DiversityNursing Blog

Source: Nurse.com

A professional practice environment that is supportive of nursing helps explain why Magnet hospitals have better nurse-reported quality of care than non-Magnet hospitals, according to a study.

As published earlier this year in the Journal of Nursing Administration, researchers with the New York University College of Nursing and University of Pennsylvania School of Nursing explored links between recognized nursing excellence and quality patient outcomes.

Only 9% of American hospitals have Magnet recognition, according to an NYU news release, and Magnet hospitals have higher job satisfaction and lower odds of patient mortality than non-Magnet hospitals. Research into the causes of the differences could create an infrastructure for positive change in nurse and patient outcomes.

“Many of the recent efforts to improve quality and enhance transparency in healthcare have been dominated by physician services and medical outcomes,” Amy Witkoski Stimpfel, RN, PhD, assistant professor at NYUCN, said in the news release. “Our study shows that the overall quality of patient care can be optimized when nurses work in a positive environment, with adequate resources and support at the organizational level.”

The study, “Understanding the Role of the Professional Practice Environment on Quality of Care in Magnet and Non-Magnet Hospitals,” focused on cross-sectional data, including the American Hospital Association’s annual survey, and an analysis of 56 Magnet and 495 non-Magnet hospitals.

Witkoski Stimpfel’s team found a clear correlation between positive work environments for nurses and nurse-reported quality of care. Even after taking into consideration hospital characteristic differences between Magnet and non-Magnet hospitals, Magnet hospitals still were positively correlated with higher reports of excellent quality of care.

“Having visible and accessible chief nurses, encouraging and including nurses in decision-making in their unit and throughout the organization, supporting nursing practice and engaging in interdisciplinary patient care are but a few examples of readily modifiable features of a hospital,” Witkoski Stimpfel said.

“Because all organizations, Magnet and otherwise, have the potential to enrich their practice environment, every organization stands to benefit from improving the organization of nursing care.

“Our findings suggest that Magnet hospitals produce better quality of care through their superior practice environments. Hospitals that invest in improving the nursing work environment have the potential to benefit from increased quality of care for their patients and families.”

Witkoski Stimpfel is continuing to research the outcomes associated with Magnet hospitals. Her current project is an assessment of the relationship between Magnet recognition and patient satisfaction in a national sample of hospitals.

Study abstract: http://bit.ly/1hxEUhy

The Agency for Healthcare Research and Quality released a toolkit to help nurses, physicians and medical office staff improve their processes for tracking, reporting and following up with patients after medical laboratory tests.

The toolkit is part of the agency’s effort to make care safer for patients in all settings, according to a news release. AHRQ is a branch of the federal Department of Health and Human Services.

About 40% of primary care office visits involve some type of diagnostic medical test provided on site or at a laboratory, according to the news release. However, if test results are lost, incorrect or incomplete, the wrong treatment may be prescribed and patient harm can occur.

“Improving Your Office Testing Process: Toolkit for Rapid-Cycle Patient Safety and Quality Improvement” offers step-by-step instructions on how to evaluate an office testing process, identify areas where improvement is needed and address those areas. Practical tools are included that can be used to assess office readiness, plan activities, engage patients, audit efforts and incorporate electronic health records. The toolkit also includes a template for practices to ensure that laboratory test results are communicated effectively to patients in English or Spanish.

The toolkit was developed by a team of researchers led by Milton “Mickey” Eder, PhD, director of research and evaluation at Access Community Health Network in Chicago, a large network of community health centers. A national panel of primary care experts contributed, and the toolkit was tested in the Access network.

“The toolkit was developed in a network of federally qualified health centers, but studies indicate that all types of primary care offices experience problems managing tests,” Eder said in a news release. “Clinicians and staff handle a lot of lab test results, and unfortunately mistakes happen. Results can get lost or misreported or patients may not understand how to follow up, and sometimes these mistakes can have serious consequences.”

Toolkit information: www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/ambulatory-care/office-testing-toolkit. 

Source: Nurse.com

by Mark Downey

One of the questions that I frequently ask my students is, “Do you need to care to be a great nurse?” It’s always interesting to read the expressions on their faces and imagine what they must be thinking, because for the majority of my students it is the wanting to be a nurse and all that it entails that is a motivating factor in studying for their nursing degree.

From “Is he trying to trick me?” to “My teacher is an idiot!”, I can see the cogs and wheels ticking over in their brains. More often than not, I don’t give them an opportunity to answer. Instead, I tell them, “You don’t have to care about people to be a nurse. I consider myself an excellent nurse, but I’m not paid to care”.

Reactions to this vary. The two most common being dumbstruck, tongue tied and not knowing quite what to say or alternatively the hairs on the back of the neck bristle and I am challenged (often quite vigorously). Rarely, if ever, does anyone agree with me.

Let me explain with an example. If you’re a patient in an Accident and Emergency Room or perhaps lying unconscious in an Intensive care bed or on an operating table, is it really going to matter if the nurse gives two hoots about caring for you? Of course not! What is important is that the nurse is clinically competent and understands your health requirements so that every opportunity is afforded in generating a positive health outcome.

A steam train driver doesn’t have to care about his train to drive it, but he does need to understand how it works. As long as the gauges stay within the safe zones and coal is regularly fed to help generate steam to drive the engine, it doesn’t matter if he cares about the train or not. In fact, regardless of his care factor, the end result will never vary as long as he is good at his job. To be a good and great nurse is to know how to do your job right. I know everyone will agree.

Isn’t a nurse just like the train driver? Health outcomes will always be the same regardless of how much caring the nurse gives. It all boils down to the nurse trainings and the skills they have developed and how they are implemented. Nothing more, nothing less. A Cardiac Nurse needs to know about your heart, how it works, what the ECG squiggles mean and what the drugs that have been prescribed for you are going to do, but they don’t need to know your hearts desires or what’s in your heart. Isn’t that the job of the Chaplain?

Another important point is not to confuse advocating for the patient with caring. Advocacy is mandatory if the nurse’s training and experience lead them to believe that an alternative option may deliver a better health outcome for the patient. But really you don’t have to care to advocate as it’s just part of being a good nurse.

My argument is further proven when you consider the nursing process. Although it comes in many forms and guises, it is essentially:

• Assess the situation.
   
• Planning a course of action.
   
• Implement that action plan.
   
• Review the effectiveness of the plan and when necessary returning to step 1 and repeating. 

Nowhere, I repeat, nowhere, in any of the literature I have read, have I ever seen or mentioned that caring was required as part of the nursing process.

So do nurses care about their patients? Of course they do! Don’t be a goose! For the vast majority it’s an integral part of what makes them who they are. Nurses are looking after people, not machines. So, do I care for the people that I look after? I do and with a passion, but I don’t have to and, if couldn’t care for people, I couldn’t do my job.

Earlier on in this post I made the comment “I consider myself to be a great nurse, but I’m not paid to care.” This, I hold, as an absolute truth. When I am nursing, I am not paid to care.  You cannot pay me to care. I will not accept money to care! I choose to care because I want to care and you get that for free.

Source: NurseTogether

As a health care giver, you have a responsibility to ensure that they have adequate knowledge in order to provide competent nursing care. Malcolm Gladwell wrote about “rapid cognition,” or our innate sense of “knowing” in his 2005 book, “Blink.” If you haven’t read it, I highly recommend it; it is a fascinating read for all nurses. Of it, Gladwell says:

“You could also say that it’s a book about intuition, except that I don’t like that word. In fact, it never appears in ‘Blink.’ Intuition strikes me as a concept we use to describe emotional reactions, gut feelings -- thoughts and impressions that don’t seem entirely rational. But I think that what goes on in that first two seconds is perfectly rational. It’s thinking -- it’s just thinking that moves a little faster and operates a little more mysteriously than the kind of deliberate, conscious decision-making that we usually associate with ‘thinking.’ In ‘Blink’ I’m trying to understand those two seconds. What is going on inside our heads when we engage in rapid cognition? When are snap judgments good and when are they not? What kinds of things can we do to make our powers of rapid cognition better?”

Within professional nursing, we call this concept “tacit knowledge.” It is not easily shared through lectures or books, but it comes with experience and knowing through repetitive, almost unaware situations and critical thinking. I explicitly learned about tacit knowledge (what an oxymoron) in my undergraduate nursing studies. However, I actually learned tacit knowledge while working with patients alongside more experienced nurses.

I picked it up from colleagues such as the night shift nurse, a LVN with 30 years of experience, who walked back to the desk after assessing a certain patient she’d cared for during the last three days saying, “I’m going to keep my eye on Mr. Second-Door-on-the-Left. I can’t put my finger on it, but I’m going to watch him.” As the oh-so-terribly-young charge nurse, I’d walk in and assess him, too, especially because I knew he was scheduled for discharge some time the next day. Not seeing what my colleague saw nor anything in the chart to cause alarm, I brushed it off only to think, What the…???, as we called a code in the wee hours of the morning -- in between patient rounds because my colleague increased her routine patient checks, “just because.” Similar situations have happened to me numerous times, and I have learned to trust members of the nursing community when they sense something going awry with a patient.

Tacit knowledge is one way to improve patient care, though it’s hard to explain when you know it as well as when you learn it. What a mysterious and fascinating concept and feeling.

Source: NurseTogether