Nursing shortage? What nursing shortage?

My husband went to Ohio last week to visit family and came home with a story about a nurse that I could hardly believe.

He and our son-in-law were sitting in a pizza parlor near Youngstown, which is in the northeast corner of the state, about an hour southeast of Cleveland. It’s an economically depressed area and has been in a slide ever since the steel mills began closing—about the mid-70s, as I recall.

As my husband and son-in-law were deciding between pepperoni or mushroom, a young woman came over to take their order. The three got to chatting and my husband learned that the waitress had recently graduated from the BSN program at Youngstown State University. So what was she doing working in a pizza parlor?

She said that she couldn’t find a full-time job in nursing that offered benefits and so was working two part-time nursing jobs as well as this part-time job at the pizza restaurant. Her goal was to save enough money to “get out.” She wasn’t sure where she’d land, but California was on her short list.

Of course, I had a million questions—none of which my husband asked—and some comments.

The first question would have been: I can’t believe there are no full-time jobs for nurses in the Youngstown area. Is there no shortage in Ohio?

I’ve read so much about the aging nursing workforce, the aging population that will need more nurses, and the lack of nursing instructors, which means a limited ability to turn out more nurses. All in all, it’s the perfect storm for a huge shortage of nurses—one that exists now, but predicted to get much worse.

The next question of this nursing grad would’ve been something about health insurance—like how can an employer who hires nurses NOT offer health insurance? (Yet more evidence of our inadequate and awful health care insurance problem.)

Were I there, I also would’ve told this graduate to go West, young woman, and bring your friends. California, as well as other Western states, is begging for nurses. The demand is high and the pay is good. Some places offer signing bonuses and other extras if you recruit a friend.

So what is the employment situation where you live?

Are nurses in short supply or is it difficult to get a job?

Is it difficult to get a job with benefits?

Tell us what you think.

When life gives you lemons, make lemonade!

This blog is a follow-up to my most recent blog in which I discussed the new regulations coming from the Centers for Medicare and Medicaid Services (CMS) regarding hospital-acquired conditions.

As of October 2009, CMS will no longer reimburse hospitals for things such as pressure ulcers, patient falls, catheter-associated urinary tract infections, vascular catheter-associated infections and ventilator-associated pneumonia. CMS has decided they shouldn’t pay for problems caused by institutional error or poor nursing care.

While some are busy finding fault with these new regulations, others see this as a golden opportunity for nurses to get the recognition and the working conditions they deserve. They say it’s an ideal time to highlight the link between quality nursing care and good outcomes.

For the record, nurses thought about these things long before CMS did.

In 2004, with the direction of nurses, the National Quality Forum (a nonprofit quality-measurement organization) developed its own list of 15 “nursing-sensitive care measures.” In a nutshell, the committee said that collecting data on the relationship between good nursing care and good outcomes has never been a priority—perhaps because of the expense involved.

Looks as if things may be changing, though.

Nurses have known all along, of course, that outcomes are better with good nursing care, made possible by adequate staffing and the right tools. Most hospitals have chosen to ignore what seems obvious because of cost considerations, but maybe CMS has finally gotten their attention: Provide good nursing care or lose money—not a difficult concept.

To paraphrase one nursing executive: Nurses now will be able to make an economic case to administrators that investing in their nursing staff is not only the right thing to do, it's also good business.

What do you think?

New Policy on Hospital-Acquired Problems: Medicare/Medicaid Won't Pay

If you go into the hospital, you have a one in 10 chance of something going wrong or picking up some bug that you didn’t bring in with you, according to the Centers for Disease Control and Prevention.

That number seems pretty high to the Centers for Medicare and Medicaid Services, so it announced about six weeks ago that after Oct. 1, it won’t be paying for the costs associated with fixing mistakes and treating hospital-acquired infections.

This decision won’t affect patients’ bills; the hospital will have to absorb the costs.

If you haven’t yet seen it, here is the CMS list of hospital-acquired problems for which it won’t pay:
• Foreign object retained after surgery
• Air embolism
• Blood incompatibility
• Stage III and IV pressure ulcers
• Falls and trauma
• Fractures
• Dislocations
• Intracranial injuries
• Crushing injuries
• Burns
• Catheter-associated urinary tract infection
• Vascular catheter-associate infection
• Surgical site infection-mediastinitis after coronary artery bypass graft

To come: an additional list of eight conditions for which CMS will not reimburse hospitals. They include:
• Surgical site infections following these elective procedures: total knee replacement; laparoscopic gastric bypass and gastroenterostomy; ligation and stripping of varicose veins.
• Legionnaires' disease
• Glycemic control problems - diabetic ketoacidosis; nonketotic hyperosmolar coma; diabetic coma; hypoglycemic coma.
• Iatrogenic pneumothroax
• Delirium
Ventilator-associated pneumonia
• Deep-vein thrombosis/pulmonary embolism
• Staphylococcus aureus septicemia
• Clostridium difficle-associated disease

Do you agree with CMS’ decision to cease paying for hospital-caused problems?

What measures or changes are being implemented at your workplace to decrease the incidence of hospital-acquired problems?

Do you think they will work?

Tell us what you think.

Google, Google Everywhere

I’m not sure, but I think Google ise taking over the world.

In mid-June, Blue Cross Blue Shield of Massachusetts announced that it will be the first insurer to participate in Google Health, an online personal health record service. It is offering this service to its three million members for nothing. Nada. Zip. And for that price, here’s what Google says the BCBS members can do, according to an Associated Press story in the Boston Herald:
• They can decide whether to open accounts or not; it is optional.
• They can decide who can access their health records.
• They can review their claims and some medical records, which the insurer says will help patients manage their care and have more productive discussions with physicians.
• They can link their medical records to certain pharmacies so that when they get new prescriptions, these will automatically be added to their records.
• They can delete their records at any time.

The insurer provides some information (I’m not exactly sure what this means), but the sum of the information depends upon the use of electronic health records by a physician, according to the story.

On first impulse, this seems pretty cool.

Each person could have one medical record—although it might not be complete—and the record would be available at any time and any place via the Internet. This would certainly save paper. And proponents of using Google Health tell me that participants will be able to check their lab results as soon as they are posted. No calls to the doctor’s office; no waiting while the staff unearths the results and returns your calls.

On the other hand, the idea of my medical record floating out there in cyberspace is a little scary.

I went to the Google Health site and it seems that there are additional “services,” not all of which I understand. And although everyone promises security, we all know there are super-geeks in the world who can crash any security wall. I shudder to think about how gleeful pharmaceutical companies would be to access my record or yours. Think of the mailing list they could amass to sell their products.

And do we really want the insurance companies to have such potential access to our records?

What do you think?

Is creating medical records on the Internet a good thing?

What concerns do you have?

How could it make our lives better or worse?

Needlesticks: Major Concern for Most Nurses

When you’re in a hurry—and what nurse isn’t—mistakes happen. And if you’re talking about needles, one mistake can change your life.

Most nurses are pretty scared of getting stuck by a used needle, according to a recent nationwide survey of 700 nurses. And their fears are great enough that they influence their job decisions and how long they might stay in the profession.

Here’s what the 2008 Study of Nurses’ Views on Workplace Safety and Needlestick Injuries found:

• More than two-thirds of the nurses surveyed said that needlestick injuries and blood-borne infections are major concerns.
• More than half believe that their workplace safety negatively impacts their personal safety.
• Almost nine out of 10 said that safety concerns influence their decisions about what types of nursing they do and how long they’ll continue doing it.
• Nine out of 10 also believe their workloads impact workplace safety.

And here are the frightening statistics:

• Despite safety syringes, 64 percent of nurses report being accidentally stuck by a needle.
• In three-fourths of these cases, the needles are contaminated.
• One in five victims doesn’t report the accident.
• Less than half of needlestick victims are treated within two hours.

In case you didn’t know (one-third of nurses don’t, said the survey), Congress passed a law in 2000—the Needlestick Safety and Prevention Act. It mandates that institutions conduct an annual product review, and that nurses be involved when it comes to picking the types of syringes that the institution uses. This year, two-thirds of those surveyed said they had no opportunity to do that—up from 57 percent in 2006.

(For complete results of the survey, visit: http://nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2008PR/WorkplaceSafetyTopConcerns.aspx.)

So what is it like in your workplace?

Have you ever experienced a needlestick, and if so, what happened?

Do you feel there is an adequate system in place for dealing with the sticks?

Do you like the type of syringes used in your workplace?

Tell us what you think.

How Do Nurses Spend Their Time?

I’m not a rocket scientist, nor do I have an MBA, but there are some things that it doesn’t take advanced degrees or protracted studies to figure out.

Like the fact that it was never a good idea to manufacture or buy SUVs.

Oil is a finite resource, so it’s going to run out someday. Even if there were no China sucking up millions of barrels of oil, we conspicuous consumers in America were going to cause the wells to run dry sometime in the not-too-distant future. Dwindling supplies mean rising prices. Duh.

And how about the latest news regarding Starbucks’ turn of economic events?

There are four Starbucks within a mile-and-a-half in my neighborhood—two of them across the parking lot from each other—and I don’t even live in Seattle. If I did, I’d see a Starbucks on every block; hence I was not surprised to hear that Starbucks is closing about 700 of their 7,000 stores. Duh.

So, nurses, do we need a two-year study to tell us that we can’t spend enough time at the hospital bedside? Duh.

Nevertheless, you have to have numbers to back up your arguments, so Ann Hendrich, RN, MSN, FAAN, vice president of clinical excellence operations at Ascension Health in St. Louis, Missouri., and Marilyn Chow, RN, DNSc, FAAN, vice president of patient care services at Kaiser Permanente in Oakland, California, wanted to document just how nurses’ spend their days. They kept tabs on 767 med/surg nurses in 36 hospitals across the country during 2005 and 2006.

Here is what they found about nurses in the study:

• Although they spent more than three-quarters of their time on nursing practice, less than 40 percent of it occurred in patients' rooms. The rest was spent on documentation, medication administration and care coordination.
• Overall, nurses spent almost 40 percent of their shifts at the nursing station and nearly 31 percent in patients’ rooms.
• Less than 20 percent of nursing time—about an hour and 20 minutes of a 10-hour shift—was spent on patient-care activities.
• About 7 percent (30 minutes) was used for patient assessment and reading vital signs. • Documentation consumed about 35 percent of nurses' time.
• Care coordination took up more than 20 percent.
• Giving meds took about 17 percent of nursing time.

Lastly—and this is a good thing—nurses in the study walked between 2.4 miles and 3.4 miles during a 10-hour daytime shift. Night-shift nurses averaged eight-tenths of a mile less.

The study, funded by the Robert Wood Foundation, was published in The Permanente Journal, a peer-reviewed medical science and humanities journal published by Kaiser Permanente.

So here are the questions:

Do you feel as though you spend enough time at the patient’s bedside?

Do you feel that your patients get slighted?

Is there too much paperwork in your job?

How would you change things if you could?

Truth in Health Care Reporting - Is It Becoming Extinct?

Here’s part of an e-mail I received recently from the Association of Health Care Journalists. It contained a story written by Naseem Miller, a health reporter at the Star-Banner in Ocala, Florida. Here are the opening paragraphs.

It seemed like a good idea at the time, and it lasted only one issue.

The Capital, a 47,000-circulation daily newspaper in Annapolis, Md., sold its weekly Health Page to Anne Arundel Medical Center, a local hospital, one day in March, putting it in charge of all content, including the stories and layout.

And a bit further into the story:

The day the Health Page was published, the alarms went off so loudly and so clearly that the newspaper ended the agreement with the hospital.

The deal, or partnership, was ethically and journalistically wrong, unfair to the readers and a bad business decision, according to experts, and even the paper's publisher.

I gasped. So the newspaper biz has come to this, I thought.

I have a soft spot for newspapers; I worked at one for 15 years, most of that time as a health and medicine writer. But now newspapers are in big financial trouble—mainly because people are doing just what you’re doing right now—getting information online. Most newspapers now are online, too, but attracting advertising to these sites has been less than a rousing success. Ad revenue for print editions also is down because advertisers figure everyone is going online for their news.

A vicious circle, to be sure. And no one knows how low newspaper bottom lines will go. The future doesn’t look bright, for sure.

So why should you and your patients care about this story or similar happenings with other newspapers?

For one thing, there are still a lot of people who read the paper and have a difficult time distinguishing between ads and editorial copy, especially when hospital ads look like editorial copy. This means consumers/patients and medical care providers are getting incomplete—and maybe even incorrect—information.

Anyone who cares about making the right decisions about health care gets a raw deal.

When patients bring in articles from newspapers, magazines or other media sources, are you able to discern the valid information from the questionable information?

Do you think it’s important to do so?

What do you consider good sources of medical and health care information for the public?

Cultural Awaremess: How important?

A couple of years ago, I wrote a story about a publication for nurses that dealt with cultural awareness. Within its covers were chapters written by nurses who were familiar with various cultures and their practices and customs. (“Culture & Clinical Care,” UCSF Nursing Press; $33.95.)

The book was fascinating reading―full of pearls like these:
• Hospitalized Haitian men should be offered pajamas instead of a patient gown.
• Menopause, in the Arab culture, is generally thought of as the “age of despair.”
• When meeting a Native American, a hard-grip or pumping handshake is inappropriate.

The book contained information on the cultural practices of 35 countries―more information than any nurse could possible gather on his/her own. (Bonus: The book can be downloaded onto a PDA.)

The need to understand various cultures and their beliefs is important knowledge, according to the American Geriatrics Society, which has put together a three-volume book series called “Doorway Thoughts: Cross-Cultural Health Care for Older Adults.”

Written for nurses, doctors and medical and nursing students, the first two volumes are designed to help care for older adults from many minority ethnic groups. The third volume addresses the role of religion in health care decision-making in this country. It explains various religious beliefs and practices and how this information can assist in caring for older patients.

"Culture and religion can play a significant role in a person's perception of health and disease, which is especially true for older adults,” says Sharon Brangman, MD, who is on the editorial board for the book series. "Therefore, it's important for health care providers to have an understanding of an older person's culture or religion to better understand why they make certain health-related decisions.”

Do you agree with the editors? Is it important to understand cultural differences in order to give good care?

Have you had an experience with people from ethnic minorities in which understanding their culture played an important part in the care you gave?