Katelyn McKibben, R.N., has always been passionate about taking care of others. At age 16, she became an emergency medical technician (EMT), where she developed her skills and discovered a lifelong passion that led her to nursing school. During that time, she fell in love with Eric Kline, a 1st Lieutenant in the Army National Guard. Eric was deployed to Afghanistan shortly thereafter, but when he returned in 2010, his disposition had changed considerably. A few weeks later, he took his own life.
Katelyn continued her nursing education and found much needed comfort in the Tragedy Assistance Program for Survivors (TAPS)—an organization that provides care and grief support programs for military survivors. Katelyn became a peer counselor at TAPS to help others in similar situations find healing and hope. Today, Katelyn is a nurse at the Erie Veterans Affairs Medical Center in Pennsylvania. “Caring for Veterans has given me a purpose. This career allows me to honor 1st lieutenant Eric Kline every single day. What my patients don’t know is that while I am helping them heal, they have done so much more to help me heal,” she says.
Ready for a rewarding career with purpose? Join VA and you, too, will experience the unique satisfaction and joy that comes with serving our nation’s heroes. To get started, search for opportunities near you and apply today.
This story was originally posted on VAntage Point.
It’s probably safe to say that nurse leaders’ favorite subject is not finance. But in today’s healthcare industry, financial incentives and reimbursement have become so entwined with patient care and outcomes, that you cannot have one without considering the other.
Below are recent HealthLeaders Media articles to help nurse leaders make sense out of the dollars and cents attached to patient care.
Last year the Centers for Medicare & Medicaid Services (CMS) reined in its mandatory bundled payment models, leaving many healthcare providers concerned that investments they made to prepare for these models might for naught.
But those investments in value-based care models may not go wasted after all under CMS’ new voluntary Bundled Payments for Care Improvement (BPCI) Advanced model.
Participants in the new model will be expected to keep Medicare expenditures within a defined budget, while maintaining or improving performance on these seven specific quality measures:
- All-cause hospital re-admissions
- Advanced care plan
- Perioperative care: Selection of prophylactic antibiotic (first or second generation cephalosporin)
- Hospital-level risk-standardized complication rate following elective primary total hip arthroplasty and/or total knee arthroplasty
- Hospital 30-day, all-cause, risk-standardized mortality rate following coronary artery bypass graft surgery
- Excess days in acute care after hospitalization for acute myocardial infarction
- Agency for Healthcare Research and Quality patient safety indicators
CMS is changing its formula for calculating and allocating funds for uncompensated care for hospitals that qualify under its Disproportionate Share Hospital program. This new method presents both opportunities and challenges for organizations.
Thanks to the changes, hospitals may be able to identify care currently written off without a determination of financial need. Additionally, the new methodology for calculation of Factor 3 — a hospital-specific factor representing its share of the total uncompensated care provided — may allow hospitals to capture a larger portion of uncompensated care funds.
However, leaders should be aware that CMS is phasing in the use of cost report Worksheet S-10 data, including charity care and unreimbursed bad debt. This year, one-third of Factor 3 will be based on this data, but by fiscal year 2020, use of this data will be fully implemented.
To ensure compliance with reporting data on Worksheet S-10, leaders need to review new guidance from CMS as well as their own organizational policies for charity care determinations, uninsured patient discounts, and bad debt collections. Training for staff involved with submission of the cost report and handling charity care write-off is imperative.
One concern consistently raised about the implementation of pay-for-performance models is that healthcare providers and organizations serving more complex patients would not reap the same rewards as hospitals caring for less sick patients.
New research suggests that those fears may be warranted. A November 2017 study found that Medicare’s Value-based Payment Modifier program inadvertently shifted money away from physicians who treated sicker, poorer patients to pay for bonuses that rewarded practices treating richer, healthier populations.
The study’s lead author Eric Roberts, PhD, of the University of Pittsburgh Graduate School of Public Health, said that if changes aren’t made, value-based payment models will continue to foster this inequity.
“Risk adjustment is usually inadequate in these programs, in part, because it is difficult to measure the differences in complexity of patients across providers. We need to take a careful look at how incentives in these programs are structured and how performance is assessed in order to create the right incentives to improve value and outcomes for the most vulnerable patients,” Roberts said.
This story was originally posted on MedPage Today.
The University of Dayton and Sinclair Community College have joined forces to provide a new bachelor of science in nursing degree, in order to help meet the four-year credential requirement that more and more health care employers are mandating.
The new degree program is designed for students to start their coursework at the University of Dayton in their first year. In the second and third years, students are dually enrolled at Dayton and Sinclair, balancing nursing courses and clinical rotations. At the end of the third year, students will complete their ASN from Sinclair, before moving on to year four at Dayton to complete their BSN. Additionally, after gaining their ASNs, students will be allowed to work as licensed registered nurses through the National Council Licensure Examination.
“The bachelor of science in nursing offers students an affordable pathway to a high-quality degree,” said UD School of Education and Health Sciences Dean Kevin Kelly. “The program draws on the strengths of both institutions, including UD’s Marianist tradition of educating the whole person and Sinclair’s long and excellent reputation in nursing education, and helps meet a critical workforce need in the Dayton community.”
As the nursing shortage continues, more degree program options like the one designed by the University of Dayton and Sinclair Community College are crucial. The Bureau of Labor Statistics is predicting a 15 percent job growth for registered nurses through at least 2026. With RNs needed in hospitals, extended care facilities, schools, and other organizations, it is critical to increase more education and certification options for those planning to become nurses.
“Employers in our region appreciate the caliber of the Sinclair nursing graduate, but also place value on registered nurses having a BSN degree,” said Rena Shuchat, Sinclair College Health Sciences dean. “Sinclair and UD have a long-standing partnership and this is another example of two great institutions partnering to provide our region with high-quality nurses with an advanced degree.”
This program is especially helpful for those wanting to pursue a BSN but concerned about costs. Sinclair tuition costs are locked in for years 2 and 3 of the program, and students are locked into a transparent net-tuition plan through the University of Dayton for years 1 and 4. Beyond the financial benefits, students will be able to seek academic help from faculty at both schools. These BSN candidates will also be working alongside UD and Sinclair students in other health science degree programs, providing them with a well-rounded education that will assist them as they begin their RN careers.
For more information on this new degree program, visit the University of Dayton’s website.
In February, the California Future Health Workforce Commission issued their final report describing recommendations to maintain the workforce needed to meet healthcare demands for the present day and the future (source). The California Future Health Workforce Commission was established in 2017 “to help close the gap between the health workforce we have and the health workforce we need.” The commission includes senior leaders from philanthropies across the state (source). The plan develops critical strategies to address professional nurse recruitment.
While the document targets issues across California, the primary concerns are generalizable to the nation. Historically in the U.S., the supply of nurses has not kept pace with demand, predominantly in underserved communities. The impending nursing shortage and an aging population crisis impact communities nationally.
The following key strategies from the report translate well into tactics for professional recruitment.
- Increase opportunities to advance in the health professions allows professional development, advancement, and job progression. Increasing job satisfaction and salaries promote staff retention.
- Align and expand education and training by anticipating areas of deficits and coordinating community and healthcare stakeholders to encourage buy-in. To guarantee continuing improvement, recruiters must look at the shortage as a process instead of a resolved episode. Healthcare organizations and hospital systems have an essential role in addressing the crisis.
- Strengthen the capacity, retention, and effectiveness of nurses by identifying how to minimize burnout and maximize utilizing nurses efficiently.
The California Future Health Workforce Commission report gives recommendations that relate to professional nurse recruitment. By keeping nurses satisfied, promoting community involvement, and reducing burnout the healthcare systems can develop a three-prong approach to recruiting and maintaining a robust nursing staff.
Our Nurse of the Week is Allison Squires, a professor in the NYU Rory Meyers College of Nursing, who has been selected as the National Academy of Medicine (NAM) Distinguished Nurse Scholar-in-Residence for the Future of Nursing 2020-2030 Study.
The Distinguished Nurse Scholar-in-Residence program is supported by the American Academy of Nursing, the American Nurses Association, and the American Nurses Foundation. It is a year-long opportunity for a fellow of the Academy to engage with nurse leaders and other scholars at the National Academy of Medicine while helping to develop health policy at the federal level.
Squires is a global health workforce capacity-building researcher with a special interest in improving immigrant and refugee health outcomes. As the NAM Distinguished Nurse Scholar-in-Residence, Squires will examine methods for increasing interprofessional collaboration and maximizing the skills of nurses through sustainable development perspectives.
Squires stated in a press release: “I am honored to be selected for this opportunity to represent the American Academy of Nursing, the American Nurses Association, and the American Nurses Foundation while undertaking this important work at the National Academy of Medicine, in collaboration with the Robert Wood Johnson Foundation. This is an excellent chance for me to utilize my international focus to advance NAM’s research on health equity and the sustainability of our nation’s nursing workforce.”
Squires was selected as the NAM Distinguished Nurse Scholar-in-Residence for her strong policy background and stated focus to examine and address sustainability of the workforce from the perspective of integrating social determinants of health. Her study comes at a critical time and will be vital to determining nursing’s course in the coming decades.
To learn more about NYU Professor Allison Squires who was selected as the National Academy of Medicine Distinguished Nurse Scholar-in-Residence for the Future of Nursing 2020-2030 Study, visit here.
Two nurse researchers from the Columbia University School of Nursing have received a combined $3.73 million in grants from the Agency for Healthcare Research and Quality, a unit of the US Department of Health and Human Services. Amanda Hessels, PhD, assistant professor at Columbia Nursing, will receive $1.86 million in funding through a five-year R18 Research Demonstration and Dissemination grant. Lusine Poghosyan, PhD, associate professor at Columbia Nursing, will receive a $1.87 million five-year R01 grant.
Hessels’ study is titled “Simulation to Improve Infection Prevention and Patient Safety: The SIPPS Trial.” The study will test a simulation intervention designed to improve provider performance of standard precautions and prevent healthcare associated infections (HAIs) and occupational blood-borne pathogen exposures.
Hessels tells Newswise.com, “Despite well-established guidelines and training, standard precautions are not reliably practiced, with self-reported adherence among nurses, who have the most direct patient contact in acute care, at less than 50 percent. HAIs are a substantial public health problem affecting approximately two million patients annually, and every year one in 25 registered nurses are exposed to blood-borne pathogens. We think simulation training may improve standard precaution adherence and ultimately improve healthcare quality and safety for patients and providers.”
Poghosyan’s mixed methods study is entitled “Social Networks in Medical Homes and Impact on Patient Care and Outcomes.” The study will combine analysis of team configurations and social networks in Patient Centered Medical Homes (PCMH) to assess quality of care and patient outcomes and identify team best practices.
Poghosyan tells Nursing.Columbia.edu, “The PCMH model aims to address such primary care challenges as poor access and quality and rising costs by delivering team-based care. Yet little is known about the composition of effective teams to achieve best patient outcomes. How team members communicate, share advice or help to deliver care, or how social networks affect quality and outcomes have not been studied. Our innovative mixed-methods study will fill this gap to assure the best quality of care and outcomes, particularly for patients with chronic diseases.”
To learn more about Columbia University nurse researchers Amanda Hessels and Lusine Poghosyan who received a combined $3.73 million in grants from the US Department of Health and Human Services, visit here.