DiversityNursing Blog

New delivery models will bring an increase in community-based facilities

With population health gathering momentum in the wake of health care reform, more hospitals are either constructing community-based settings or are including them in their plans. The goal is to offer sophisticated levels of care at patient-friendly sites and reduce costs with fewer hospital admissions.

Montefiore Medical Center is a perfect example of what is expected to become a growing trend. It recently announced plans to lease a new 11-story, 280,000-square-foot building at Hutchinson Metro Center, a mixed-use development in New York City.

The project, scheduled for completion in the third quarter of 2014, will provide space for multidisciplinary care and integrate technology that allows Montefiore to provide necessary treatments without the need for hospitalization.

"This new tower will allow Montefiore to bring the health care of tomorrow to our patients here in the Bronx," says President and CEO Steven M. Safyer, M.D. "We are reshaping outpatient care and establishing leading practices that provide Montefiore's world-class treatments through multidisciplinary teams at a hospital without beds."

The decision to develop a freestanding ambulatory facility emerged because of several factors, including the ability to provide high-tech imaging and surgical procedures in an outpatient setting, says Ed Pfleging, vice president of engineering and facilities.

The site will include 12 operating rooms and four procedure rooms that will allow difficult cases requiring a hospital-type setting to be scheduled more easily and completed quickly, he says.

While not all new off-campus facilities will be as large as this one, the 2013 Hospital Construction Survey conducted by H&HN's sister publication, Health Facilities Management, and the American Society for Healthcare Engineering also identifies a trend involving increased community-based health care.

Of the 612 survey respondents — who include vice presidents and directors of facilities management and operations at U.S. hospitals — future facility development plans and construction projects include:

• 11 percent, ambulatory surgery centers, 
• 11 percent, satellite offices catering to specialities;
• 15 percent, outpatient facilities in neighborhood settings; 
• 12 percent, urgent care facilities in neighborhood settings;
• 15 percent, new medical office building construction.

According to the National Association of Community Health Centers, the number of Americans who rely on community health centers for care is expected to double to an estimated 40 million by 2015 — from about 20 million in 2010. The Affordable Care Act allocated $11 billion to expand these centers, including $1.5 billion for construction.

Richard Taylor, managing director, health care solutions group, Jones Lang Lasalle, a real estate services firm based in Chicago, says health care systems are evolving into integrated delivery systems that reach out to their customers through a variety of facility types.

"It's all part of that overall trend that you can track back to the health care legislation and consumer preferences," he says. Lower cost of delivery and competition are two other key factors in the trend, he adds.

Marisa Manley, president, Healthcare Real Estate Advisors, agrees that the drive is in full swing for hospitals to move urgent, ambulatory and primary care to community-based sites to meet patient preferences and to cut costs.

Another positive outcome of the trend is that hospitals likely will start to utilize some of the empty buildings and office spaces caused by the Great Recession in addition to building new facilities when necessary, she says.

Source: H&HN

Patient satisfaction scores soar after hospital trains staff to treat patients — and each other — with respect.

When Laurent Gueris took over the housekeeping department at Providence Little Company of Mary Medical Center in San Pedro, Calif., the staff of 15 was well-trained in cleaning, but any people skills they had, they'd picked up on their own. Some entered rooms without knocking, did their jobs wordlessly with heads down, and then rushed out. Wanting to be invisible, they instead came off as sullen and unhelpful.

"They would do their little cleanup and leave," recalls Gueris' boss, Providence CEO Nancy Carlson. "They were very intimidated by other staff in the hospital and they were not being respected and valued."

At first, Gueris, manager of environmental services, concerned himself with easy fixes in his department, like purchasing paper towel dispensers that didn't have to be changed as often and swapping out conventional mops for microfiber ones. But a trip to France to visit his dying mother in the hospital prompted him to think about bigger issues, such as getting his workers to say "hello," be pleasant, even chitchat occasionally with patients.

"One day, I would see a housekeeper who was very friendly and connected with my mom," he says. "And another day, somebody would just go into the room and not even knock on the door."

Gueris became a student of the hospital's staff, noticing how some were able to defuse difficult situations and others made it worse. He also saw how a few pleasantries — and treating difficult patients as otherwise decent people reacting with fear and anxiety to a very stressful situation — made a big difference.

Back home, Gueris introduced role-playing sessions. Every morning, the staff met to rehearse interactions with patients. Gueris offered guidelines, something they hadn't had: Knock on the door. Ask permission to come in. Introduce yourself and tell them you're from housekeeping.

At first, Gueris played the patient, really throwing himself into his role. Sometimes, he'd be angry, sometimes insulting — whatever he knew would push a particular worker's buttons. After the session, he gave pointers on such matters as looking people in the eye or defusing an overly flirtatious patient with "Thank you very much, I appreciate that, but I'm not interested."

Gradually, the staff started coming around. After six months, they grew confident to the point that they wanted to take turns playing the patient.

"They give each other a real hard time," Carlson says. "They come up with scenarios that really challenge their peers."

They also began challenging Gueris.

"I'd say, 'You didn't look me in the eye,' and they'd say, 'Yes, Laurent, I did.'" So he started recording the morning sessions, which the staff would watch, discuss and then erase.

He was expecting resistance with the videotaping, but didn't get much. "I'd been working with them for a while to build that trust," he says. "We did the first video, it broke the ice and, by the next day, they were fine with it.

"Seeing it on their own was very powerful," he adds. "Not just the eye contact, but their facial expressions, their body language. Maybe they thought they did not look nervous, but they were [twitching] their legs."

They now follow a script: "Hi, I'm here; my name is …. I'm here to clean your room. I'm hoping you're having a good day today; here's a flower," then hand the patient a card with a flower printed on it. Once the room is clean, they ask whether the patient would like his or her curtains open or closed and whether they need anything else.

"Even though they can't answer a clinical question or stop an IV from alarming," says Carlson, "they can move a telephone closer, get a blanket, or ask a nurse to come in and respond to a clinical concern or question."

The housekeepers' patient satisfaction scores have jumped from the 60th to the 70th percentile to the 90th percentile in 2012. For his efforts, the Hospital Association of Southern California named Gueris a Hospital Hero for 2012.

Gueris' training techniques are now rolling out to other parts of the hospital, starting with nurses' aides and administrative staff. "Our goal is to roll it out to anybody who has interaction with a patient, including the phlebotomist who comes in, sticks a patient with a sharp object and leaves," Carlson says.

Source: H&HN

By ANGEL McCURDY 

On any given day you can see a group of people sitting in a small corner at Emerald Coast Center nursing facility.

Members of the reading club deal with disease, death and heartache, but there are no tears because of the special attention Covenant Hospice volunteer Brice Horwell gives them.

They enjoy their books, some conversation and milkshakes Horwell brings.

Horwell does more than visit with patients. He becomes their friend.

Horwell brings fresh flowers to the nursing facilities he visits each week. He tours the halls to say hello to each person he sees; he knows most by name.

He also visits hospital rooms and people’s homes.

“I feel like I’m doing something,” Horwell said. “I don’t want to see anyone die alone.”

Horwell, who is retired from the Navy, has volunteered with Covenant Hospice for eight years. He visits his clients weekly, runs errands and finds ways to make hard days better.

“I‘ve done some weird things,” Horwell said, laughing. “There‘s a patient that loves pigs feet. I would never eat pigs feet, but I’m happy to go and get them.”

Tim Morgan is a member of the Emerald Coast Center’s reading club. Morgan, who is no older than 60 but suffers from kidney failure, says Horwell’s weekly visits add joy to his day.

“Life wouldn’t be what it is without this guy,” Morgan said. “He brings us outside contact and is a great conversationalist. It means a lot to have somebody come to visit.

“It really makes a difference and lifts your spirit.”

In the last year, Horwell has accumulated more than 350 volunteer hours through his weekly visits, 11th-hour work and Hospice’s We Honor Veterans.

“He is the last face they will see as a measure of comfort,” said Dennis Krebs, Covenant Hospice’s volunteer services outreach assistant. “That means something to him and it means something to the people he’s with.

By Tony Moton

It didn't take long for Annette Staack to realize that making the decision to pursue a career as a registered nurse (RN) was the right one for her.

"It was my calling," says the energetic Staack. "With the first thermometer that I put into my first patient's mouth, I loved it."

A 55-year-old mother of two adult children, Staack earned an associate's degree in nursing from an Iowa community college when she was in her 20s. She says she decided to go to school because she had long had an interest in a career that would allow her to help others.

And while circumstances are different for all nurses, Staack says that she was able to finish her nursing degree in two years, which led to a career that has provided her with a good living and a better work/life balance.

Staack currently holds the title of cardiac liaison and cardiac procedure nurse at her Los Angeles-area hospital, where she has worked for more than two decades. She specializes in testing and assisting in the treatment of patients with heart ailments. And most importantly, she enjoys every moment of it.

"You get to work with patients in all kinds of situations," she says. "You've got emergencies, patient contact, and being responsible for their lives. I like the hands-on aspect of it."

Here's a closer look at how Staack spends a typical day on the job at her hospital.

8:45 a.m. - In the cardiac procedure room, I greet a new patient and call for an Armenian translator because the patient doesn't speak English. I check the patient's vital signs and they are all normal.

9:00 a.m. - The translator explains the process to the patient and she verbalizes her understanding. I finish my computer charting, obtain sedation IV medicines, and wait for the doctor. I text him that we are ready.

9:15 a.m. - The doctor arrives and we begin a procedure to look at the patient's heart and determine whether there are any abnormalities. Within two-to-three minutes the patient is sedated. Images are taken during a five-to-seven minute time period.

9:45 a.m. - The patient slowly wakes up and responds appropriately. I check the patient's vital signs, which are stable. I fill out a patient's chart on the computer. I also provide a written report of meds and findings for the bedside nurse to review.

1:15 p.m. - I go to the surgery room, where a heart surgery is just finishing. The surgery involves another one of my patients, so it's important for me to monitor their progress. I update the patient's family, tell them "all is well," and the MD will speak with them in about 30 minutes. They were so worried, but now are so grateful and give me a hug.

1:45 p.m. - I go to eat my lunch and, sure enough, I get interrupted by EKG. I do three back-to-back-to-back Lexiscan stress heart tests. Today is a pretty hectic day, which is usually the case. But no two days are exactly alike for me.

2:30 p.m. - I head back to my office - to a cold lunch - but I eat it anyway.

3:00 p.m. - I head to Telemetry Unit to speak with a patient and their family about tomorrow's coronary bypass surgery. I need a Spanish translator to help explain and repeat the process to the patient and family. They verbalize understanding and agree to proceed. I schedule the surgery with the OR (Operating Nurse) booking clerk.

5:15 p.m. - I am out of here. Tired but fulfilled! I am thinking about what I might have for dinner and having a relaxing night at home in front of the TV. I'm usually in bed and asleep by 10 during the week because I need my energy for the next day.

BY DARIA WASZAK, RN, MSN, CEN, COHN-S

Gerardo Gorospe, RN, BSN, MSN, is frequently mistaken for a physician — not necessarily due to his skillset, expertise, white coat or bedside manner, but because of his gender.  “I am often asked why I am not a doctor. I politely say, ‘Because I wanted to be a nurse.’” 

Gorospe is the clinical nurse manager in the Department of Hematology and Hematopoietic Cell Transplantation at City of Hope in Duarte, Calif. He has been an RN for over 21 years and has his MSN in education and nursing administration. Although nursing is a predominantly female profession, he decided to become a RN because of his interest in health and science, helping patients achieve wellness and the “personal interaction aspect” of being a nurse.

He spends his workday managing a team of transplant coordinators and hematology clinical trial nurses, resolving problems, supervising staff and managing projects, among many other tasks. “I think because we are in a female-dominated environment, there is, in the community at large, not a great understanding of who we are and what we do,” he says. “There are some gender stereotypes when it comes to the territory of nursing.”

That couldn’t be more evident than when you take a look at older nursing textbooks, like a 1962 edition of Mosby’s Practical Nursing that Gorospe recalls picking up from a thrift store; the cover featured a picture of a woman in a white nursing dress, white cap and heels, holding a tray. “There is certainly gender bias in our early textbooks of nurses as women,” he says.

Heavy Lifting
So, does there continue to be a social stigma surrounding being male in a predominately female profession? What difficulties do men in nursing face today? Gorospe, 45, who went to nursing school in the early 1990s, says his patients never had a problem with his gender, but he did remark that since he is often the only male on duty, his female colleagues frequently turn to him for his physical strength. “I think when it comes to the physical work — lifting patients and heavy equipments — male nurses are often asked to assist,” Gorospe says, adding that his colleagues would often exclaim, “We are glad you are here today, so you can help lift.”

A Need for Role Models
Samuel Gomez, MSN, RN, PHN, CENP, was one of only two men in his nursing program in the early 1980s. Since men were even more uncommon in nursing at that time than they are now, he, like Gorospe, was frequently asked why he didn’t just become a doctor instead of a nurse.

Gomez, 48, explains that he was inspired to choose nursing as a career by a high school guidance counselor who was also a RN. “She told me that as a man, nursing was a great profession for me to explore and that it had many possibilities and opportunities,” he says. “She was absolutely right.” 

Now, Gomez is the one inspiring other men to join nursing. He is currently the executive director of cardiovascular services at Mission Hospital Regional Medical and Trauma Center in Mission Viejo, Calif., but he often speaks to medically underserved middle school youth. When he was a professor at the University of Southern California, he even started a special interest group for male nursing students. 

“What is most important to me as a nurse who is male is the importance of role-modeling for others, the importance men have in nursing and that as a profession, it is open and ready for more men to join,” he says. “I am always sure to point out to male students that nursing has been an outstanding career for me and it can be for them as well.”

A Tailored Fit
According to a 2005 “Men in Nursing” survey conducted by Hodes Research and published on the website of the American Assembly for Men in Nursing (AAMN), approximately 6 percent of nurses are men. Nearly half of the almost 500 respondents to that survey reported experiencing gender-related problems in the workplace, including being stereotyped as “muscle,” being a minority in the nursing profession, being perceived as not caring or having trouble communicating with female colleagues.

Scott Topiol, co-founder of the online men’s scrub store Murse World, adds that male nurses often face an additional problem: Nursing scrub stores rarely have a good selection or variety of scrubs for men. Unisex scrubs, which feature solid colors, a baggy fit and a V-neck cut, are no solution; they only come in a few styles and stores seldom carry all of those.         “Scrubs that are made specifically for men not only fit their bodies better,” says Topiol, “they also offer more masculine styling options that help male nurses and healthcare professionals look and feel their best on the job.“

Topiol says that one of the goals he and co-founder Alex Mayzels had in starting Murse World was to provide scrubs that are more attractive to men. “One thing we've found is that many men are looking for a more athletic, sporty cut and also want color accent options such as contrast color stitching,” he explains.  

Communication Styles
Like the respondents of the 2005 Hodes survey, 38-year-old Troy Gideon, RN, BSN, critical care clinical coordinator at St. Jude Medical Center in Fullerton, Calif., says that one of the biggest challenges male nurses face is continuing to improve their professional interactions with female colleagues. “A man in a female world must learn the intricacies of female communication and the dynamics of their interrelationships to be able to work collaboratively towards a goal,” he explains. 

Despite the communication hurdles, Gideon has seen improvement for men as nursing has evolved over time. “I think that the industry has changed greatly in its social context as the field has become more educated and professional,” he says. “With this change and the financial stability that comes with it, nursing has become a magnet for more males, thus dissolving preconceived stigmas.” 

Managing the Whole Patient
Gomez, Gideon, and Gorospe all spoke about how rewarding their nursing careers have been, whether they have involved teaching, leading and supervising other nurses or performing patient care.

“As nurses, we are for the whole individual, not just managing the medical condition or surgically managing a patient. We manage the patient holistically,” Gomez says. “That was all I needed to know about the profession of nursing — that it was aligned with who I was as a person and as a human being.”

BY CHILTON TIPPIN

With a baby on the way, Desharia Uribe, then 17, put her hopes in the Nurses Aid Program at Whiting High.

“I wanted to be a nurse,” she said. “And I knew this program would get my foot in the door.”

She enrolled in the program at the start of her senior year in 2005. Upon graduation in 2006, she was ready to take the Certified Nursing Assistant Test, administered by The Wyoming State Board of Nursing. She worked for about a year, saving money to take the test, and passed it in 2007. The Spring Wind Assisted Living and Memory Care Community hired her for her first job as a CNA shortly thereafter. She was 19, and her career was just beginning.

“Had I been a typical student, without a baby to care for, I could have taken my boards even sooner,” Uribe said.

Lorraine Saulino-Klein, a registered nurse and instructor of the course, which is also offered for Laramie High students, said about 40 juniors and seniors go through the program each year. They graduate with the knowledge and skill set to work in one of the fastest growing industries in the community: health care.

“This Nurses Aid program fills a tremendous niche,” Saulino-Klein said. “I have students in every medical institution or organization in this town.”

Since the program began eight years ago, about 98 percent of Saulino-Klein’s students have passed the course and the CNA exam, she said.

Ursula Harrision, principal at Whiting, revived the program after it had been defunct for nearly a decade. She was looking for an instructor to teach it, and Saulino-Klein filled that void.

“It’s a vocational program,” Harrison said. “And I particularly looked for programs that people could use to get jobs in this town.”

The course certifies students with the American Heart Association in CPR, AED and basic first aid. In the first nine-week period, students work with Saulino-Klein in the classroom, learning about the theories and tools used for the care of patients.

The second nine-week period is geared toward clinical experience. Students spend 40 hours at Ivinson Memorial Hospital and Laramie Care Center, working with patients and filling in journals, which they review periodically with Saulino-Klein. At the end of the semester-long course, students graduate with three college credits, awarded by Laramie County Community College.

Once they pass the CNA test, “they can go right out and get a job,” Saulino-Klein said.

“And these are decent paying jobs, too.”

Her students have spread into dozens of niches within the field of health care, from medics in the military to nurses in hospice or the surgical unit at the Laramie Premier Bone & Joint Center. Two of her students from the flagship class went on to become doctors.

Jamie Rhodine, a senior in this year’s program, said she decided to enroll because CNA certification is a prerequisite for pre-medical school.

“My plan is to hopefully get a CNA job this summer in Laramie,” she said.

This fall, Rhodine plans to enroll at the University of Wyoming to pursue a registered-nursing degree. After working for a few years as a nurse, she wants to go back to school for her doctorate.

“(The program) made me excited to see how large the field is and how many opportunities I have,” Rhodine said.

Brenna Westhoff, also a senior in the program, is going into pre-medical school at the University of Kansas on scholarship in the fall.

She plans to go on to medical school and specialize in pediatric oncology and hematology. For her, the program’s benefits stem not only from the experience, but from getting to see the medical practice from a nurse’s point of view.

“I’m excited to have the clinical time under Ms. Saulino-Klein,” she said. “It gives me experience on the opposite end of what I want to do, so I’m kind of getting the full spectrum of the medical field.”

Uribe said she gained everything from Saulino-Klein’s course. After landing her first CNA job with Spring Wind, she worked for four years in a home health agency. During those years, she cared for her first and second child and put herself through nursing school at Laramie County Community College.

This May, she graduates from LCCC with a registered-nursing degree.

The Nurses Aid program “gave me a responsible job to care for my child that I have,” she said. “The whole school at Whiting was supportive over everything. They really do find ways to set you up to be successful for life after high school.”

Uribe said Saulino-Klein will be the first person she invites to her graduation.

The most comprehensive review of new legal and regulatory issues affecting advanced nursing practice across the United States is now available in the "25th Annual Legislative Update," presented exclusively by The Nurse Practitioner: The American Journal of Primary Healthcare.The Nurse Practitioner is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. 

Compiled by Susanne J. Phillips, MSN, FNP-BC, the annual supplement presents a comprehensive review of the legislative proceedings, bills, and laws pertaining to advanced practice registered nursing (APRN) practice in every state. The 25th Annual Legislative Update is now freely available on the journal website. 

Progress in Evidence-Based Reforms Improving Access to APRN Care 

The 25th Annual Legislative Update incorporates current information provided by state nursing boards and APRN associations about the "hot topics" affecting APRN practice in their states. "Despite attempts by medical boards to limit current practice authority, APRNs succeeded in improving access to APRN care in several states," writes Phillips. 

The special edition provides an essential update on recent legislative and regulatory activity promoting access to APRN care, prompted by decades of peer-reviewed research demonstrating the quality and safety of APRN practice. Efforts are ongoing to standardize laws and regulations governing APRN practice across states, and to establish effective consumer protections. 

Yet legislation continues to be "vehemently opposed" in many states, according to Phillips. She discusses steps APRNs can take to "empower legislators to move beyond the outdated, evidence-lacking arguments that APRNs are not educated enough, safe enough, or credentialed enough to care for the nation's residents." 

This year's update presents a rundown of the latest developments in the areas of legal authority, reimbursement, and prescriptive authority for all 50 states. It also includes a table summarizing practice authority for nurse practitioners in every state and the District of Columbia, along with updated statistics and the total number of APRNs reported by state boards of nursing. 

Nurses Encouraged to Work Together to Meet Challenges 

The past year has seen several important improvements in legal authorization of APRN practice, including passage of legislation and promulgation of regulations in 17 states. In addition, eight states reported statutory or regulatory activity leading to improvements in prescriptive authority. 

But challenges remain, including reports of defeated bills and unsuccessful regulatory reform efforts in five states. In addition, two states - Kentucky and Missouri - passed legislation limiting APRN practice in specific ways. Phillips urges APRNs and others interested in ensuring access to evidence-based healthcare to support state APRN organizations. 

Nurses are also encouraged to check out the Future of Nursing Campaign for Action, supported by the Robert Wood Johnson Foundation and AARP, to see what steps are being taken and participate in efforts to improve nursing practice. Phillips adds, "This is a great way for all of the APRN organizations to work together to implement the recommendations and improve practice in your state."

Article adapted by Medical News Today from original press release.

BY SCRUBS EDITOR

Ever wonder what the top 10 best paying nursing specialties are?. So far we’ve covered the top 3 – #1: certified RN anesthetists, #2 orthopedics and #3 geriatrics. This week, at number 4, we’re taking a look at perioperative nursing.

Nurses in this field make between $61,000 and $108,000 (high end, which you get by being an advanced practice nurse). It’s the perfect gig for OR nurses who don’t want to deal with anesthesia. Typically, it’s a good idea to have Basic Life Support and Advanced Cardiac Life Support certification.

If you’re a new nurse you may be wondering: What the heck is perioperative nursing? Quite simply, it’s the specialty that works with patients who are about to have operative or other invasive procedures. Perioperative nurses work closely with a range of medical personnel from surgeons, nurse anesthetists, surgical technologists and nurse practitioners. On a typical day you could find yourself performing preoperative, intraoperative or postoperative care.