Patient Experience: One Person at a Time

Here is another HealthLeaders Media article that I was intrigued by.  We all know about Patient Satisfaction Scores and how much they mean to the hospital.  We all know that nurses everywhere are being held accountable for these scores.  Unfortunately, these scores leave no room for examination; no room for individual issues that could skew the results.

Please read this rather lengthy article about a creative way to capture the patient experience instead of the patient satisfaction.  See if you agree with the author’s points.

Patient Experience: One Person at a Time

Jennifer Thew, RN, September 1, 2016

How can an organization get its arms around something as massive and variable as the patient experience? By listening to the experts—the patients.

This article first appeared in the September 2016 issue ofHealthLeaders magazine.

Carol Raimondi, RN
Carol Raimondi, RN

Carol Raimondi, RN, knows what it’s like to be a patient. Born with congenital heart defects, the 40-year-old’s life has been entwined with the healthcare system for decades. Raimondi had her first open-heart surgery when she was 6 years old, and has since had multiple surgeries and hospitalizations both at well-known academic medical centers and at her local community hospital, 259-bed Elmhurst (Illinois) Hospital.

In her time as a patient and a provider, Raimondi has noticed changes in the way healthcare is delivered. What was once a very patient-focused experience has morphed into something less personal and more procedural, she says.

“Over the years, everybody just became busier. There was more charting and more things to do,” says Raimondi, who worked as a nurse for eight years, but stepped away from clinical practice in 2006 due to health issues. “Healthcare has become so big, with all these pharmaceutical and insurance companies and all these different regulations. Patient experience has become focused on HCAHPS scores, and what are we going to do to get our scores higher?”

For healthcare executives, attention to results of the Centers for Medicare & Medicaid Services’ Hospital Consumer Assessment of Healthcare Providers and Systems survey— the organization’s tool for measuring patients’ perceptions of care—has become a necessity due to reimbursement changes, public reporting of scores, and the shift to value-based care. But a single-minded focus on HCAHPS scores is a missed opportunity to improve quality, safety, and patient engagement through a broader, more multifaceted approach to patient experience. The Beryl Institute, an independent nonprofit thought leadership organization focused on improving patient experience, defines this approach as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across a continuum of care.” (read the rest of the article here)

Posted in Nursing, Nursing Articles, Nursing Issues | Tagged , , , , , | Leave a comment

Geriatric ERs Reduce Stress, Medical Risks For Elderly Patients

This article from HealthLeaders Media is interesting and makes quite a bit of good sense.  While the population is aging, we need to make sure the care we are giving coincides with this aging.  The elderly population have unique needs and they deserve to receive care from professionals trained to deal with them.

Although I think the idea for geriatric ERs is great, I can see them going the way of psychiatric ERs, who are trained to deal with those patients specialized needs.  Unfortunately, hospitals are usually profit driven and these specialized ERs would not carry a census that would remain stable.  Fluctuating census makes it difficult to staff and keep costs down.

Please read this article and see what you think about this issue.


Geriatric ERs Reduce Stress, Medical Risks For Elderly Patients

Kaiser Health News, August 23, 2016

Geriatric ERs have the potential to lower health care costs because staff can more carefully discern who needs to be admitted and who can be cared for outside of hospital walls.

This article first appeared August 23, 2016 on the Kaiser Health News website

By Anna Gorman | Photos by Heidi de Marco

NEW YORK — The Mount Sinai Hospital emergency room looks and sounds like hundreds of others across the country: Doctors rush through packed hallways; machines beep incessantly; paramedics wheel stretchers in as patients moan in pain.

“It’s like a war zone,” said physician assistant Emmy Cassagnol. “When it gets packed, it’s overwhelming. Our sickest patients are often our geriatric patients, and they get lost in the shuffle.”

But just on the other side of the wall is another, smaller emergency room designed specifically for those elderly patients.

Patients like Hattie Hill, who is 105 years old and still living at home. A caregiver brought her in one rainy day in late spring because she had a leg infection that wasn’t responding to antibiotics. Hill, who also has arthritis and a history of strokes, said she prefers the emergency room for seniors because she gets more attention.

“I don’t have to wait so long,” she said. “And it’s not so loud.”

Packed emergency rooms are unpleasant for everyone. But they can be dangerous for elderly patients, many of whom come in with multiple chronic diseases on top of a potentially life-threatening illness or injury.

“Who is going to suffer the most from these crowded conditions?” asked Ula Hwang, associate professor in the emergency medicine and geriatrics departments at the Mount Sinai School of Medicine. “It is going to be the older adult … the poor older patient with dementia lying in the stretcher with a brewing infection that is forgotten about because it’s crazy, chaotic and crowded.”

Seniors who come into traditional emergency rooms are frequently subjected to numerous and sometimes unnecessary tests and procedures, according to research and experts. They stay longer and their diagnoses are less accurate than younger patients. And they are more frequently admitted to the hospital by ER doctors overwhelmed by the constant influx of very sick patients.

“You’ve got this surge of more and more older adults coming to the emergency departments,” said Kevin Biese, co-director of geriatric emergency medicine at the University of North Carolina School of Medicine. “Yet there hasn’t necessarily been this recognition that [they need] different screening, different treatment and they are going to have different outcomes.”

Geriatric emergency rooms, which are slowly spreading across the country, provide seniors with more expertise from physicians, nurses and others trained specifically to diagnose and care for the elderly, researchers said.(read the rest of the article here)

Posted in Nursing, Nursing Articles, Nursing Issues | Tagged , , , | Leave a comment

5 Paths to Better Clinical Outcomes

Here is an article from HealthLeaders Media that I found very interesting and thought maybe you would also.  Nurses everywhere are known for their creative and skillful ways of solving patient problems.  This article tries to address some of those creative changes that are taking place around the country.

For any nurse who may be looking to do research on a particular problem, maybe this article will give you a stepping off place and point you in the right direction.

Please read the entire article and see if you find these 5 paths as interesting as I did.

5 Paths to Better Clinical Outcomes

Jennifer Thew, RN, August 30, 2016

Here’s how hospitals and healthcare systems have cut sepsis mortality, reduced post-discharge costs, and lowered ED usage—without breaking the bank.

In today’s healthcare environment, an organization’s success often hinges on patient outcome measures such as rates of readmission, hospital-acquired infections, and avoidable medical errors.

While there’s no one-size-fits-all fix to these issues,HealthLeaders Media editors have written extensively about many programs, care models, interventions, and research that offer promising solutions.

Here are five articles to help CNOs discover ways to improve clinical outcomes:

1. How Ohio Hospitals Are Tackling Sepsis

Sepsis is deadly, costly, and all too common. So why was a rise in sepsis rates at Ohio hospitals seen as a positive development?

“Because we are encouraging people to identify it, we are not surprised that we have a more honest assessment of the problem in our state,” says Ohio Hospital Association (OHA) President and CEO Mike Abrams.

In July 2015, The Institute for Health Innovation of the OHA launched a statewide initiative with the goal of reducing severe sepsis and septic shock by 30% by the end of 2018. Nine months in to the initiative, OHA is reporting an 8% reduction in sepsis mortality.

2. New Developments in Nursing Roles and Care Models

During HealthLeaders Media‘s inaugural CNO Exchange in November 2015, nurse executives shared how they have redesigned nursing roles to better meet the needs of their patients and their healthcare organizations.

Baptist Medical Center in Jacksonville, FL, has been expanding its use of nurse navigators to improve care coordination at the bedside, while Catholic Health Initiatives of Englewood, CO, is using technology to bring clinical nurse leaders located in a central command center into patients’ hospital rooms, virtually.

3. Predictive Data Cuts Mortality by 30%

Have you ever felt like a patient was “off,” but didn’t have the data to justify that gut feeling?...(read the rest of the article here)

Posted in Nursing, Nursing Articles, Nursing Issues | Tagged , , , , , | Leave a comment

Distracted Driving & Impaired Driving: 6 Things Nurses Can Do

Here is another article from American Mobile, a well known travel nursing agency.  I actually did my travel nursing with them.  They are extremely efficient and professional and they find you plenty of work.

This article about distracted driving really hits home because I am sure that we all have been guilty of at least one of these actions, or have driven beside someone on the highway putting on mascara.  Driving–even stone cold sober and alert–is dangerous and we have become lazy about how we respond to distracted drivers.

Please read this entire article and see if you don’t agree with the author.  Maybe you will be a little more mindful next time you are behind the wheel.



Distracted Driving & Impaired Driving: 6 Things Nurses Can Do

By Jennifer Larson, contributor

Don’t drink and drive.

Everyone’s heard that message a million times. But what about these messages?

Don’t text and drive.
Don’t brush your hair and drive.
Don’t be exhausted and drive.
Don’t take certain medications and drive.

Drunk driving is incredibly dangerous. According to the National Highway Traffic Safety Administration (NHTSA), more than 10,000 people died in vehicle crashes related to alcohol-impaired driving in 2012.

But distracted driving and other forms of impaired driving are very dangerous, too. Nearly 3,000 fatal accidents were the result of distraction in 2014, according to NHTSA, and another 431,000 people were injured by distracted drivers that year.

As nurses, you may have seen the victims of some of those crashes, cared for them in the ED or critical care unit, or consoled their grieving family members. You’ve seen first-hand the type of devastation that can result.

MAKE A DIFFERENCE with one of these ER or ICU travel nursing jobs.

As a neurosurgery nurse practitioner who worked in a Level 1 trauma center, Megan Keiser, RN, DNP, CNRN, has cared for these victims, as well. Now an assistant professor in the department of nursing at the University of Michigan-Flint, Keiser is currently conducting a research study on distracted driving attitudes and behaviors among undergraduate college students. She noted that older teens and young adults are the most likely to engage in risky behavior.

But anyone can become a distracted driver. Even you.

Here are six ways you can take the initiative to reduce distracted and impaired driving:

1.   Examine your own risky behaviors. When was the last time you succumbed to the temptation to check your smartphone while behind the wheel? Or put on makeup, or run a comb through your hair on the way to work? Take an honest look at what you are doing and remember it only makes a momentary slip to cause an accident. “Behind the wheel is not the time to multi-task,” noted Holly Carpenter, BSN, RN, policy associate for the American Nurses Association’s nursing practice and work environment division.

2.   Give yourself plenty of time. Keiser has heard people justify their distracted driving behaviors by claiming to be in a hurry. “But you’re putting yourself or somebody else at risk,” she said. Find ways to give yourself more time to do those important tasks so you can completely focus when you’re behind the wheel.

3.   Drive distraction-free and encourage others to do so, too. The End Distracted Driving campaign, organized by the Casey Feldman Foundation–which was set up to honor the memory of a young woman killed by a distracted driver–encourages drivers to set good examples for others. Model good behavior and minimize distractions when you’re driving. And when you’re a passenger, support your driver so he or she won’t be distracted;…(read more here)


Posted in Nursing, Nursing Articles, Nursing Issues | Tagged , , , | Leave a comment

Zika Virus Update: 10 Things Nurses Need to Know

With all the panic in the media about Zika, this article may be of some help to nurses who are struggling with what to do and how to do it; who need to know how to best help their patients deal with this new and frightening disease.

Zika is a terrible condition and warrants the dissemination of information to all the people at risk.  Since this disease causes such devastation to babies inutero,  there really is a need to spread the news, but is there a need to make a panic?

People need to know how they are a risk, why they are at risk, and what to do if they feel at risk.  They need help not hype.  If the media would just broadcast concrete facts and send people to sites for more information, it would be better.

Please read this article in full as it may help you in your practice and it may help you if you feel at risk.


Zika Virus Update: 10 Things Nurses Need to Know

By Debra Wood, RN, contributor

The Zika virus continues to make headlines, and the Centers for Disease Control and Prevention (CDC) has issued a travel advisory for a location in the continental United States. What do nurses need to know about the virus, on behalf of themselves and their patients?

SUBSCRIBE to NurseZone for important nursing news.

Here are quick answers to 10 of the top questions about Zika infection:

1. Am I at risk?

It depends where you live and travel. The vast majority of Zika cases in the United States have been travel-related, with those who have contracted the disease having been in a country where Zika is common, or having sex with someone who has traveled to one of those areas.

As of early August 2016, more than a dozen cases of locally contracted Zika had occurred in the Wynwood neighborhood in Miami.

2. How is it contracted?

Most people contract Zika through a bite of an infected Aedes mosquito. This species is found in 30 states. So far, Florida is the only one with local transmission. These mosquitos travel only 150 meters, so widespread infection is unlikely, according to Tom Frieden, MD, MPH, director of the CDC. It can take two weeks for the infection to develop.

Zika also can be transmitted during sex and from a pregnant woman to her baby. Although not confirmed in the United States, it may be spreadable through a blood transfusion. There also have been reports of laboratory-acquired Zika infections.

3. What are the symptoms of Zika infection?

Four out of five people experience no symptoms. Some will have mild symptoms of fever, rash, muscle or joint pain, headache or conjunctivitis. Symptoms can last for a few days to a week.

4. What is the big fear then?

Babies born to pregnant women with a Zika virus infection may be born with severe birth defects, including microcephaly, in which the child’s head is smaller than normal and the brain may not have developed properly. Women do not need to have symptoms to transmit Zika to their babies.

5. How to prevent transmission?

Although Zika vaccines are in clinical trials, none are available now.

(read the rest of the article here)

Posted in Nursing, Nursing Articles, Nursing Issues | Tagged , , , , , | Leave a comment

We are not taking care of nurses. Who will heal the healers?

I have to admit that I really do love reading KevinMD’s blog posts.  It is so refreshing to find a medical doctor who is willing to align with nurses against bad practices and does not go into automatic “blame the nurse” mode when there is a problem.

I understand that some nurses are more prepared and responsible than others, but the majority of the nurses out on all the floors in every hospital in the US are working their butts off and getting no help from anyone while they are struggling to help their patients get better.  It really has become a thankless job, but there are still nurses who see it as their calling and continue to do what they can despite these issues.

The title of this article says it all.  There is a growing nursing shortage now, but what happens if all the current working nurses become ill, or get burned out and there is no one to replace them?  Will you want to be hospitalized knowing there is not a licensed and trained person there to care for you?  Would you want your family to be?

Please read this great article and make up your own mind.  Remember, this article is written by a doctor who works with nurses to care for his patients.

We are not taking care of nurses. Who will heal the healers?

On the day that I penned this post, I rounded at our community hospital.   My first patient was in the step-down unit, which houses patients who are too ill for the regular hospital floor.   I spoke to the nurse in order to be briefed on my patient’s status.  I learned that this nurse was assigned six patients to care for — an absurd patient volume for a step-down unit.

“Why so many patients?” I asked.

She explained that some nurses called off work and the patients had to be spread around among the existing nurses.

This occurs every day in every hospital in the country.  Nurses are routinely required to care for more patients than they should because there is a nursing shortage on a particular day.  Why do hospital administrators allow this to happen?  If any are reading this post, I invite your response.  Enlighten us.  When a nurse is overburdened, how do you think this affects quality of care and nursing morale?

I suppose it saves a few bucks on the payroll, but this strikes me as very short term gain that risks medical and financial consequences.   Providing high-quality medical care can’t be a rushed effort.  If a nurse’s job description increases by 30 percent, do you think the quality of care and patient/family satisfaction won’t decline? (read the rest of the article here)

Posted in Nursing, Nursing Issues | Tagged , , , , , | Leave a comment

Nurse Salaries Dip Nationally

Here is a short article I found in Hospital and Health Networks. It seems that there is not enough problems with being a nurse, now we have to deal with shrinking pay.  It is not uncommon for salaries not to take into consideration the years of experience a nurse brings to the table.  It is also not unusual for nursing wages to be lower than other professions in the same geographic area.

Read this article and see what you think.

Nurse Salaries Dip Nationally

August 16, 2016

Only about half of nurse practitioners are satisfied with their compensation, according to a new salary guide, released last week by Health eCareers.

Polling nearly 20,000 health care job seekers nationwide (about 27 percent of which were nurses or NPs), the firm found some interesting insights about the field. Only about 17 percent of nurses said they are happy with their job and planning to stay put, while 13 percent said they were unhappy and looking for change. Some 44 percent of nurses, meanwhile, said they were “very” or “somewhat” satisfied with their current pay.

Common reasons for dissatisfaction with the nursing profession, Health eCareers found, included salaries that don’t match up with experience, or that are lower than similar jobs in the region. Burnout showed up as a concern in the study, too, as nurses expressed a heavy workload and staff morale as key concerns going into next year.

Low salary also is a concern for nurses, and the survey has some numbers to back that up. Year over year, average RN compensation dropped by about 3.1 percent, down to nearly $62,000. Health eCareers speculates that 40-hour workweek limits, could be one reason for the dip. Other reasons found in the survey included changed employers (51 percent), hours cut (8 percent), and no or lower bonus for performance (8 percent).

Salaries for NPs, meanwhile, swung upward 5.3 percent year over year to about $100,000 on average. The uptick may be related to hospitals hiring more such nurses to help address the shortage of docs, according to the report.

It appears to be a job-seekers market, overall, with about 89 percent of nurses polled expressing confidence in their job search.

(read more articles like this here)

Posted in Nursing, Nursing Articles, Nursing Issues | Tagged , , , | Leave a comment

Use the power of words to reduce bullying of nurses

Here is another great article from that was actually written by a nurse.  I am always amazed at how pro-nurse this doctor is.

Bullying is a big problem in the workplace and leads eventually to workplace violence.  The incidents of bullying are persistent and pervasive in health care and we need to look at finding a solution rather than pointing fingers.

As nurse Boynton states, I also have been a part of some of the ways that nurses express their disrespect for others.  I am not proud of this behavior, however, I am human and I allow myself to make mistakes.

Please read this article and make up your own mind about whether bullying in nursing is a problem or not.


Use the power of words to reduce bullying of nurses


Distinguishing between the terms “bully” and “bullying” is an important step that we can take in order to eliminate or at least minimize any disruptive or undermining behaviors that are often associated with bullying.  Yelling at, humiliating, excluding, gossiping about others are a few of ways we humans cleverly demonstrate disrespect for others.  And we all know that lack of respect is a persistent and pervasive problem in health care.

As we work to establish and maintain safe cultures and respectful workplaces, there are three reasons for using terminology that addresses individual and organizational behaviors rather than trying to identify and blame one person.  Each of these will help to reduce resistance, fear, and confusion about zero tolerance for abuse.

Reveals the true problem. When we use the term “bully,” it allows us to blame one person.  “Bullying,” on the other hand invites us to consider victims, bystanders and culture.  Since all of these are part of the history and cause of workplace violence, it makes sense to understand and address these aspects of the problem.

A bully can’t exist without a victim or in an environment that doesn’t tolerate bullying behaviors.

Reflection process is safer. Looking inward is often a difficult process for many of us and yet an integral part of changing behavior.  Consider how these reflective questions might feel:

“I wonder if I am bullying the new nurse?”

“I wonder if my behaviors could be perceived as bullying?”

“I wonder if I am a bully?”

The first and second statements allow us to be human and imperfect and include another person’s perception as part of the picture.  The third one is more threatening and defines the very core of our being.  If we are going to change these dynamics, doesn’t it make sense that we give ourselves and each other permission to make…(read the rest of the article here)


Posted in Nursing, Nursing Articles, Nursing Issues | Tagged , , , , | Leave a comment

ICU patients lose helpful gut bacteria within days of hospital admission

Here is an article about a small study done by the University of Colorado School of Medicine regarding the loss of helpful gut bacteria when in the hospital.

This is a serious concern and can be life threatening for patients.  The study’s hypothesis was confirmed, leading to the development of nutrition-related interventions for this population of hospital patients.

Please read the article and keep this information available during your practice.

ICU patients lose helpful gut bacteria within days of hospital admission

Hospital room. Researchers suspect that critical illness requiring a stay in the ICU is associated with the the loss of bacteria that help keep a person healthy. The new study, which prospectively monitored and tracked changes in bacterial makeup, delivers evidence for that hypothesis.
Credit: © txakel / Fotolia

The microbiome of patients admitted to the intensive care unit (ICU) at a hospital differs dramatically from that of healthy patients, according to a new study published in mSphere. Researchers analyzing microbial taxa in ICU patients’ guts, mouth and skin reported finding dysbiosis, or a bacterial imbalance, that worsened during a patient’s stay in the hospital. Compared to healthy people, ICU patients had depleted populations of commensal, health-promoting microbes and higher counts of bacterial taxa with pathogenic strains — leaving patients vulnerable to hospital-acquired infections that may lead to sepsis, organ failure and potentially death.

What makes a gut microbiome healthy or not remains poorly defined in the field. Nonetheless, researchers suspect that critical illness requiring a stay in the ICU is associated with the the loss of bacteria that help keep a person healthy. The new study, which prospectively monitored and tracked changes in bacterial makeup, delivers evidence for that hypothesis.

“The results were what we feared them to be,” says study leader Paul Wischmeyer, an anesthesiologist at the University of Colorado School of Medicine. “We saw a massive depletion of normal, health-promoting species.”

Wischmeyer, who will move to Duke University in the fall, runs a lab that focuses on nutrition-related interventions to improve outcomes for critically ill patients. He notes that treatments used in the ICU — including courses of powerful antibiotics, medicines to sustain blood pressure, and lack of nutrition — can reduce the population of known healthy bacteria. An understanding of how those changes affect patient outcomes could guide the development of targeted interventions to restore bacterial balance, which in turn could reduce the risk of infection by dangerous pathogens.

Previous studies have tracked microbiome changes in individual or small numbers of critically ill patients, but…(read the rest of this article here)

Posted in Nursing, Nursing Articles, Nursing Issues | Tagged , , , | Leave a comment

The Key Health Care Issues in the 2016 Election

This article from Nursing Jobs outlines quite clearly why nurses should be very involved in the upcoming election.  We as nurses feel powerless most of the time, but at the voting booth we do have some power and we need to exercise this power.  The problem is that we rarely do anything as a unit, which is sad.  The nursing profession  should wield more power in the legislature and in our government since we are a huge group.  Unfortunately, we vote as individuals not as a group.  That is good in some ways and bad in others.

This year’s election is turning out to be pivotal in addressing healthcare issues.  We need to be aware of what changes will be put forth by either candidate.  We need to know at the state level who is pro-nursing and who is not.  We need to know what any changes in Medicare and Medicaid will affect our jobs.

Please read the entire article and see if you agree that nurses need to become more involved with politics.


The Key Health Care Issues in the 2016 Election

By Megan M. Krischke, contributor

“I think that the upcoming presidential election is going to be focused on public health,” began Donna M. Nickitas, PhD, RN, NEA-BC, CNE, FNAP, FAAN, editor of Nursing Economic$. “We will see issues around public safety–we certainly need to address the gun issues and protecting our schools and children. There will be concerns about our environment–clean air and safe water–and as climate changes occur, we need to be concerned about disaster relief and preparation.”

Katherine Evans: Nurses should know health care issues in Election 2016

“I think that we are going to see a lot of focus on health care entitlements–nurses need to be paying attention to that,” added Katherine Evans, DNP, FNP-C, GNP-BC, ACHPN, president-elect of the Gerontological Advanced Practice Nurses Association (GAPNA). “Nurses need to find out how those running for office are thinking about Medicaid expansion, Medicare and how reimbursement is going to be handled. Our new elected officials are going to be critical in how health care exchanges are modified and adjusted.”

Nickitas said that it is important for nurses to be aware of the political world because much of health care is regulated by state and federal law, as well as regulatory agencies such as state boards of health. Nurses are bound by license to follow those statutory and regulatory laws.

“As a health provider, I am concerned about the health and well-being of society and advancing the health of the nation,” Nickitas said. “I want elected officials who share these values and who want to see the homeless or mentally disabled get the care they need.”

“Nurses should be seeking to elect people who will look at local and national health care needs critically, and who are willing to bring in a nursing perspective,” Evans stated. “We need to look for candidates who understand, or who will let us help them understand, what nursing is, that there are a variety of education levels and that nurses practice in a variety of ways.”

“Does the candidate understand the nursing and the nursing faculty shortage and the reality of the ‘silver tsunami’ that is beginning to hit healthcare?” she continued. “Are they bringing nurses to the table to help develop a plan for dealing with a health care system that is going to be stretched thin?”

These nursing leaders note that many candidates are saying that there need to be changes to the Affordable Care Act (ACA), but nurses should know what changes these candidates have in mind and how they will impact patients and the nursing profession.

Donna Nickitas: Nurses can impact the health care system

As more people are entering the health care system due to the changes brought on by the ACA, legislators and those leading regulatory agencies need to understand that allowing to nurses to practice at the full extent of their training will relieve some of the pressure on the system.

“Nurses need to be concerned about seeing state laws that will enhance their practice rather…(read the rest here)


Posted in Nursing, Nursing Articles, Nursing Issues | Tagged , , , , , , , , | Leave a comment