The University of Maryland Charles Regional Medical Center has received multiple accolades recently. For the 15th successive year, the medical center has earned the Workplace Excellence Seal of Approval Award from the Alliance for Workplace Excellence. UM Charles Regional Medical Center was also awarded the Health & Wellness Seal of Approval award, for the 13th successive year, and the Ecoleadership award for a second year.
“There is a lot to be said for the continued growth and development of our organization and our workforce,” said Stacey Cook, UM Charles Regional Medical Center vice president of human resources. “To be recognized again this year for the programs we offer that help our employees with work life balance, opportunities for development, wellness and a positive impact on the environment is amazing.”
The Alliance for Workplace Excellence (AWE) is a non-profit
based in Montgomery County, Maryland, dedicated to increasing workplace
excellence through education and recognition, in order to strengthen quality of
life and economic growth. They do so with several kinds of awards, including those
recently given to UM Charles Regional Medical Center. All recipients are
thoroughly assessed by an independent review panel.
Excellence award is given those with strong commitment to balance in leadership
and success throughout their workforce, where the Ecoleadership award is given
to employers leading the way for environmental sustainability within the
workplace. The Health & Wellness Seal of Approval is awarded to employers
who create and provide programs to better employees’ health and wellness.
These awards and successes are the result of UM Charles Regional Medical Center putting their employees and community first and foremost every day. “We are celebrating 80 years of service to the community this year and that would not be possible without our engaged and committed employees,” Cook added.
For more information about the UM Charles Regional Medical Center, click here.
Years after “To Err is Human” report, studies show marginal improvement
Failure to improve working environments for nurses poses a threat to patient safety, a speaker said at a panel discussion hosted by Health Affairs.
In addition, clinician delays in recognizing emerging complications, and communicating concerns effectively with other medical staff, can increase postsurgical mortality, explained another presenter at the briefing Tuesday, which explored progress in patient safety since the 1999 release of the landmark report “To Err is Human: Building a Safer Health System” by the Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine).
According to the report, 44,000 to 98,000 deaths each year result from medical errors.
“Everyone agrees we haven’t made as much progress as we’d like to make [with reducing medical errors], and the improvements have been uneven,” said Linda Aiken, PhD, RN, professor and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia.
In a recent Health Affairs study, Aiken and colleagues assessed safety at 535 hospitals in four large states during two time points between 2005 and 2016, and reported that the results were “disappointing.” Only 21% of the hospitals showed “sizeable improvements” in “work environment scores” while 7% saw their scores worsen, Aiken said.
Another 71% of hospitals “basically remained the same,” she said.
Aiken also reported a similar lack of improvement in patient safety measures at hospitals that showed little improvement in their work environment. In the study, about 30% of nurses graded their own hospitals “unfavorably” on measures of patient safety and infection prevention and about 31% of nurses had high scores on the Maslach Burnout Inventory.
Aiken pointed out that “To Err is Human” specifically identified “transforming the work environment of nurses” as an evidence-based strategy to improve patient safety and highlighted the need for “staffing adequacy,” as well as environments that enable nurses to conduct effective “patient surveillance and timely intervention[s].”
And despite the “blame-free culture” espoused by the 1999 report, which stressed that errors are due to problems with systems not individuals, 50% of the nurses in the study by Aiken’s group reported that they believed their errors would be held against them, she said.
Aiken said the recommendation for how to fix the situation hasn’t changed since it was outlined in the 1999 report — “identify safe nurse staffing and supportive work environments as patient safety interventions.”
In another Health Affairs study, Margaret Smith, MD, of the University of Michigan Medical School in Ann Arbor, and colleagues examined the interpersonal and organizational factors that may increase the chance of “failure to rescue,” or deaths following a major surgical complication.
“We decided to take a slightly different view and look at interpersonal, organizational dynamics and their relationship with rescue,” she explained at the Tuesday panel.
Recent studies have explored targets for interventions that could improve rescue, and focused on resource-heavy solutions, such as increasing ICU staff or improving nurse-patient ratios. While important, these factors only account for a proportion of the variation seen in rescue rates among hospitals, Smith noted.
The typical course of events is an operation, followed by a seminal complication, then a domino effect of other complications, which ultimately end in a patient’s death, she added.
Smith’s group conducted 50 semi-structured interviews at five hospitals across Michigan with a range of providers (surgeons, nurses, respiratory therapists), and asked what they felt were the greatest contributors to effective rescue. The study was done from July to December 2016.
After recording and transcribing each 30-60 minute interview, Smith and colleagues identified five core elements as being part of the “successful rescue” of surgical patients:
- Teamwork: working well together in moments of crisis
- Action taking: responding swiftly after identifying a complication
- Psychological safety: ability of all clinicians to feel comfortable expressing their concerns regardless of where they fit in the clinical hierarchy
- Recognition of complications
The interviewed clinicians said they generally felt they performed well on the first three measures, but said early recognition of complications and effective communication were areas that needed improvement, Smith stated.
For example, attending surgeons said they did not think complications were spotted early enough. “When we’re talking about early recognition, people have this kind of clinical hunch [that] ‘something’s wrong’… [and] how that’s communicated is often very poor,” Smith said.
The challenge is how to communicate these “hunches” in a way that everyone understands them and ways that trigger actionable steps, she added.
In terms of communication, a senior nurse reported that when more providers cared for a single patient, it was more challenging to pass information along, or have information miscommunicated or misinterpreted.
Smith recommended that hospitals focus upstream of these potential crises by providing all clinicians, regardless of their experience, with the tools to know when a patient is deviating from a normal trajectory.
Her group also stressed the need for more effective language in communicating concerns.
“We need to ‘tool and task’ these providers with the skill-set to work on these multidisciplinary teams to communicate and identify developing complications,” she said.
Smith said her group is developing pilot programs to help clinicians recognize when patients are deviating from a traditional course.
If a patient completes a procedure without a complication, certain daily benchmarks should be expected. These benchmarks would be given to junior nurses and night staff, so that even without years of experience, they can recognize when a patient is not on track, Smith said.
This story was originally posted on MedPage Today.
Expect more non-physician professional hires in correctional institutions
When correctional nurse author and educator Lorry Schoenly, PhD, RN, was writing a book about nursing in prison, her publisher asked her who would buy the book. “We were trying to figure out how many correctional nurses there are,” said Schoenly who scoured state boards of nursing for the numbers of those specializing in corrections. But, unlike cardiology or obstetrics, correctional nursing was rarely listed as a specialty and Schoenly was unable to get a reliable count. “It’s an invisible field,” she said.
But even though centralized data on staffing trends in corrections healthcare is elusive, the demand for NPs and PAs is expected to grow. According to UConn Health, which currently staffs Connecticut’s correctional institutions with “half MDs and half midlevels,” increasingly more “midlevels” are being utilized. “Future job growth will most likely continue to rise as incarcerated populations rise and the age of the population rises,” a UConn Health representative told MedPage Today in an email.
Although rising rates of overall incarceration leveled off in 2006 and reversed a bit after 2015, life sentences have increased almost five-fold since 1984.
This increase in life sentences, along with longer sentences and more incarceration late in life, has contributed to a trend, often referred to as the greying of the inmates. “People are growing old in prison,” said Owen Murray, DO, MBA, vice president of offender health services at the University of Texas Medical Branch in Galveston.
UConn Health noted that inmates 50 and older are the fastest growing demographic in federal prisons. With advancing age comes an increase in chronic disease, physical disability and cognitive decline. In Texas, there is pressure to either maintain current staffing or add more providers due to this shifting demographic. Spending per state is associated with, among other factors, the percentage of individuals 55 and older who are incarcerated, according to the Pew Charitable Trusts.
Greater use of NPs and PAs is one way prisons can provide legally required standards of care at lower cost. “The real impetus to use the lowest cost practitioner is not because there is less attention to quality, but to drive down healthcare costs,” said Kamala Mallik-Kane, MPH, a researcher at the Justice Policy Center at the Urban Institute.
Murray has noticed a rising presence of NPs and PAs over the past three decades. “Certainly as it relates to both jail and prison medicine, there has been a significant increase not just within the state of Texas but pretty much every other state that I’m familiar with in terms of the growth opportunities for midlevel providers.”
According to the American Academy of Physician Assistants, the absolute number of PAs working in prisons increased from 1995 to 2015. For NPs, a survey conducted by the American Association of Nurse Practitioners demonstrated that since 1999 the estimated NP population working in corrections has grown from 550, or 0.8%, of total NPs in 1999, to 2,400, or 1.1%, in 2016.
According to UConn Health, staffing depends on the medical acuity of the inmates, the inmate population and the level of onsite infirmary services.
Predicting future workforce demand for NPs and PAs depends on many conditions beyond sentencing, policy, and crime rates, according to National Institute of Corrections, and incarceration rates could change again depending on policy of the Trump administration. Whether that means releasing low-level offenders, potentially increasing the number of immigrant detainees, diverting offenders from the criminal justice system, or rollbacks in sentencing reform is unclear.
As people enter prison with high health needs – from a lack of preventive healthcare, substance abuse, or homelessness — for some, incarceration provides stability. “There’s an expression,” said Mallik-Kane, “three hots and a cot,” meaning regular meals and shelter. “A person with medical needs might now have access to healthcare. On the other hand, there’s criticism of the quality of prisoner health services.”
In an Urban Institute study of a group of people returning to a major city from prison, 80% of men and 90% of women had chronic health conditions requiring treatment or management; 15% of men and more than one-third of women reported a diagnosis of depression or mental illness.
In Texas, as the complexity of care has grown, the demand for PAs and NPs has grown. “The midlevel provider group has really become the backbone of our delivery system augmented with our physician group,” said Murray.
Yet as prisoners’ medical acuity has increased, healthcare spending in corrections has decreased from a peak in 2009. In some states, the downturn stems in part from a reduced prison population. But states with relatively larger shares of older inmates have higher per-inmate spending for these more complex patients continues to pose a fiscal challenge.
According to Maria Schiff of The Pew Charitable Trusts, outsourcing the employment of clinicians has become increasingly appealing for states to overcome the challenges of recruiting healthcare workers to remote prisons. Private entities can offer hiring incentives, student loan repayments, and bonuses where state agencies are prohibited from doing so.
Schiff said there are 50 different programs in the U.S. since each state raises its own tax money and allocates to corrections. “There’s no nurse to patient ratio that is standard among hospitals, and [corrections departments] are no different, but states do track the age, the gender and certainly the average daily census of who they’re incarcerating,” she said. Anecdotally, several states noted that their staffing ratio of NPs or PAs to physicians is about two to 2.5 to one.
Two issues that remain for any provider considering a job in corrections is their personal safety and litigation exposure.
Unlike outpatient settings, providing continuity, rapport and safety in correctional healthcare can sometimes prove impractical. Inmates are moved often and even in secured settings, the risk of violence and danger is ever present. “A big theme is always personal safety,” said Schoenly. “And the expectation is that you’re doing evidence based standard of care because it’s very litigious. We have a saying that if you haven’t been named in a lawsuit, you haven’t been in correctional healthcare very long.”
The Joint Commission’s presence is limited in correctional healthcare. Unless a health care organization is in a state that requires its accreditation or is in part of an agency such as Veteran’s Affairs or the Department of Defense, which also require accreditation, its process is voluntary. The Joint Commission doesn’t require specific staffing levels, but it does require a sufficient number and mix individuals to support safe care. The American Correctional Association (which declined to comment for this article) and National Commission on Correctional Healthcare operate in corrections and can be consulted to review their policies and procedures. Accreditation can sometimes offer a layer of protection against malpractice, but does not ensure immunity.
These risks do come with rewards, said Schoenly, who views correctional healthcare as a mission to serve the most underserved population in healthcare, and one with broad public health implications, since most inmates do return to society. “You realize that this is really a part of our society who is marginalized and who desperately needs healthcare,” said Schoenly. “And the idea that it’s a vulnerable population with great need can draw in individuals who want to possibly help and improve society.”
This story was originally posted on MedPage Today.
In 1975, with the Vietnam War still fresh in the minds of the American public, most high school senior graduation plans did not include joining the U.S. Army. But for eighteen-year-old Virginia “Ginny” Warren, the North Texas daughter of a cotton farmer, the Army looked like an ideal path. Much to the chagrin of her father, Ginny Warren had just set forth on a 44-year journey from soldier to VA Nurse.
“The Army offered me a way to broaden my horizons and to learn,” said Warren, Nurse Manager at VA North Texas Health Care System.
Warren began her military career with two-years in medical administrative field before spending the next twenty-two years as a medic with the U.S. Army Reserve’s 94thCombat Support Hospital, based in Seagoville, Texas. With a primary mission to take a 150-person deployable hospital anywhere in the world and be ready to receive casualties within 72 hours of arrival, Warren continuously trained for the opportunity to apply her talents while developing a new passion to become a Registered Nurse (RN).
Through her career in the Reserves, the Army sent Warren to licensed vocational nurse (LVN) training and Warren quickly realized she had an aptitude and attitude for nursing. Warren went on to attend the University of Texas at Tyler School of Nursing to become a RN and was subsequently commissioned in the U.S. Army Nurse Corps.
“I had to find my place as a new nurse and new military officer,” said Warren. “I had a lot to learn, but I felt I had a lot to offer as well.”
After becoming an RN, Warren brought her health care experience to VA and joined another family of nursing professionals at VA North Texas in 1997.
In 2003, Warren’s Reserve unit was called upon to deploy to Landstuhl Regional Medical Center to treat wounded servicemembers straight from the battlefields of Iraq and Afghanistan. The ability to muster tremendous internal strength and compassion, coupled with her many years of training to deploy on a moment’s notice, was exactly what the soldiers, Marines and airman she treated would need to make their next journey back stateside to recover with family and friends.
“I vividly remember leaning over this big sergeant, hugging him, and whispering in his ear that it would be okay, and the pain won’t last,” said Warren.
Warren would go on to give more than 40 years in uniform, retiring as a field grade officer in 2015.
With over 22 years of service as a VA nurse, Warren now walks the inpatient wards of the Dallas VA Medical Center where she once served as junior nurse, as a manager and mentor to a new generation of nursing professionals who rely on her expertise and experience to care for many of the 134,000 active patients who use VA North Texas for their health care each year.
“Nursing is not just a career, it’s a passion and a devotion,” said Sheila Wise, VA North Texas Nurse Manager, and herself a retired U.S. Army Nurse. “To bring that passion and devotion to the service of our Veterans the way the Ginny has, and continues to do every day, for as long as she has, makes her an inspiration and a guiding figure for our nursing team. She makes all of us better.”
While eighteen-year-old Ginny Warren could have never foreseen the impact she would have on our nation through her service to military servicemembers and Veterans over 44 years, the nearly 3,000 nurses who apply their skills at VA North Texas are glad that the cotton farmer’s daughter left home to make the journey of a lifetime.
“Nursing has always been where I could pour my heart and soul,” said Warren. “I can’t imagine doing anything else.”
This story was originally posted on VAntage Point.
The Star Tribune reports that nurses across Twin Cities hospitals are pressing for more workplace safety in their contract negotiations. As hospitals are in negotiations with the Minnesota Nurses Association (MNA), they’re hearing that protections for nurses are becoming a top priority, as nurses are wearied from being hit, shoved, or yanked by their patients.
This is the first time nursing contract negotiations are being
held since 2016, when Allina hospital nurses went on strike for health
insurance benefits. These current negotiations have been in talks, with
contracts set to expire May 31. But it appears that no deal will be happening
by then, and the MNA is planning to strike again.
One nurse, Mary McGibbon, shared with the Star Tribune that she wore a sling for her elbow injury (brought about accidentally by a patient) to a contract negotiation meeting. Accidents with patients are common enough, but there is more concern as hospitals have seen an increase of patients with mental health issues. Sometimes the patients will deliberately attack their nurses, which can be so traumatic it affects their ability to work.
“These can be life-changing attacks,” McGibbon said. “Some [nurses] can’t go back to the bedside.”
Steady Increase of Patient-Caused Injuries
Workers compensation claims increased by nearly 40 percent
between 2013 and 2014, up to 70 percent, and have remained at 65 percent or
higher since then. These numbers reported by the Minnesota Department of Labor
and Industry only count the most severe cases reported, including those where
nurses missed three or more days of work due to injury.
Talks for nurse protection have been gaining speed since a
2014 incident, where a patient attacked and injured four nurses with a metal
bar. Minnesota passed a law in 2015, making hospital staff training on
de-escalating and preventing violence mandatory.
Another nurse, Michelle Smith, is back to work in surgical recovery but still going through recovery from a concussion she got roughly two years ago. She similarly is pushing for more support in negotiations to prevent these incidents from happening.
“There’s that fear,” Smith shared with the Star Tribune. “You still treat your patients the way you’re going to treat your patients, but there’s that thing in the back of your head — ‘could this happen again?’”