Nurse-led clinics may not be new, but they may be the future

Here is an article that talks about the benefits for having nurse led clinics and the difference between a clinic run by medicine versus one run by nursing.  It’s an interesting article and is worthy of  your time to read.

I believe that nurse led clinics are going to become more available to the general public in the future.  We have a physician shortage as well as a nursing shortage.  There are large parts of our population that go unserved due to this shortage.  Nurse led clinics may be one way to reach some of those who need services quickly.  Nurses have always gone into the trenches when necessary to help those in need, so I don’t see this as any ground-breaking type of behavior, but I do see it as necessary.

Please read this article and leave me your comments, won’t you?

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By Richard Kipling | September 4, 2012

Who doesn’t remember running to the school nurse’s office with a nosebleed or ear ache? But how many among us have gone to a nurse-managed clinic for our adult health care?

In this era of experimentation in health delivery, the nurse-led clinic is part of the conversation about how best to medically serve us, particularly the poor and uninsured populations.

These safety net clinics fly pretty far beneath the general public’s radar, despite the fact most have been around for a decade or more. In California, there are now at least seven of them, mostly in the Bay Area.

To find out more about what they do and how they differ from a typical health clinic, I got in touch with Patricia Dennehy, director of Glide Health Services, a pioneering nurse-led health center in San Francisco that promises “compassionate healthcare.”  The clinic, located in the Tenderloin area of downtown, addresses such issues as hunger and housing as well as providing medical support. It partners with Saint Francis Memorial Hospital, which offers pharmacy and lab services at no cost.

Glide Health resembles other community-based health centers, she told me, “except the leadership is a nurse – typically a nurse practitioner — instead of a physician or other health professional.”

The more important difference, though, is Glide’s “nursing model” approach, which contrasts with the “medical model” that governs most clinics, said Dennehy, who is also a clinical professor in the school of nursing at UCSF.

“The nursing model puts the person in the center instead of the disease,” Dennehy said. “In the nurse-led model, the patient is more than, say, a diabetic. It’s about all the social determinants of your health. Are you a victim of trauma? Depressed? We take time to get to know you. It’s less prescriptive and more of a partnership.”

Nurse-led centers developed out of “the service mission of schools of nursing,” she said. “The faculty wanted to provide service and educate their students.”  The National Nursing Centers Consortium lists 128 nurse-led center members across the country, and more than 85 schools of nursing run such clinics, which function as training centers as well.

In many cases, it’s a “marriage between the school, the community and a community hospital,” said Dennehy. “That’s not unusual and it’s the perfect triangle.”

The clinics may be nurse-run, but that doesn’t mean there isn’t a doctor in the house. Many of the clinics recruit doctors to come in on appointed days as part of their professional team. “We have a wonderful internist, a psychiatrist and a pharmacist for parts of the week,” she said.

How does all this play with patients? Is there a lot of explaining to do when a doctor is not around? “If any patient wants to see a doctor, we give them a referral to our doctor or to another place,” said Dennehy. “It doesn’t happen with great frequency, but it does happen.”

The clinic’s bottom line, she said, is that “We think that everyone has the right to choose their care. We’ll do everything we can to help you find another place.”

Is there new momentum for more nurse-led clinics because of the Affordable Care Act?

“It’s very clear that we cannot doctor-up to meet the country’s primary care needs,” said Dennehy.

People are searching for different models, she said, particularly when the ACA is bringing so many new people into full insurance coverage.

Many more medical professionals will have to practice “at the full scope of their competency and their training,” she said.

So what about nurse-led clinics’ prospects?

“There are plenty of new buds on the vine that are trying to get up and going,” Dennehy said. “I think there are going to be more.”

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Do I really need Certification?

I have been thinking about getting my certification in Mental Health Nursing now for quite some time.  Every time I convince myself to do it, I back out at the last minute.  It’s not just the expense and time involved, which is nothing to laugh about, but I cannot understand what getting this certification will do for me.  Will it make me a better nurse?  I think not.  Will it get me more money? Of course not.  So why do it?

I did a Google search and found several articles on Nursing Certification.  The gist of them follows here.  NurseTogether.com had an article that listed the benefits of being certified in your specialty.  According to the article certifications demonstrates professionalism; commitment; promotes self-fulfillment; promotes quality health care; can influence insurance companies; improves marketing yourself; can influence patient outcomes; and demonstrates competence and credibility.  Wow!  Taking a test can do all that!

I agree with some of the above.  If certification is a goal, then attainment will promote self-fulfillment.  I am not sure that having BC after my name means I am more professional or have a stronger commitment to nursing.  How does passing a test promote quality health care?  Why do insurance companies care if I am board certified or not?  I can see that if I were looking for a job, I might edge out non-certified nurses in a judgement call.  But does having BC after my name really demonstrate better competence and give me more credibility?  There have been many studies that show improved patient outcomes with board certified nurses, but since I haven’t read them all I cannot comment about them.

I don’t know.  I keep sitting on the fence.  I am at a point in my career where I am not sure that another initial after my name will make any difference to me.  Does certification translate into a higher rate of pay?  Not with the majority of hospitals, so obviously the hospitals themselves don’t give much credence to certification.

Today, I am of a mind to just go sit for the test and be done with all this soul searching once and for all.  Tomorrow, who knows?

What do you think about certification?  Do nurses need to be certified in a specialty to be deemed professional?  Does your hospital pay you more if you are certified?  I am really interested in your response because I vacillate between yes and no so often I am getting dizzy!  I would like to have some help in making this decision.

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Nursing Burnout

I have been reading articles about burnout recently.  Maybe it’s because I am fast approaching that state.  I don’t know if I told you before, but I quit posting here for a while because I was injured at my job.  I got hit in the face and had to have surgery to repair my face.  I was not very pleased during this as you might guess, but I did get through it.  However, since returning to work, I find that my priorities have changed drastically.  Now, safety takes the most prominent place in my working priority.  It makes it hard to deal with the population I care for as most of my patients are very labile and unpredictable.

I even changed my focus at my job.  Instead of working with the patient population I loved to help, I am now working on a safer unit.  Believe me there is a major difference between these two populations, although both can still be unpredictable.  I do feel safer working there, but it is not the population I would have chosen for myself.

So, back to burnout.  Some of the articles I have been reading talk about job stress as a driving factor.  I can certainly agree.  I am certainly stressed at work.  Between having     6-8 patients at a time that need to be assessed and monitored every hour and having no control over admissions and discharges, this is a very stressful job.  So, I find myself looking for excuses to miss work.  I have vague somatic complaints when I am at work.  These are some classic symptoms of burnout.

Burnout affects retention in nearly every hospital in the country.  Most nurses feel exhausted and discouraged about their jobs.  Many will say they feel saddened that they cannot provide the quality of care to their patients that they would like to.  Some are even thinking of leaving the profession.

Burnout can affect infection rates due to nurse’s exhaustion and detachment.  A recent cross-sectional study estimated that for each additional patient assigned to a nurse, there was roughly one additional infection per 1000 patients.  Doesn’t sound like much, but it is still unacceptable.  More than one-third of the 7,000 respondent nurses in this study fulfilled the criteria for burnout.  That is a scary number.

Nursing burnout is also tied closely to patient satisfaction surveys.  When the patient is cared for by a nurse experiencing burnout, the patient knows that something is not right and this manifests as high anxiety and dissatisfaction with the hospital and the care.  This then is  seen by the nurse as a high maintenance patient, when in fact they are just anxious about the quality of care they are receiving.

Some of the causes of burnout that are discussed in just about every article I have read lately are poor staffing, lack of autonomy at the bedside, lack of respect for what a nurse does, and lack of recognition of what the professional nurse contributes to patient care.  These factors are making nurses everywhere decide that they don’t want to do what they do anymore.

Burnout, if left uncared for, quickly escalates into compassion fatigue.  The nurse feels all alone and drained of energy with no obvious resources to draw from.  Compassion fatigue is akin to PTSD in its effects on the person.

So, what is the answer?  Out of all the articles I read, only one had any suggestions.  Most of the suggested solutions were placed on the individual nurse who is experiencing the burnout.  Things like stress reduction classes, creating a place for relaxation, mentoring programs are fine, but if you have no energy you probably will not do these things.

Some solutions suggested for the hospitals themselves are things like better recognition and reward programs, better manager involvement, improved training and education, or counseling through the EAP.  These solutions seem like band-aids to me.

I don’t really think that putting my picture up in the hallway as the Employee of the month; or having my manager set up times “to meet with me to discuss current issues”–usually on my days off; or sending me to more classes or seminars (again on my days off); or even referring me to the Employee Assistance Program for counseling are really going to change my feelings of burnout.

I don’t have the answer.  I’m too busy going through the problem right now to be able to see the solution.

You can find some of the articles mentioned above here:

http://www.ncbi.nlm.nih.gov/pubmed/8056566

http://www.nursetogether.com/career/career-article/itemid/2652.aspx

http://www.nhs.uk/news/2012/07July/Pages/Is-nurse-burnout-putting-patients-at-risk-of-infection?

http://nsweb.nursingspectrum.com/Articles/FiredUpCF2003.htm

http://pensylvanianurses.blogspot.com/2009/02/burnout-effects-of-unavoidable-job.html

http://www.healthleadersmedia.com/content/NRS-252471/Seven-Strategies-to-Reduce-Nurse-Burnout##

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904602

 

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Patient location, gloves, worker type predict hand hygiene compliance

Here’s another article on the ever growing battle about handwashing in the hospital.  It is true that strict adherence to handwashing policy will save lives and money, but for some reason we have trouble following this simple policy.  Why is that?  Maybe there is not enough time in a shift to do all the handwashing called for?   I don’t have any answers, but would love to hear your take on this growing concern.

This article is from FierceHealthcare, which is a source I like very much.  I find many interesting articles about medicine and nursing here and you will, too.

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Patients who receive care in a hallway bed are the most likely victims of healthcare workers not washing their hands, according to researchers from Boston’s Brigham and Women’s Hospital in a study to be published in the November Infection Control and Hospital Epidemiology.

In the largest hand hygiene study with more than 5,800 patient encounters in the emergency department (ED), researchers found that bed location, the type of healthcare worker providing the care, and whether the provider used gloves all were predictors of poor hand hygiene in the ED.

“We found that receiving care in a hallway bed was the strongest predictor of your healthcare providers not washing their hands,” said study author Dr. Arjun Venkatesh, an emergency medicine resident at Brigham and Women’s Hospital, in a Society of Healthcare Epidemiology of America press release yesterday.

In addition, researchers found that workers transporting patients were less likely to wash their hands because they likely do not receive as much hand hygiene training as others, according to the press release. They also said that providers using gloves was not a substitute for handwashing in controlling infections.

However, in most cases (90 percent of time), ED workers do wash their hands.

Handwashing could save up to $33 billion, according to a UPI article. In a Health Affairs study, infection control interventions such as handwashing resulted in patients leaving two days earlier and reduced mortality rates by 2 percentage points. Hospital costs also were $12,000 less, according to the article.

For more information:
- read the press release
- here’s the study abstract
- read the UPI article

Related Articles:
Hospital workers comply with hand hygiene signs about patients, not themselves
CDC: Physician offices too lax about infection control
Handwashing more common in public restrooms than in hospitals
Doctors, nurses don’t want patients to bug them about handwashing
Is 100 percent compliance on handwashing possible?

Read more: Patient location, gloves, worker type predict hand hygiene compliance – FierceHealthcare http://www.fiercehealthcare.com/story/patient-location-gloves-worker-type-predict-hand-hygiene-compliance/2011-10-04?utm_medium=nl&utm_source=internal#ixzz1x6O2AD00
Subscribe: http://www.fiercehealthcare.com/signup?sourceform=Viral-Tynt-FierceHealthcare-FierceHealthcare

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Mental illness means higher risk of physical problems

Here’s an article from Nurse.com that talks about a study showing a correlation between mental health and physical health.  As a psychiatric nurse, I have always know that my patients have a higher risk of certain physical diseases.  It’s amazing to me that it has taken so long for others to notice and try to figure it out.

Asthama, diabetes, hypertension, and even strokes are common Axis III diagnoses for inpatient mental health patients of all ages.  There has to be a reason for this correlation.  Maybe now there will be more studies to try to figure out the connections.  I can only hope so.

Please read this excerpt of the article and click over to Nurse.com to read the rest.  It’s worth your time and effort to do so.  While there, check out some of the other articles they have about current nursing issues.

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Adults who had a mental illness in the past year have higher rates of certain physical illnesses than those not
experiencing mental illness, according to a report by the Substance Abuse and Mental Health Services
Administration.
For example, 21.9% of adults in a SAMHSA national survey who experienced any mental illness (based on
diagnostic criteria specified in DSM-iv) in the past year had hypertension. Meanwhile, 18.3% of those without any
mental illness had hypertension.
And 15.7% of adults who had any mental illness in the past year also had asthma, while 10.6% of those without
mental illness had the condition.
Adults who had a serious mental illness (a mental illness causing serious functional impairment that
substantially interferes with one or more major life activities) in the past year also showed higher rates of
hypertension, asthma, diabetes, heart disease and stroke than did people who did not experience serious mental
illnesses.
Adults experiencing major depressive episodes (periods of depression lasting two weeks or more including
significant problems with every-day aspects of life such as sleep, eating, feelings of self-worth, etc.) had higher
rates of the following physical illnesses than those without major depressive episodes in the past year:
hypertension (24.1% vs. 19.8%), asthma (17% vs. 11.4%), diabetes (8.9% vs. 7.1%), heart disease (6.5% vs.
4.6%) and stroke (2.5% vs. 1.1%).
The report also shows significant differences in ED use and hospitalization rates in the past year between adults
with mental illness in the past year and those without. For example, 47.6% of adults with serious mental illness
in the past year used EDs, as opposed to 30.5% of those without past-year serious mental illness. Adults with
past-year serious mental illness were more likely to have been hospitalized than those without (20.4% versus
11.6% respectively).
“Behavioral health is essential to health. This is a key SAMHSA message…[read more]

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Millions of Patients Are Coming. Can Nurses Care For Them?

Here is an interesting article I found at Hospitals and Health Networks Daily.  This article talks about the need for more and better educated nurses to fill the need in the near future.  Won’t you read this article and leave me a comment?  I’d love to hear what your thoughts are on this topic.

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By Haydn Bush
H&HN Senior Online Editor

 

 

March 22, 2012
Nursing advocates call for increasing the role of RNs in primary care.

CHICAGO — With a wave of new patients expected to access primary care services when insurance provisions of the Affordable Care Act kick in starting in a little over 20 months, hospitals and other providers are bracing for a major shock to their already stretched delivery systems. And a growing chorus of health care leaders is calling for nurses to lead the way in filling expected gaps in primary care.

I heard two of those voices Wednesday at the American College of Healthcare Executives’ 2012 Congress, as Harvard Public Health Professor Jack Rowe and Tami Minnier, R.N., chief quality officer at the University of Pittsburgh Medical Center, discussed the implications and reactions from the field to the landmark 2010 Institute of Medicine report on the issue, Leading Change, Advancing Health. The report’s big-picture takeaways include more responsibilities for nurses, increased educational opportunities and the removal of scope of practice barriers — issues that writer Whitney L. J. Howellexplores in depth in this month’s H&HN.

Rowe — who served on the Robert Wood Johnson Foundation Committee of Nursing that helped draft the report, noted that as global payments and accountable care organizations loom, nurses with increased responsibilities and better qualifications are going to be critically important.

“The more highly educated nurses have lower readmission rates, high quality outcomes and better coordination,” Rowe said.

Getting there isn’t easy, of course — while the report calls for doubling the number of nurses with doctoral degrees by 2020, Rowe noted that 40,000 qualified applicants are turned away from nursing school each year because of a lack of capacity. And calls to increase the number of nurses in the U.S. aren’t exactly new, he added.

“These are the exact same words as [another] blue ribbon panel 20 years ago, but they wanted it by 2010.”

Nursing advocates also have to contend with existing barriers around scope of practice arrangements in order to allow advanced practice nurses and BSNs to deliver more primary care services. Still, providers in 48 states have implemented some of the report’s recommendations, and Minnier explored how the report has informed a new nursing care model at UPMC that emphasizes the importance of responsiveness to patient needs.

“[Hospitals] get complaints like ‘They didn’t take me to the bathroom, they didn’t answer the bell,’” Minnier said. “In reality, that is the core of why they’re in the hospital. They need meds and treatments, but they also need the basics.”

The changes have led to an 85 percent reduction in call bell response time and a 70 percent increase in compliance with turning and repositioning patients.

“It’s a new nursing care model. Same work, same money, same space, and… a 60 percent increase in some of the outcomes.”

I had a chance to interview Minnier after her presentation for a future H&HN Daily videocast — look for it this April.

Email your thoughts on the role of nurses in health care’s ongoing transformation tohbush@healthforum.com.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

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Nurses Get Pushed Around, Again

I recently read this article about the Kennedy baby and the struggle with these nurses.  Upon first reading, I was confused as to what really happened.  Having been in a hospital with a Code pink is called, I can tell you that hospitals take infant safety extremely seriously.  This entire incident reeks of special interest being upset because they had to follow the rules like every other person in that hospital.

I hope the hospital is prepared to back up these nurses who were simply doing their job and protecting their very young and very vulnerable patients from harm.  Read this article from HealthLeadersMedia

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Alexandra Wilson Pecci, for HealthLeaders Media , February 28, 2012

Aggression involving nurses is at the center of a he-said-she-said dispute that pits Douglas Kennedy, son of the late Robert Kennedy, against the nurses caring for his newborn son. It seems that a misunderstanding between the two parties somehow escalated into a physical confrontation that’s gained national attention.

Kennedy was was arrested on misdemeanor charges of child endangerment and harassment after a Jan. 7 struggle with two nurses at Northern Westchester Hospital in Mount Kisco, NY. According to media reports, the nurses allege that Kennedy twisted one of their wrists and kicked the other when they tried to stop him from taking his newborn son outside for some “fresh air.”

In a statement provided to HealthLeaders Media, the hospital said:
“On January 7th, 2012 an incident occurred involving a patient’s family member and NWH staff members. At Northern Westchester Hospital, patient safety is our priority and we completely support the actions of our nursing staff in this case as they were clearly acting out of concern for the safety of a newborn baby. Out of respect to all parties involved, we are not elaborating on the details of this incident or providing any additional comments.”

Yet the folks in Kennedy’s corner have come out swinging hard against the nurses, saying that they tried to grab at his baby. He calls the allegations against him “absurd” and “sickening,” and says anything he did was simply an attempt to protect his son.

An emergency department doctor and family friend of Kennedy who witnessed the incident, calls the nurses the “only aggressors.” And Kennedy’s lawyer is accusing the nurses of trying to “cash in” on the events, according to media reports.

Surveillance camera footage of the incident shows the nurses trying to block Kennedy from leaving via the elevator and then the stairs. It also shows one of the nurses falling to the floor. The nurses said they called code pink, indicating child abduction.

Kennedy’s attorney, Robert Gottlieb, said in an ABC News interview that his client was only trying to protect his baby. “One of the nurses actually goes to grab the baby. How dare she?”

It’s hard to glean many details about the incident from the choppy security footage. But it seems even harder to imagine why any nurse would want to be an “aggressor” against a new dad.

In contrast, it is easy to imagine why a nurse would do everything she could to protect a newborn and comply with rules that aim to prevent infant abduction.

Although data from the National Center for Missing & Exploited Children shows that infant abductions from hospitals are relatively rare—there were only 128 cases of completed infant abductions from healthcare facilities between 1983 and 2010—hospitals obviously take the threat of abductions very seriously.

Maternity wards are often locked, and the comings and goings of visitors and family are heavily monitored. Hospitals also tightly control babies’ whereabouts; in some hospitals, babies wear security bracelets that trigger an alarm if they’re carried beyond designated boundaries.

Penalties for lax security can be hefty: Last year, Santa Barbara Cottage…(read more)

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Most in-hospital adverse events unreported: OIG

Here is an article from ModernHealthcare.com  that addresses the failure to report events causing patient

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harm.  The article goes on to point out reasons for such a failure and the reasoning does make sense.  However, I feel quite strongly that if nurses had the time to make reports and if those reports were simple and easy, there would be quite a few made.  As it is, nurses are drowning in patient loads, paperwork, and have little to no time to eat or use the restroom, so forgive me if we sometimes don’t stay after our shift to enter cumbersome reports into the computer about events that really did not cause harm but could have.

Please read this article and I would love to hear your take on this topic.

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By Maureen McKinney

Posted: January 6, 2012 – 4:00 pm ET

The vast majority of in-hospital adverse events go unreported by staff, according to a report from HHS’ inspector general’s office (PDF).

Using a month of survey data from a sample of 189 hospitals, the inspector general’s office found that hospitals’ voluntary incident reporting systems captured only about 14% of events that cause patient harm, such as medication errors. Federal investigators attributed low reporting rates, at least in part, to poor knowledge among hospital staff about what patient harm actually means.

“For example, staff reported only one of 17 sample events related to catheter usage (e.g., infection and urinary retention), a common cause of harm to Medicare beneficiaries,” according to the report.Other types of events that went unreported included cases of excessive bleeding related to misuse of blood thinning medications, and hospital-acquired infections.Incident reporting systems are a requirement for participation in Medicare, but a lack of uniform requirements—such as lists staff can use to identify patient harms—can damage the systems’ reliability, according to the report.“Because hospitals rely on incident reporting systems to track and analyze events, improving the usefulness of these systems is critical to hospitals’ efforts to improve patient safety,” the report said.

The report urged the CMS and HHS’ Agency for Healthcare Research and Quality to develop a list of adverse events for hospitals to use. Additionally, the office said, the CMS should reassess its methods for judging hospital compliance with the reporting-system requirement.

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It’s out with the old and in with the new….

Happy New Year!

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To all my nursing friends everywhere….

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