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?’”
In-hospital patients with delirium are vulnerable during the early posthospitalization period
In-hospital delirium is a predictor of readmission, emergency department visits, and discharge to a location other than home, recent research shows.
The development of delirium in the hospital setting impacts about 12.5% of general medical admissions and as many as 81% of intensive care unit patients. Earlier research has shown delirium among hospitalized patients is predictive of prolonged hospital length stay, lengthened mechanical ventilation, and mortality.
The recent research in the Journal of Hospital Medicine featured data collected from more than 700 delirious patients and nearly 8,000 non-delirious patients. The researchers found delirious patients had increased odds for 30-day readmissions, ED visits, and discharge to postacute care facilities.
“These results suggest that patients with delirium are particularly vulnerable in the posthospitalization period and are a key group to focusing on reducing readmission rates and post-discharge healthcare utilization,” the researchers wrote.
Linking in-hospital delirium and readmissions
The Journal of Hospital Medicine research builds on earlier studies about in-hospital delirium, the lead author of the research said. “Prior studies have shown that delirium is associated with functional decline at discharge, so these patients may be particularly vulnerable in the days and weeks following hospital discharge. Our work helps to confirm this as we show that patients who become delirious in the hospital are far more likely to be readmitted within 30 days of discharge, compared with patients who do not develop delirium,” said Sara LaHue, MD, a resident physician in the Department of Neurology, School of Medicine, University of California San Francisco.
The new research indicates that hospital-based interventions should be targeted at delirious patients to reduce readmissions, she said. “Hospital-based interventions that reduce the development of delirium may then reduce the complications of delirium, such as readmission.”
Reducing delirium-associated postacute care service utilization
To avoid hospital readmissions linked to delirium, clinicians should focus on preventing patients from becoming delirious in the hospital.
“This may include systems for identifying patients at high risk of becoming delirious, screening for active delirium, and enacting interventions that target the underlying cause in order to reduce the severity or duration of delirium. While such a program can take a bit of work to get off the ground, the benefits for patients, their families, and the hospital system can be significant,” LaHue said.
One team member who is often overlooked is the caregiver at home, she said. “Educating caregivers about delirium risk factors can be very helpful — he or she can bring glasses or hearing aids from home, engage the patient in meaningful conversation to help with orientation, and encourage regulation of sleep-wake cycles. If a patient does become delirious, the caregiver can continue to help with these interventions.”
Caregivers at home are an essential component of postacute care, LaHue said. “We know that delirium is associated with functional decline at discharge, so coordinating safe discharge plans with the caregiver, especially to identify [the] need for resources — physical therapy, occupational therapy, home health, and nursing — can potentially help reduce post-discharge complications.”
Follow-up care is another crucial factor, she said. “Ensuring expedited follow-up with a primary care provider, who can assess for any additional needs, is also important.”
This story was originally posted on MedPage Today.
Ballad Health, a healthcare system serving parts of Tennessee, Virginia, North Carolina, and Kentucky, recently committed $10 million to ensuring their nurses receive well-deserved raises. As the Kingsport Times News reported, this investment will be directly put toward wages for acute care registered nurses, long-term care licensed practicing nurses, and scrub techs, among other roles for direct inpatient care and behavioral health.
Alan Levine, Executive Chairman, President and CEO of Ballad
Health, shared this announcement during National Nurses Week in an email to
Ballad Health team members, noting that this increase will be helping thousands
“These areas of focus have been most impacted by the national shortages of health manpower, and have consistently shown the greatest number of vacancies throughout the nation, and certainly our experience is no different here,” Levine stated in his email. “We compete heavily for these professionals and must continue to do so.”
The pay increases will go into effect on June 23 for
existing team members. This investment will also affect starting hourly rates
for new hires.
“Our nurses and those who work with them in the provision of direct patient care are heroes,” Levine added. “Each of us does important work, and that, no doubt, is an important fact. Our amazing nurses would be the first to say they could not do their work without all the people who make a hospital or health care facility operate. And that is part of the humility that makes them great servants. However, it is also true that in an environment where we face a significant national shortage of these critical health care providers, a shortage so significant that the productivity of our nurses and direct bedside caregivers is as high as it has ever been, it is important we appropriately recognize the sacrifice that is being made.”
For more information about Ballad Health, click here.
Fewer nurses on staff linked to increases in length of stay
Ask a nurse and they will tell you that staffing levels matter. Now a study in the Western Journal of Emergency Medicine supports that popular opinion, providing further evidence to make the case for nursing’s role in achieving healthcare outcomes and metrics.
“Our study provides additional data that may help providers further engage hospital administration to supply adequate nurse staffing that allows EDs [emergency departments] to better achieve performance goals and improve the patient experience,” the researchers wrote. “This analysis is a pivotal step in identifying and ensuring appropriate nurse staffing to optimize ED quality metrics.”
In the retrospective observational review of the electronic health record database from a high-volume, urban public hospital, researchers compared nursing hours per day with door-to-discharge length of stay, door-to-admission length of stay (LOS), and the percentage of patients who left without being seen.
From January to December 2015, more than 100,000 patients were seen in the ED at an average of 290 visits each day. During this time, the ED had an average of 465 nursing hours worked per day.
The researchers found that regardless of daily patient volume, occupancy, and ED admission rates, days in the lowest quartile of nursing hours experienced a 28-minute increase per patient door-to-discharge LOS when compared with the highest quartile of nursing hours.
However, door-to-admit LOS showed no significant change across quartiles.
There was an increase of nine patients per day that left without being seen by a provider from the lowest to highest quartile of nursing hours.
The authors concluded that lower staffing rates contribute to a statistically significant increase in wait time for patients, which then impacts how many patients receive treatment each day.
In addition to the clear patient safety and patient satisfaction issues around failing to receive timely treatment, the decrease in patients seen can also impact throughput metrics and decrease the overall revenue of facilities.
This story was originally posted on MedPage Today.
While medical technology is booming, the art of caring is becoming a highly profitable field as well. By focusing on employee engagement, hospitals embrace the staff and the highly personable touch they have to offer. The healthcare workers are essential to improving HCAHPS scores and reducing hospital-acquired conditions (HACs) (source).
Employee Engagement versus Satisfaction
Employee engagement and employee satisfaction are miles apart. A nurse can be satisfied with a position, show up to every shift without complaint, and leave for a neighboring hospital that offers a seven minute shorter commute. Job satisfaction rewards the bare minimum of effort and reliability to the hospital. Employee engagement is the nurse’s dedication to working on behalf of the hospitals and patients.
Engagement Prevents Medical Errors
Nurse engagement requires more than showing up with a smile to do the job. It entails an emotional commitment to the company and its goals. A Gallup study showed that the most critical element in reducing medical errors is employee engagement. Engagement matters more than any other single factor including staffing.
How to Foster Employee Engagement
While employees welcome picnics and parties, the most important factors are recognition and feeling connected to nursing management. There is a significant positive link between a high-quality supervisor and nursing engagement. It is vital that nurse managers create an environment of appreciation, trust, and growth.
Employee engagement increases nurse retention and keeps costs down. It reduces medical errors, the transmission of HACs, and the hospital mortality rate. By believing in both the management and hospital, patients and nurses thrive.
The first step in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) performance is recruiting nurses with a focus on long-term retention. The national turnover rate for bedside RNs was 16.8% in 2017 with an average associated cost of $38,000 to $61,000 per nurse. Nursing turnover impacts each hospital’s bottom line, with costs averaging from $4.4 million to $7 million annually (source).
Multiple Costs of Turnover
More importantly, high nursing turnover negatively affects morale, quality of care, and HCAHPS scores. When there is a critical acute need to satisfy scheduling demands, hospitals cannot afford the luxury of being proactive in their recruitment efforts. Unfortunately, patching a schedule full of holes causes rapid hiring decisions instead of considering a quality applicant.
There are connections between patient perceptions of their health care experience and nurse staffing ratios. The hospitals with the highest number of nursing hours per patient day consistently rate higher on HCAHPS scores than other facilities. Nurses and patients alike thrive in a positive nurse work environment. But recruiting nurses with long-term retention factors is only half the battle.
Revisiting the Recruitment Process
Health systems have to streamline their recruitment process to re-focus on hiring and retaining nurses with targeted HCAHPs behaviors like responsiveness, ability to listen, and audience awareness. When interviewing candidates, it is essential to identify how the nurse will communicate with and answer patients. Optimal applicants will treat the patient with respect, communicate effectively, and respond quickly.
Hospitals must strive to recruit candidates who are committed to their work, patients, and the organization. When hospitals remain competitive to hire and retain talent, patients stand to benefit. Top-quality employees make for top-quality organizations and nurses are at the forefront.
Caitlin Goodwin MSN, RN, CNM is a Board Certified Nurse-Midwife and freelance writer. She has ten years of nursing experience and graduated with a MSN from Frontier Nursing University.