By Debra Wood
Modern Healthcare readers selected four nurses in leadership roles to be ranked on this year’s 100 Most Influential People in Healthcare list, based on their effect on the industry.
“It’s great for nursing, because we do this together,” said Marla J. Weston, PhD, RN, FAAN, chief executive officer of the American Nurses Association, who made the magazine’s annual list for the first time, ranking 45th.
“I’m honored to be recognized,” she continued, “but I realize this is not about me. It’s about the hundreds and thousands of nurses working together to make the American Nurses Association a powerful force, to make nursing a powerful force, and to help our colleagues in health care and the general public understand the impact of nursing practice. I am the lucky person to be in the CEO role, but there are a lot of people making this happen.”
Other nurses in leadership who made the list included Marilyn Tavenner, agency administrator with the Centers for Medicare & Medicaid Services (CMS), listed fifth; Sister Carol Keehan, DC, MS, RN, president and CEO of Catholic Health Association in Washington, D.C., 34th; and Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI) in Cambridge, Mass., 50th.
“The four nurses on Modern Healthcare’s 100 Most Influential People list this year are transformative and visionary leaders, and some of the brightest lights in the nursing world,” said Susan B. Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing. “They are role models.”
Weston was one of 19 new people to join the list, which is dominated by elected and appointed government officials, top executives of health care industry corporations and physicians. Anyone can nominate a candidate. The magazine received 15,000 submissions for 2014. The top 300 nominees, including 10 nurses, were presented to Modern Healthcare readers for voting. Half of the candidates are selected through the reader votes and the other half by the magazine’s editors.
While not a nurse, RoseAnn DeMoro, executive director of National Nurses United (NNU), with 185,000 members, made the list again, at 41st.
“With the disproportionate economic influence of the hospital and insurance giants in particular, it is especially gratifying to see the name of RoseAnn and NNU on this list,” said NNU Co-president Deborah Burger, RN.
With the relatively small showing for nursing on this year’s list, opportunity exists for more nurses to move up to positions of leadership and influence.
“Nurses spend the most direct time with patients and, therefore, offer a vitally important perspective,” Keehan said. “As a nurse myself who moved into leadership, I encourage nurses to lend their voice to management decisions and consider leadership roles in their units or hospitals. It may not feel natural for some nurses to assert themselves, but the future of health care requires that we listen to their ideas and concerns. I hope to see many more nurses bring their passion for patient care and support of staff to the work of making health care better for everyone.”
Weston pointed out that nurses practice throughout the health care system, not only in hospitals but in home health, public health, primary care and long-term care. They observe when the system works and when it doesn’t for patients.
“That gives nurses the capacity to help make the system work for patents and communities and to redesign the system to transform and improve care,” Weston said. “Nurses are stepping forward to be leaders, and people are understanding nurses are not just functional doers of things, but thoughtful strategists.”
Weston expects more nurses will make the list in the years ahead. She encourages nurses to talk more about the work they do and the effect it has on people.
“The more we highlight the impact we are making, the more people will understand the great strategists and decision makers that nurses are,” Weston said. “There are a lots of pockets of innovation being led by nurses that are improving the quality of care, reducing the cost of health care and improving the access. We need to support each other in taking those pockets of innovation and spreading them.”
Weston has forged partnerships with other disciplines when delivering clinical care and when transforming the health care system.
“Health care is a team sport,” Weston said. “The degree we can work together catalyzes the work getting done.”
Increasing the number of nurses in leadership positions is one of the key recommendations of the Institute of Medicine’s groundbreaking Future of Nursing report and a central goal of the Campaign for Action.
“As the largest group of health professionals, and as those who spend the most time with patients, nurses have unique insight into health care,” Hassmiller said. “We need that insight at the highest levels of our health care system--on the boards of health care systems and hospitals; leading federal, state and local agencies; and more.”
Two members of the Campaign for Action’s strategic advisory committee made the 2014 Most Influential People in Healthcare list: Leah Binder, president and CEO of The Leapfrog Group, and Alan Morgan, CEO of the National Rural Health Association. Additionally, several members of organizations on the Champion Nursing Council and Champion Nursing Coalition were recognized.
“Health care transformation is underway in our country,” Hassmiller concluded. “Nurses possess the skills to ensure that the perspectives of people, families and communities remain front and center in any health decisions that get made.”
Meet the ‘Most Influential’ Nurses¹
5. Marilyn Tavenner, agency administrator with the Centers for Medicare and Medicaid Services, began her career as a nurse at Johnson-Willis Hospital in Richmond, Va., and spent 25 years working in various positions for HCA Inc., culminating as group president for outpatient services. Tavenner was one of several people in government to make Modern Healthcare’s annual list of the 100 Most Influential People in Healthcare.
34. Sister Carol Keehan, DC, MS, RN, president and CEO of Catholic Health Association, started out as a nurse and served in the 1980s as Providence Hospital's vice president for nursing, ambulatory care, and education and training. She joined the Catholic Health Association in 2005. She told NurseZone that she hopes many more nurses will bring their passion for patient care to make health care better for everyone.
45. Marla J. Weston, PhD, RN, FAAN, chief executive officer of the American Nurses Association, has held a variety of nursing roles, including direct patient care in intensive care and medical-surgical units, nurse educator, clinical nurse specialist, director of patient care support and nurse executive. She has served as executive director of the Arizona Nurses Association and deputy chief officer of the Veteran’s Affairs Workforce Management Office. Weston reported that she has had great role models and mentors in her nursing career.
50. Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement, began as a staff nurse in 1973 at Quincy City Hospital, moved up and became chief operating officer in 1986, before joining IHI. Bisognano is one of many quality improvement leaders on this year’s Most Influential list.
A study in the current issue of Policy, Politics & Nursing Practice estimates 17.5% of newly licensed RNs leave their first nursing job within the first year and 33.5% leave within two years, according to a news release. The researchers found that turnover for this group is lower at hospitals than at other healthcare settings.
The study, which synthesized existing turnover data and reported turnover data from a nationally representative sample of RNs, was conducted by the RN Work Project, funded by the Robert Wood Johnson Foundation. The RN Work Project is a 10-year study of newly-licensed RNs that began in 2006. The study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas. The RN Work Project is directed by Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University, and Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo.
“One of the biggest problems we face in trying to assess the impact of nurse turnover on our healthcare system as a whole is that there’s not a single, agreed-upon definition of turnover,” Kovner said. “In order to make comparisons across organizations and geographical areas, researchers, policy makers and others need valid and reliable data based on consistent definitions of turnover. It makes sense to look at RNs across multiple organizations, as we did, rather than in a single organization or type of organization to get an accurate picture of RN turnover.”
According to the release, the research team noted that, in some cases, RN turnover can be helpful — as in the case of functional turnover, when a poorly functioning employee leaves, as opposed to dysfunctional turnover, when well-performing employees leave. The team recommends organizations pay attention to the kind of turnover occurring and point out their data indicate that when most RNs leave their jobs, they go to another healthcare job.
“Developing a standard definition of turnover would go a long way in helping identify the reasons for RN turnover and whether managers should be concerned about their institutions’ turnover rates,” Brewer said in the release. “A high rate of turnover at a hospital, if it’s voluntary, could be problematic, but if it’s involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story.”
The RN Work Project’s data include all organizational turnover (voluntary and involuntary), but do not include position turnover if the RN stayed at the same healthcare organization, according to the release.
By Jeroen Tas
Imagine a time when a device alerts you to the onset of a disease in your body long before it’s a problem. Or when your disease is diagnosed in Shanghai, based on the medical scan you did in Kenya. This future is far closer that you might think due to rapid advances in connected devices and sensors, big data and the integration of health services. Combined, these innovations are introducing a new era in healthcare and personal well-being.
In only a few years, mobile technologies have spawned tremendous innovation of consumer-level health tools. The emerging solutions are focusing on health conditions over a person’s lifetime and on holistic care. They generate constant insights through analytics and algorithms that identify patterns and behaviours. Social technologies enable better collaboration and interconnected digital propositions that reach out to communities of people with similar conditions, engaging them in ways which were never before possible.
We are starting to get a taste of what the consumerization of healthcare will mean in the future. In two to three years, analysing your personal health data will become commonplace for large parts of the population in many countries. Also, it is very likely that for the first time it will not be the chronically ill but the healthy people who will invest the most in managing their health.
Digitization and consumerization will rattle the healthcare industry. It is already tearing at the very fabric of the traditional healthcare companies and providers. Innovation is not only about just adding a new channel or connecting a product. It is also a complete redesign of business models, adjustment of systems and processes and, most importantly, it calls for changing the culture in companies to reflect the new opportunities – and challenges – presented by the digital world.
To drive true industry transformation, companies need to collaborate and continue to learn from each other. Great strides will be made in alliances, which, for example, will deliver open, cloud-based healthcare platforms that combine customer engagement with leading medical technology, and clinical applications and informatics.
The game will not only be played by the traditional healthcare providers. With consumerization, even companies without healthcare expertise, but with strong consumer engagement and trust, could potentially become healthcare companies. Big multinationals invest incremental budgets in developing new propositions and count on their global user bases or professional networks to gain a foothold in the market.
And in parallel, a raft of start-ups are attempting to transform the worlds of preventive or curative healthcare – in many cases, limited only by their imaginations. For example, we may see virtual reality technology moving from gaming industry to healthcare for improving patients’ rehabilitation after a stroke. Or we may see facial recognition software become common in monitoring and guiding patients’ daily medical routines.
While these new propositions tackle a number of healthcare industry’s core concerns and provide solutions to completely new areas, these propositions still need to mature. They need to become scalable, reliable, open, and the user experience needs to be harmonized.
But perhaps one of the most important challenges is related to people’s behaviour and preferences. Regardless of whether these new and existing companies are analysing health data, using virtual reality or reading people’s vital signs, they all need ample time to become trusted and accepted in the emerging digital health care space. Especially for the new entrants, obtaining the right level of credibility will be one of the key success factors.
Consumers, patients and professionals alike, will need the right motivation, reassurance and mindsets to adopt these new solutions. The companies that know how to offer us tailored, cutting-edge solutions, combined with meaningful advice and trustworthiness, will be the winners and become our trusted advisers in health.
Source: World Economic Forum
Making the transition to working nights may feel a bit intimidating, but many night nurses, myself included, have grown to love the position! It tends to be quieter and less chaotic because the patients are generally asleep, and there's a special camaraderie that develops between a team of night nurses. Put these tips into practice to survive, and even thrive, in your night shifts.
Stack several night shifts in a row: Rather than spacing out your night shifts during the week and having to switch between being up during the day and up during the night, try to put all your night shifts for the week in a row. That way, you can really get yourself onto a schedule of being awake during the nights you work and sleeping during the days in between.
Nap before work: As you transition from being awake during the day to being awake as you work at night, take a nap in the afternoon to help you go into your first night shift as rested as possible. Alternately, if your schedule allows, stay up later than usual the night before your first night shift and sleep in as late as you can the next morning.
Fuel up with healthy foods: While sugars may seem like they provide energy, they also come with a crash. Before heading into work, eat a filling meal with a healthy balance of carbohydrates, protein, and fiber. Then bring healthy snacks for the night that include protein and fiber to keep you going strong. Some options include yogurt, mixed nuts, hard boiled eggs, cheese cubes, or carrots with hummus dip
Plan caffeine carefully: It can be tempting to drink a cup of coffee anytime you feel sleepy, but you may develop an unhealthy dependence or be unable to fall asleep when you get home after your shift. Therefore, try to limit yourself to just one or two cups of coffee per shift, and drink your last one at least six hours before you plan to go to sleep.
Create a restful sleeping environment at home: The key to surviving night shifts in the long term is getting lots of restful sleep after each shift. Set up room darkening curtains and a white noise machine to help you block out signs of the day. When you get home, don't force yourself to go to bed right away. Instead, develop a routine that includes some time to bathe, read, and relax as your body winds down after work. Try to avoid bright screens, which block your body from releasing melatonin, the hormone that makes you feel sleepy.
With some attention to detail, you will probably find yourself really enjoying working at night. Many of the night nurses I know started out stuck on the shifts, but grew to prefer them. Plus, the pay differential doesn't hurt at all!
By SYDNEY LUPKIN
At Boston Children’s Hospital, doctors perform practice surgeries with replicas of their patients’ body parts. Though the hospital has had a simulation program for about a decade, it started 3D-printing children’s body parts about a year ago, said Dr. Peter Weinstock, director of the hospital’s simulator program.
“They perfect what they want to do before ever bringing the child into the operating room or putting them to sleep,” Weinstock said.
The models are also used to help parents understand their children’s surgeries before the operation and to educate students afterward, Weinstock said.
The printer is precise, with a resolution of between 16 and 32 microns per layer. That means each layer is about the width of a “filament of cotton,” Weinstock said. And since the printer can print multiple resins or textures, doctors can work on replicas that model different tissue types, like brain matter and blood vessels.
The printer only takes a few hours to do their work once CT scans and other forms of imaging are collected and rendered into 3D models. A child’s finger might take three hours to print, but a chest replica they made last week took longer, Weinstock said.
The team has already printed about 100 body parts over the last year and demand is growing, Weinstock said, adding that the printer is running around the clock.
Dr. Ed Smith, a pediatric neurosurgeon at Boston Children’s, said he recently used several different 3D models to perform brain surgery on a 15-year-old patient with an abnormal cluster of veins above his optical nerve. One wrong maneuver and the patient could have gone blind.
He even used a see-through replica of the patient’s skull on a light box in the operating room as a reference.
“It’s kind of like being superman with X-ray vision where you can actually hold this up and see right through it,” Smith said.
The surgery, which would have normally taken five or six hours, wound up clocking in at 2 hours and 20 minutes, Smith said.
Though Boston Children’s hasn’t conducted any formal studies of how the models help surgeons, Smith said he’s heard anecdotally that they result in shorter surgeries because doctors know what to expect.
Emergency department nurses aren't like the rest of us - they are more extroverted, agreeable and open - attributes that make them successful in the demanding, fast-paced and often stressful environment of an emergency department, according to a new study by University of Sydney.
"Emergency nurses are a special breed," says Belinda Kennedy from Sydney Nursing School, a 15 year critical care veteran who led the study.
"Despite numerous studies about personalities of nurses in general, there has been little research done on the personalities of nurses in clinical specialty areas.
"My years working as a critical care nurse has made me aware of the difficulty in retaining emergency nurses and I have observed apparent differences in personality among these specialty groups. This prompted me to undertake this research which is the first on this topic in more than 20 years.
"We found that emergency nurses demonstrated significantly higher levels of openness to experience, agreeableness, and extroversion personality domains compared to the normal population.
"Emergency departments (ED) are a highly stressful environment - busy, noisy, and with high patient turnover. It is the entry point for approximately 40 per cent of all hospital admissions, and the frequency and type of presentations is unpredictable.
"Emergency nurses must have the capacity to care for the full spectrum of physical, psychological and social health problems within their community.
"They must also able to develop a rapport with individuals from all age groups and socioeconomic and cultural backgrounds, in time-critical situations and often at a time when these individuals are at their most vulnerable.
"For these reasons, ED staff experience high levels of stress and emotional exhaustion, so it's understandable that it takes a certain personality type to function in this working environment.
"Our research findings have potential implications for workforce recruitment and retention in emergency nursing.
"With ever-increasing demands on emergency services it is necessary to consider how to enhance the recruitment and retention of emergency nurses in public hospitals. Assessment of personality and knowledge of its influence on specialty selection may assist in improving this.
"The retention of emergency nurses not only has potential economic advantages, but also a likely positive impact on patient care and outcomes, as well as improved morale among the nursing workforce," she said.
Since this article is from Aulstralia, do you agree that Emergency Room Nurses in the US should have the same characteristics to be successful in a US Emergency Room?
By Robert Preidt
Many children get anxious or afraid when they have to get a vaccination, but there are a number of ways that parents can make these shots easier for their kids, an expert suggests.
The first step is to explain to children in an age-appropriate way that the vaccinations help protect their health, said Rita John, director of the pediatric primary care nurse practitioner program at Columbia University School of Nursing in New York City.
"Children need to know that vaccines aren't a punishment or something negative, vaccines are something that keeps them from getting sick," John said in a Columbia news release. "When parents are anxious, they pass that fear on to their kids. The best way to talk about vaccines is to keep the conversation positive and focused on the benefits of vaccination."
Before a vaccination, you can reduce toddlers' and preschoolers' anxiety if you give them a toy medical kit so that they can give pretend shots to you or a favorite doll or other toy.
When you arrive for the shot, ask the clinician to use a numbing cream or spray to limit the pain caused by the needle. Blowing on a bubble maker or a pinwheel can help distract younger children during vaccinations, while listening to music, playing games or texting may benefit older children and teens.
"If the kids think something is going to reduce their pain, there can be a placebo effect where the technique works because they expect it to work," John explained.
"It doesn't matter so much what you use to make your child more comfortable so long as you do something that acknowledges that they may experience some pain and that they can do something to make it hurt less," she added.
Be sure to reward and/or praise children after a vaccination. For example, give stickers to younger children. "You want the final part of the experience to make kids feel like even if they suffered some momentary pain, it was worth it," John said.
"Good play preparation, a positive attitude about immunization, and bringing something to distract kids during the shots can all help make the experience better," she concluded.
By Bill Toland
Pharmacy errors, hard-to-find clinical alerts, “farcical” training, and potentially life-threatening design flaws: Reading through the U.S. Food and Drug Administration’s catalog of electronic medical records malfunctions could be hazardous to your mental health.
If not yours, than that of the physicians and nurses who must work with the records systems, and who are reporting their experiences to the FDA’s adverse event database, otherwise known as MAUDE (the Manufacturer and User Facility Device Experience).
Most of the events submitted to the database involve misfiring medical equipment — broken aerosol compressors, faulty defibrillators — but as electronic records and computerized physician-order entry systems take hold at hospitals and clinics across the country, complaints about those systems are on the rise.
For decades, electronic patient records systems have been heralded as a potential game-changer for the health care industry, leading to improved patient health outcomes, fewer duplicate tests and, eventually, savings for the health care industry.
While most clinicians and academics still believe the promise is there, the systems are coming under increased scrutiny from doctors, nurses and some on Capitol Hill who say the technology is poorly regulated, often unproven and occasionally unreliable.
As such, the health records systems haven’t yet lived up the promise that was made when the Obama administration won passage its 2009 stimulus bill, which included $25.8 billion for health IT investments and incentive payments.
“Like with any new technology, there’s going to be unintended consequences,” said William M. Marella, director of Patient Safety Reporting Programs for the suburban Philadelphia Emergency Care Research Institute. He’s also director of the state’s Patient Safety Reporting System, which tracks adverse events and near-misses in Pennsylvania.
“In the long run, [electronic health records] will make us safer than we were” using paper records, Mr. Marella said. “But in the short term, we’ve got a lot of [implementation] issues that need to be addressed before [electronic health records] meet their promise.”
Last month, the nation’s largest union of registered nurses sent a letter to the FDA asking for broader and more stringent oversight of electronic records systems and of computerized physician-order entry systems, which allow clinicians to log treatment instructions for patients.
The National Nurses United, as part of its broader campaign highlighting the potential dangers of “unproven medical technology,” says FDA officials should test electronic medical records as rigorously as they might a new drug or an artificial hip implant.
“I don’t think that opinion is an outlier opinion,” Mr. Marella said. “Lots of clinicians are unhappy with the way these systems work, and are unhappy with the documentation burden we put on them.”
The nurses union also wants the U.S. Centers for Medicare and Medicaid Services to suspend its “meaningful use” program, which requires providers to start installing electronic medical records systems at the risk losing Medicare funding, “unless and until we have unbiased, robust research showing that [electronic health records] can and do, in fact, improve patient health and save lives.”
To date, since 2011, that CMS program has issued nearly $24 billion to hospitals and physicians clinics seeking to upgrade their electronic records systems and make the transition away from paper records.
Tracking the errors
The letter submitted by the nurses union to the FDA was part of the commentary related to the federal government’s proposed overhaul of its framework for regulating health IT. That draft proposal was published in April, a joint effort of the FDA, the U.S. Department of Health and Human Services, the Federal Communications Commission and the Office of the National Coordinator for Health IT.
Others offered their own responses. The College of Healthcare Information Management Executives and the Association of Medical Directors of Information Systems, in joint comments to the FDA, said that the government needs a retooled electronic health records certification program in order to “identify clear standards and require strict adherence to those standards.”
The report itself noted that “a nationwide health information technology infrastructure can offer tremendous benefits to the American public, including the prevention of medical errors, improved efficiency and health care quality, [and] reduced costs. … However, if health IT is not designed, developed, implemented, maintained, or used properly, it can pose risks to patients.”
Patient risk was a concern when, last summer, UnitedHealth Group Inc. recalled software that was used in hospital emergency rooms in more than 20 states “because of an error that caused doctor’s notes about patient prescriptions to drop out of their files,” according to Bloomberg News. There were no reports of patient harm, a UnitedHealth spokesman said, but the glitch illustrates the potential pitfalls for digital health records.
The MAUDE system, which accepts voluntary and anonymous incident reports from practitioners, and Mr. Marella’s own reporting have turned up plenty of other glitches. Some involve human error, others involve software and interoperability malfunctions, and many are simply design flaws, such as this example from a 2012 Pennsylvania Patient Safety Authority report:
Patient with documented allergy to penicillin received ampicillin and went into shock, possibly due to anaphylaxis. Allergy written on some order sheets [but] never linked to pharmacy drug dictionary.
And this one, from MAUDE:
Potassium chloride was prescribed twice per day as treatment for hypokalemia. The lab testing revealed a [bad] jump in the potassium level, but the result came to the EHR without alert or warning, and the nurses continued to give the patient potassium anyway [because] the nurse did not know that the potassium level was high. ... Though this patient did not die, others have from this type of defect.
Or this one, from 2013:
Patient’s medication list and other active orders did not appear on the doctor’s order section on the CPOE system, rendering it impossible for the doctor to confirm, alter, and reconcile the medication list. ... For obvious reasons, this defect in the CPOE is potentially life threatening when the doctor(s) do not have access to the current medication list.
And from April:
A patient [was] at risk for respiratory arrest due to a narrowing in the trachea. There is no place on the EHR to list such a life-threatening condition that would be visible to each and every care team member who opened the EHR for this patient. ... Care was delayed due to the above mentioned reasons, [and] the patient sustained a complete respiratory arrest that led to a cardiac arrest and anoxic brain injury.
While examples of electronic health records problems can be retrieved via various state and federal databases, many in the medical field say tracking the issues in a more comprehensive way will lead to better systems. Mandatory reporting would help, too, since only a fraction of adverse events related to electronic health records are actually reported to the FDA or state authorities.
But health IT vendors are against mandatory reporting, or any other system that would run afoul of the confidentiality clauses that are built into contracts with hospitals and clinics. Public, mandatory confessions of errors might also discourage such reporting, since the clinician who admits the error could be punished by his or her employer.
“We have felt that reporting by both providers and vendors should be voluntary. That is most consistent with the notion of a learning environment,” said Mark Segal, the chairman of the Electronic Health Records Association, told The Boston Globe.
Clinicians, too, are also wary about striking the right balance. “FDA oversight and regulation could slow innovation,” particularly if electronic health records and related systems are indeed scrutinized like other medical devices, according to a letter to the FDA from American Medical Association CEO James Madara.
And they have the FDA on their side. The agency does not intend to require the reporting of electronic health records-related adverse events, and does not intend to vet electronic health records in the same way that it reviews drugs and other medical devices.
But when push comes to shove, though, regulators should err on the side of safety, said Dean Kross, a cardiologist in private practice at the Allegheny Health Network and a longtime critic of electronic health record companies and the side effects of health IT adoption.
“The vendors have not been held accountable for the devices they are manufacturing,” he said. There is negligible pre-installation vetting, or post-market surveillance, for “safety, usability and efficacy,” he said.
And regulators should keep a watchful eye on human usability.
“Ninety percent of [complaints] have got something to do with faulty user-device interaction,” said Robert A. North, chief scientist at Human Centered Strategies, a Colorado company that studies and seeks to reduce risk and error in medical device design. “It’s not that something that is breaking or freezing. ... it’s nothing to do with the electronic circuit board. It’s the human circuit board.”
While Mr. Marella is aware of the design shortcomings of electronic health records, he’s still a believer that the systems can, and are, improving patient and population health.
He points to the example of a Pennsylvania hospital that noticed some its patients were overdosing on narcotic painkillers while in the hospital, and had to be given reversal agents to mitigate the overdose symptoms. When clinicians dug into the electronic records, they saw that the overdoses were happening primarily among people being given painkillers for the first time.
“So they decided that the default dose was actually too high” for first-time opioid recipients, and adjusted the first-time dosage going forward, Mr. Marella said. Identifying a hospital-wide problem, and addressing it quickly, probably couldn’t have happened without electronic health records.
“We really have to do a lot more work in what we call human factors,” so that the systems are intuitive, he said. “We’re quite a long ways from there.”
By Cornell University
In a forthcoming Cornell study published in the journal Health Environments Research and Design, Rana Zadeh, assistant professor of design and environmental analysis, discovered nurses who had access to natural light enjoyed significantly lower blood pressure, communicated more often with their colleagues, laughed more and served their patients in better moods than nurses who settled for large doses of artificial light.
Letting natural light into the nurses’ workstations offered improved alertness and mood restoration effects. “The increase in positive sociability, as measured by the occurrence of frequent laughter, was … significant,” noted Zadeh in the paper.
Nurses work long shifts, during non-standardized hours. They work on demanding and sensitive tasks and their alertness is connected to both staff and patient safety. Past evidence indicates natural light and views have restorative effects on people both physiologically and psychologically. Maximizing access to natural daylight and providing quality lighting design in nursing areas may be an opportunity to improve safety though environmental design and enable staff to manage sleepiness, work in a better mood and stay alert, according to Zadeh.
“Nurses save lives and deal with complications every day. It can be a very intense and stressful work environment, which is why humor and a good mood are integral to the nursing profession,” Zadeh said. “As a nurse, it’s an art to keep your smile – which helps ensure an excellent connection to patients. A smart and affordable way to bring positive mood – and laughter – into the workplace, is designing the right workspace for it.”
Access to natural daylight, and a nice view to outside, should be provided for clinical workspace design, said Zadeh. In situations where natural light is not possible, she suggests optimizing electric lighting in terms of spectrum, intensity and variability to support circadian rhythms and work performance.
“The physical environment in which the caregivers work on critical tasks should be designed to support a high-performing and healthy clinical staff,” she said “ improving the physiological and psychological wellbeing of healthcare staff, by designing the right workspace, can directly benefit the organization’s outcomes”.
In addition to Zadeh, this study, “The Impact of Windows and Daylight on Acute-Care Nurses’ Physiological, Psychological, and Behavioral Health,” was authored by Mardelle Shepley, Texas A&M University; Cornell doctoral candidate Susan Sung Eun Chung; and Gary Williams, MSN, RN. The research was supported by the Center for Health Design Research Coalition’s New Investigator Award.
By MICHELLE ANDREWS
School nurses today do a lot more than bandage skinned knees. They administer vaccines and medications, help diabetic students monitor their blood sugar, and prepare teachers to handle a student's seizure or asthma attack, among many other things.
"Chronic disease management is what school nurses spend most of their time doing," says Carolyn Duff, president of the National Association of School Nurses. "We do care for students in emergencies, but we spend more time planning to avoid emergencies."
And though school nurses see many students regularly, they don't always have the most up-to-date information about the students' health. School nurses must get permission from parents to communicate with a child's doctor. Once the doctor gives them a care plan for the child, they generally rely on the doctor and/or parents for updates and changes.
"When things change, we don't always get told in a timely manner," says Nina Fekaris, a school nurse in the Beaverton, Ore., school district. "It works, but it takes a lot of coordination."
At the same time, school-based health care is unfamiliar territory to many medical professionals, who operate in a health care universe largely separate from school clinics and other community-based medical services.
But schools and health care systems are trying to bridge that gap. In these projects, some funded by the Affordable Care Act, school health professionals gain access to students' electronic health records, specialists and other health system resources. The initiatives are up and running or on the drawing board in Delaware, Florida and Oregon, among other locations.
In Delaware, "lots of nurses expressed that they had difficulty communicating with providers" at Nemours Health System, which serves children around the state, according to Claudia Kane, program manager of the Student Health Collaboration at Nemours.
In 2011, Nemours got together with the Delaware School Nurses Association and the state Department of Education to develop a program that, with parental approval, gives school nurses read-only access to the electronic health records of more than 1,500 students who have complex medical conditions or special needs. That includes conditions such as diabetes, asthma, attention deficit hyperactivity disorder, seizure disorders or gastrointestinal problems.
Beth Mattey, a school nurse in Wilmington, says that now that she has access to the Nemours system, she can check the recent lab test results of a student who has diabetes. "It's helpful for me to monitor his [blood sugar levels] and work with him to make sure he's in better control," says Mattey, who is president-elect of the National Association of School Nurses.
When a student put a staple through his finger, Mattey was able to check to make sure he went to the doctor and got treatment. "Checking with him directly involves calling him out of class," she says.
Eventually, school nurses will be able to put information into the Nemours electronic records system as well, says Kane.
In the meantime, Nemours doctors, some of whom were initially skeptical about allowing school nurses access to health system medical records, are warming up to the arrangement. Kane says it encourages communication between physicians and school nurses, and eases the burden of routine tasks because Nemours doctors no longer have to fax over care plans or instructions to the school nurse every few months for students who are part of the program.
The Nemours Student Health Collaboration project is operating in all Delaware public school districts as well as half of charter schools and about one-third of private schools. Kane says Nemours plans to extend the program to school-based health centers next.
Do you think they should have access to medical records?