidence was insufficient to determine whether there was a causative relationship between nurse staffing and quality of care and that more research was needed.6 Since then, the relationship between hospital nurse staffing and patient outcomes has been more thoroughly and convincingly well documented, with literature connecting nurse staffing to patient mortality, failure to rescue (i.e., death following the development of a complication), readmissions, healthcareassociated infections (HAIs), patient satisfaction, and a number of condition-specific outcomes. In its much later work, IOM concluded that appropriate nurse staffing is critical to patient safety. Further, all factors point to the need for efficiently deployed nurses, working to the full extent of their education and training across varying settings of care.7,8 Highlights from three of the IOM’s more recent major nurse staffing reports can be seen below in Table 1. Table 1. IOM Reports Relating to Quality and Nursing Care—Key Points IOM Report Title (Year) IOM Conclusions Nursing Staff in Hospitals and Nursing Homes. Is It Adequate? (1996)9 The growing elderly population, especially the older elderly, will increase admissions to inpatient hospitals and nursing homes. This situation, combined with the rising acuity of patients in hospitals and nursing homes, will exacerbate the long-standing problems of staffing, including the paucity of appropriately educated and trained professional nursing personnel. Keeping Patients Safe: Transforming the Work Environment of Nurses (2004)7 The typical nurse work environment is characterized by many serious threats to patient safety. To counter threats and reduce medical errors, IOM recommended changes to workforce deployment, process design, and leadership. The Future of Nursing: Leading Change, Advancing Health (2010)8 To meet the increase in healthcare demands brought about by health reform, IOM recommended that nurses should: 1) practice to the full extent of their education/training; 2) achieve higher levels of education/ training through an improved education system that promotes seamless academic progression; and 3) be full partners, with physicians and other health professionals, in redesigning U.S. healthcare. 

-Avalere Health, LLC (2015) in Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes  [ANA White Paper] retrieved from: http://www.nursingworld.org/DocumentVault/NursingPractice/Executive-Summary-and-White-Paper.pdf

As a member of the ANA, I was able to retrieve this entire report. It is surely a great resource for all nurses seeking to make sure the quality of the care they are providing is not negatively impacted by administrative efforts to reduce staffing/expenditures. What can you do?

  1. Join the ANA if you haven’t already…there is an online membership which is very affordable.
  2. Go to the ANA website for the executive summary of this report, or contact me if you can’t find it.

Let’s MAKE history, not become a part of it!