Joint Commission Sentinel Event Alert - "Leadership Committed to Safety"

Issue 43, August 27, 2009

In a Sentinel Event Alert released today, the Joint Commission urges health care leaders to take a stronger role in preventing medical errors. As they say, "Leadership is a critical function in promoting high quality, safe health care. In health care organizations, leadership is provided by the governing body, the chief executive and senior managers, and the leaders of the clinical staff. When a sentinel event occurs in a health care organization, inadequate or ineffective leadership is often one of the contributing factors."

To read the alert, click here.

INQRI Team Honored with the AONE Best Paper Award

Congratulations to Eileen Lake and Jeannette Rogowski, the Project Investigators of the INQRI project, "Acuity-adjusted Staffing, Nurse Practice Environments and NICU Outcomes." Today, they learned that their abstract, “Better Very Low Birth Weight Infant Outcomes in Nursing Magnet Hospitals,” won the American Organization of Nurse Executives (AONE) Best Paper Award to honor an outstanding paper presentation at the International Nursing Administration Research Conference in Baltimore in October.

Click here to learn more about their work.
Click here to learn more about the AONE.

Shared Resource: Treatment Fidelity

At the INQRI annual meeting, Cohort 3 researcher Barbara Resnick offered to share a presentation she has given regarding treatment fidelity. Click on her slide to view the slides as a PDF.

Issues in Nursing and Staffing...

State, Federal Lawmakers Debate Safe Patient Handling Legislation

State and national lawmakers have enacted or are considering enacting safe patient handling legislation aimed at reducing sick days and workers' compensation claims, HealthLeaders reports. Minnesota, New Jersey, Rhode Island, Texas and Washington state have already enacted safe patient handling laws, and several other states have bills pending.

For more information, click here.


Texas Considers Ban on Mandatory Overtime for Nurses

Texas Gov. Rick Perry (R) is expected to sign legislation that would prohibit mandatory overtime for nurses, Healthcare Finance News reports. According to the associate director of State Government Affairs at the American Nurses Association, many states currently have varying degrees of overtime restrictions in place for nurses. However, in most instances, such overtime restrictions focus on voluntary rather than involuntary overtime and exert no cap on the total number of hours worked.

For more information, click here.

AHRQ Innovations Exchange - Long Term Care

Check out today's edition of the AHRQ Innovations Exchange, highlighting issues in long term care.

A few highlights:

• Interdisciplinary Team Identifies and Addresses Risk Factors For Falls Among Nursing Home Residents, Leading to Fewer Falls and Less Use of Restraints
• Nurse-Led Program Increases Provision of Cessation Counseling to Inpatients Who Smoke
• Nursing Home Learning Collaborative Improves Quality of Care, Reduces Staff Turnover

INQRI's Connection to Long Term Care

Although much of our work is focused on acute care settings, in the last couple of years, INQRI has expanded to other health care settings. To that end, we are very interested in the issues surrounding long term care.

"The Res-Care-AL Intervention Study" is a randomized controlled trial to test a restorative care intervention for assisted living (AL). The project incorporates patient centered outcomes (falls); nursing centered outcomes (restorative care services); and system-centered outcomes (staff turnover) as designated by the National Quality Forum. The primary aim of this study is to maintain or improve the residents' physical activity, physical status, function, and length of stay in the facility. The secondary aim related to residents focuses on mood, life satisfaction, resilience, self-efficacy and outcome expectations, social-support for exercise, and person-environment fit. This team is co-led by Barbara Resnick, PhD, CRNP, a nurse researcher, and Sheryl Zimmerman, PhD, MSW, a social worker.

Click here to check out an update on the project.

As previously mentioned in this blog, our program director, Mary Naylor is the Marian S. Ware Professor in Gerontology at the University of Pennsylvania. She is passionate about ensuring that top quality care is delivered across settings. Click here to learn about Dr. Naylor's transitional care model.

Examining the Impact of Nursing Structures and Processes on Medication Errors

Drs. Linda Flynn and Dong Suh present findings on their INQRI project: "Examining the Impact of Nursing Structures and Processes on Medication Errors" at the 4th Annual INQRI Meeting.





Project Description: The Institute of Medicine noted that a hospital patient on average is subject to at least one medication error per day, making medication errors the most common cause of preventable adverse events. This interdisciplinary study has been designed to disentangle the effects of nursing structures and care processes on non-intercepted medication errors in acute care hospitals. The economic impact of non-intercepted medication errors will be determined to explore the business case for evidence-based recommendations.

September Meeting of RWJF's Initiative on the Future of Nursing, at IOM

We are pleased to announce that registration has opened for the September 14, 2009 meeting of the Robert Wood Johnson Foundation's Initiative on the Future of Nursing, at the Institute of Medicine. The meeting will be held at the Kaiser Family Foundation in Washington, DC. The agenda for the open session is now posted on the Initiative website. If you would like to attend, please register online by September 9, 2009 as space is limited.

Webcast

If you are unable to attend the meeting in person, you are welcome to join via webcast. The webcast will be provided by Kaisernetwork.org, and a link to it will be posted on the project website, www.iom.edu/nursing the day of the meeting.

Future Public Forums

The committee has set the dates, locations, and themes for three public forums. More information on the forums, including options for public involvement, both in person and via webcast, will be sent to the listserv in the coming weeks. We hope that you will be able to attend and ask that you save the dates below.

• Future of Nursing Forum: Acute CareOctober 19, 2009 - Los Angeles, CA
• Future of Nursing Forum: Primary Care, Community Health, and Public Health December 3, 2009 - Philadelphia, PA
• Future of Nursing Forum: EducationFebruary 22, 2010 - Houston, TX

More Information

For more information on the Initiative and members of the committee, or to sign up for updates on the Initiative via email, visit www.iom.edu/nursing. If you have questions, please contact us at nursing@nas.edu.

Nursing Care Quality in Acute Care Hospitals: New Linkages to Patient Outcomes

Dr. Arlyss Anderson Rothman and Dr. R. Adams Dudley present their INQRI project: "Nursing Care Quality in Acute Care Hospitals: New Linkages to Patient Outcomes" at the 4th Annual INQRI meeting.





Project Description: Increased public reporting of hospital performance and the emergence of hospital pay-for-performance initiatives provide new impetus to defining and maximizing all aspects of hospital care. This interdisciplinary team has examined whether increases in nurse staffing and skill mix improve hospital performance on a subset of JCAHO core measures, enhance patient perceptions of nursing performance, and improve overall nursing performance as measured by composite indicators that capture patients' perceptions of care and other selected outcomes of care such as complication rates.

Group Launches Online Tool to Help Nurses Avoid 'Never Events'

Health care information services provider Elsevier has developed an online tool designed to help nurses prevent the 10 "never events" identified by the Centers for Medicare and Medicaid Services (CMS), Healthcare IT News reports. The tool, which will be available on Elsevier's Mosby's Nursing Consult Web site, was developed in response to a CMS decision in 2008 to cease reimbursing for adverse events that could have been prevented if specific evidence-based protocols had been followed. To create the tool, Elsevier researchers paired each of the 10 never events with the relevant articles, reports, monographs and studies. Nurses can use the tool to search for a never event and review a complete definition, evidence-based nursing content, book excerpts, journals, guidelines, patient education, images and relevant news. Elsevier's online tool includes information on all 10 never events, including catheter-associated urinary tract infection, foreign objects retained after surgery, air embolism, blood incompatibility, stage III and IV pressure ulcers, falls and trauma, manifestations of poor glycemic control, vascular catheter associated infection, surgical site infection and deep vein thrombosis/pulmonary embolism. In addition, the online tool includes decision-making guidance for six conditions—including delirium, ventilator-associated pneumonia, Staphylococcus aureus septicemia, Clostridium difficile-associated disease, Legionnaire's disease and iatrogenic pneumothorax—currently being considered by CMS for inclusion on the never events list. According to the president of Mosby MCS, a business unit of Elsevier Health Sciences, "nurses have a powerful role to play in ensuring that hospitals are paid appropriately for their services," and the company is "proud to support nurses in improving the safety and quality of care they provide, not just to Medicare patients but to all the patients and family members they treat and care for." (Manos, Healthcare IT News, 8/11/09)


(c) RWJF, 2009

Pharmacists Ensuring Patient Safety

An article in this week's North Carolina News and Observer tells the story of "Senior PharmAssist," an agency that has been working for 15 years to help low-income seniors "take the right prescription drugs, in the right amounts at the right times." In addition, the non-profit works to educate their clients about dangerous combinations of drugs or interactions between their prescriptions and foods or medical conditions.

In her INQRI study, "Nursing-Pharmacy Collaboration on Medication Reconciliation: A Novel Approach to Information Management," Linda Costa found that local pharmacists are powerful partners to health care teams trying to ensure that patients continue taking the correct prescriptions in safe ways once they have returned home from the hospital.

This summer, Costa presented her work at two meetings held at the Robert Wood Johnson Foundation. First, she participated in an INQRI panel at the Health Funders Forum, co-sponsored by the INQRI program and the Donaghue Foundation. Click here to see her slides from the Funders Forum presentation.

Most recently, she and her co-investigator Bob Feroli presented at the INQRI annual meeting. Click here to view their presentation via YouTube.

Reducing Distractions = Reducing Medication Errors

Yesterday, Patricia Iyer, MSN, RN, LNCC, the president of Med League, wrote a post on the Medical-Legal Topics blog in which she states that "the patient safety movement is now taking lessons from the airline industry." In her piece, Reducing Distractions is Reducing Medication Errors, she explains the impact that interruptions have on nurses as they prepare medications in busy hospital hallways and contrasts this type of setting with the sterility of a cockpit - designed to prevent interruptions.

In her INQRI study, "Examining the Impact of Nursing Structures and Processes on Medication Errors," Linda Flynn has also noted the incredible affect that interruptions can have on nurses and on the patients in their care. She has witnessed firsthand nurses having to answer phone calls from the lab for a non-emergency when they are in the middle of counting pills, or having to stop what they are doing to reconcile medications to respond to a patient's family member seeking a drink of juice for their loved one. Flynn recounts how one nurse, unable to find a quiet place to focus on her task, simply sat in the middle of a chaotic medical unit hallway to reconcile medications for her patient panel. Flynn observed that the nurse was interrupted every 45 seconds for tasks that could have easily been done by others on staff or could have waited until she finished. These are the kinds of interruptions that can lead to medication errors, she warns.

Flynn says hospitals need to foster work environments that let nurses focus on safety efforts without the fear of being needlessly interrupted. "Hospital systems are not designed in a way to keep patients safe. Nurses are just out in the open and subject to constant stimuli."

The good news, says Flynn, is the INQRI research is showing that "all of these things we are looking at are modifiable. If nurse staffing is a predictor of medication errors, we can do something about that. Hospitals can staff better or they can look at what nurses are being asked to do and take extraneous activities away and assign them to others."


Click here to read Pat Iyer's piece.
Click here to read more about Linda Flynn's work.

From the Future of Nursing blog: The Promise of Nursing

"It would be easy to get caught up in the day-to-day news coverage of the ongoing health reform discussions taking place in Washington and begin to think that health reform is only about access to care and coverage issues. It certainly is about those concerns, but it’s also about so much more. We forget that we are at the tip of a very large iceberg. The goals of health reform are not only who pays for health care, which is the topic that currently dominates health reform discussions, but how we make quality health care affordable. This goal, and the vital role that nurses play in achieving it, are at the core of the Foundation’s Initiative on the Future of Nursing, at the Institute of Medicine."

To read the rest of the blog entry, please click here.

This blog post is from Susan B. Hassmiller, Ph.D., R.N., F.A.A.N., Initiative Director, Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine and Senior Adviser for Nursing at the Robert Wood Johnson Foundation.

The Nurse as Leader in Delivering Care

This panel presentation was delivered by members of INQRI's third cohort of grantees at the 4th Annual INQRI Meeting. Facilitated by NAC Member Shelley White-Means.

Part 1 features Dr. Barbara Resnick, presenting on the study "The Res-Care-AL Intervention Study."



Part 2 features Dr. Doug Wholey, presenting on the study "Multidisciplinary Organization and Outcomes for Chronic Heart Failure Patients in the VA."



Part 3 features Dr. Kathleen Stevens, presenting on the study "Small Troubles, Adaptive Responses [STAR]: Fostering a Quality Culture in Nursing."



Part 4 features Dr. Cynthia Corbett, presenting on the study "Empowering Home Care Nurses to Efficiently Resolve Medication Discrepancies."

Nursing-Pharmacy Collaboration on Medication Reconciliation: A Novel Approach to Information Management

In the first part of this presentation, Drs. Bob Feroli and Linda Costa present the outline and background on the study "Nursing-Pharmacy Collaboration on Medication Reconciliation: A Novel Approach to Information Management." Introduced by INQRI National Advisory Committee member Jose Pagan.



In Part 2, Dr. Costa provides the findings.



Project Description: Deficits in communication across the continuum of care in regards to medication use can place patients at serious risk for harm. This interdisciplinary team has examined how to economically support direct care providers in medication reconciliation in order to facilitate safe transition to and from hospital and community. The team evaluated the effectiveness of a nurse-pharmacist clinical information coordination team in improving drug information management on admission and discharge, quantified potential harm due to reconciliation failures, and determined cost-benefit related to averted harm.

Interdisciplinary Collaboration Reduces Cost

A new Johns Hopkins study has found that teams of nurses and physicians that provide proactive, evidence-based care for patients with chronic conditions reduce health care spending. The researchers found 24% fewer hospital days, 37% fewer nursing home days and 15% fewer emergency department visits in 500 patients enrolled in the Guided Care program. They estimate that this equals an average savings of $1,364 per patient. For more information on the study, click here.

Last month, during INQRI's 4th Annual Meeting, our co-director Mark Pauly (a healthcare economist) explained the importance of our program's focus on interdisciplinary collaboration.

10 Years after "To Err is Human"

According to "Dead by Mistake," an investigation undertaken by the Hearst Corporation, an estimated 200,000 Americans will die from preventable medical mistakes and hospital infections this year. In 1999, the Institute of Medicine released "To Err is Human", a report which outlined a comprehensive strategy which could be used to reduce preventable medical errors. The report stated that the "know-how already exists to prevent many of these mistakes," and set a goal of 50% error reduction over the next five years. It is now ten years later and Hearst states that "98,000 Americans die from preventable medical errors each year and just as many from hospital-acquired infections." To read more about the Hearst investigation, click here.

Last year, INQRI researchers David Thompson, Jill Marsteller, Bryan Sexton and Peter Pronovost completed their project, "Linking Blood Stream Infection Rates to Intensive Care." The goal of this study was to implement a comprehensive safety program including an evidence based intervention to reduce central line-associated blood stream infections while examining the context of nursing care delivery on patient outcomes. This interdisciplinary research team used the expertise of nurses to develop and deliver a quality improvement initiative that reflects the positive clinical contributions of nurses in the critical care setting. Using their intervention, central line blood stream infections were practically eliminated. Click here to learn more about their project.

Quality of Pediatric Nursing Care from the Children's Perspective

Part 1: Dr. Nancy Ryan-Wenger (Nationwide Children's Hospital) presents the study, "Quality of Pediatric Nursing Care from the Children's Perspective" at INQRI's 4th Annual Meeting.



Part 2: Dr. Bill Gardner (Nationwide Children's Hospital) presents findings and the researchers answer questions. Moderated by INQRI National Advisory Committee member Randall Krakauer, MD.



Project Description: This interdisciplinary research team identified hospitalized children's perceptions of the linkages between the quality of nursing care and outcomes. This study identified the nursing care processes and outcomes that matter most to children during their hospitalization, and estimated the extent to which disparities exist in the quality of their care and outcomes.

Linking Processes of Nursing Care and Patient Safety Outcomes: An Analysis of the Cause and Effect of Safe Practice

Part 1: Dr. Richard Lindrooth (University of Colorado) presents the study, "Linking Processes of Nursing Care and Patient Safety Outcomes: An Analysis of the Cause and Effect of Safe Practice" at INQRI's 4th Annual Meeting.



Part 2: Dr. Lindrooth (University of Colorado) presents the findings.



Part 3: Drs. Richard Lindrooth (University of Colorado) and John Welton (Medical University of South Carolina) respond to comments from Leapfrog CEO Dr. Leah Binder and questions from Dr. Nancy Donaldson (CalNOC) after their presentation.




Project Description: This interdisciplinary team has examined how adoption of the National Quality Forum (NQF) safe practices affects nursing sensitive patient safety outcomes. Barriers to adoption of these practices was also explored. This team has taken a step beyond existing literature, testing whether the implementation of safe practices leads to more effective use of nurses, and whether this leads to better performance on patient safety outcomes.

RWJF Study Suggests Strategies for Reducing Nurse Turnover

A new study by the Robert Wood Johnson Foundation (RWJF) proposes a series of strategies aimed at improving nurse retention, the Wichita Eagle reports. Coordinated by The Lewin Group, the Wisdom at Work study is based on seven case studies of health care and nonhealth care employers that have been recognized for their efforts to retain experienced workers, as well as on findings from 13 research projects conducted between January 2007 and December 2008 that evaluated various retention efforts in hospitals. Although the researchers were unable to identify a common strategy that improved retention at all of the evaluated institutions, they were able to identify several successful initiatives implemented at individual institutions. For example, Tucson, Ariz.-based Carondelet Health Network implemented a "snow bird" program, which allows R.N.s to work for three, six or nine months at a time, which presents an appealing option to R.N.s who reside in Tucson only during particular months of the year. The report also highlights a mentoring program at Virginia-based Bon Secours Richmond Health System that taps experienced R.N.s to provide clinical and leadership mentoring to new nurses. According to an RWJF release, the program has helped to reduce turnover among new nurses. In addition, the report profiles a continuing education opportunity offered by Pitt County Memorial Hospital in North Carolina that allows tenured nurses to participate in three-day off-site training sessions to learn how they can practice more effectively in the hospital environment. Another practice that seemingly bolstered nurse retention was providing nurses with a voice. For example, Scripps Health in San Diego created a "leadership cabinet" under which nurse leaders were invited to advise hospital administrators on important decisions and serve as a liaison to voice employee concerns. Meanwhile, the research projects revealed that nurse turnover rates improved in cases where employers took innovative approaches to staffing; offered employee health and wellness programs; and provided training and development opportunities for senior nurses. In addition, although ergonomic initiatives, such as safe patient handling programs, did not directly contribute to an overall decline in turnover rates, it did improve employee morale. Commenting on the report, RWJF Senior Adviser for Nursing Susan B. Hassmiller notes that "at a time when organizations everywhere are looking hard at their bottom lines, the 'Wisdom at Work' evaluations demonstrate the economic benefits of retaining experienced workers, which can improve productivity and workplace morale." (Shideler, Wichita Eagle, 7/29/09; RWJF release, 7/29/09; RWJF report, 7/29/09)

(c) RWJF, 2009

How do you reduce hospital readmissions?

Louisiana Governor Bobby Jindal's administration plans to launch a program aimed at reducing hospital visits for patients with chronic disease, the Baton Rouge Advocate reports. During the 2009 legislative session, the state Department of Health and Hospitals (DHH) received $10 million in state and federal appropriated funds to curb escalating Medicaid costs. The administration plans to use the funding to begin soliciting proposals from contractors to implement a disease management program that will target Medicaid beneficiaries with diabetes, asthma and congestive heart failure (CHF), which the DHH secretary notes are the leading causes of high-cost and frequent emergency department visits throughout the state. For more information, click here.

Several Michigan hospitals will soon begin participating in a three-state collaborative project aimed at reducing hospital readmissions, the Livonia Observer reports. The 15 Michigan health centers participating in the State Action on Avoidable Rehospitalizations (STAAR) project will seek to reduce 30-day rehospitalization rates by 30 percent. For more information, click here.


For information on INQRI-related work involving discharge, please click here.

Measuring How Nurses Contribute to Patient Safety and Health Care Quality

Update from RWJF on the Joint Commission's Work

In 2007 and 2008, the Joint Commission tested specifications for 15 "nursing sensitive" performance measures in 49 acute-care hospitals across the United States. The goal was to determine the reliability and feasibility of these measures for assessing and improving the ways nurses contribute to patient safety and health care quality.

Key Findings

• All 15 performance measures, individually and as a set, were effective in improving patient care, and hospitals could feasibly collect data on them all.
• Specifications for some of the measures needed further refinement and clarification. For example, hospitals are not consistent in the way they classify injuries from falls or how they measure the onset of infection.

Key Recommendations

• Performance measures can be strengthened and greater uniformity achieved across hospitals by clarifying the definitions of what is being assessed, refining data-collection approaches and collaborating with others to align terminology.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this unsolicited project from January 2007 to December 2008 with a grant of $299,490.

(c) RWJF, 2009

INQRI's Work on the NQF-15

In INQRI's first year, our call for proposals focused on measurement, with special attention paid to the 15 nursing sensitive measures endorsed by the National Quality Forum. Several INQRI teams have examined these measures.

• Developing and Testing Nursing Quality Measures with Consumers and Patients
  Baruch College
  Led by scholars in health policy, public policy and nursing, the goal of this project was to develop nursing-sensitive quality measures that patients and other decision-makers will find important and useful. In addition to checking out, with recent patients, how they respond to existing nursing quality measures, the project also worked on new measures in an area that both patients and professionals often point to as critical: the coordination of their care. The Baruch team recently held a briefing in Washington, DC to discuss their findings. Click here for more information.

• Quality Care on Acute Inpatient Units
  The University of California, San Francisco
  The goal of this project led by a nurse scholar was to test the power of the National Quality Forum-endorsed measures to advance quality nursing research and design, test other measures as potential indicators of nursing quality, and determine the impact of nurse staffing on these indicators in specific types of patient care units.

• Validating NQF Nursing-Sensitive Performance Measures
  University of Pennsylvania
  Led by a nurse scholar, the goal of this team was to analyze and validate measures from the National Quality Forum nursing-sensitive measure set using data collected from approximately 600 acute care hospitals in three states, as well as Medicare hospital performance measures, in 2005-2006.

• Lessons Learned from State Roll-Out of the NQF Nursing Sensitive Measures
  Massachusetts Hospital Research and Education Association, Inc.
  Led by a team of health services researchers, the goal of this team was to evaluate two statewide implementations of the NQF Nursing-Sensitive Measures created to provide hospitals and the public with comparative measures of nursing quality. The two statewide implementations are a voluntary effort in Massachusetts hospitals and a government mandated effort in Maine hospitals.

• Improving the NQF Failure to Rescue Metric
  Mayo Clinic
  Led by scholars in nursing and health services research and informatics, the goal of this team was to refine one of the most controversial measures of nursing-sensitive quality of care: failure to rescue.

Study finds that work environment dissatisfaction causes nurse turnover

A study published in the July issue of Nursing Outlook suggests that dissatisfaction regarding work environment is a key driver of turnover among newly licensed R.N.s (NLRNs), Modern Healthcare reports. The study, which was funded by the Robert Wood Johnson Foundation, was based on survey responses gathered from 612 R.N.s practicing in 34 states and Washington, D.C., who had first passed the National Council Licensing Exam between six months and 18 months prior to completing the survey.

For more information on the study, click here.

***

INQRI Grantees Patti Hamilton and Gretchen Gemeinhardt are concerned about the impact of working environment on the quality of patient care and the effect on nurses. In their study, "The Effect of Off-peak Hospital Environments on Nurses' Work," the team is using an Institutional Ethnography (IE) to situate nursing in the center of an interdisciplinary approach to learn how and why off-peak work environments are different, and how they affect nurses' work and patient care. This project will provide researchers with insight into how to account for temporal variations in nurses' work environment when specifying causal models linking nursing care to patient outcomes. The project also will provide stakeholders with materials that help them identify, evaluate, and anticipate effects of initiatives to improve efficiency, effectiveness, quality and cost on nursing care provided during off-peak periods.

For more information, please check out their blog.

Time Magazine: If a Health-Care Bill Passes, Nurse Practitioners Could Be Key

"As the House and Senate prepare to embark on their summer recess without having passed any health-care-reform bills, President Obama's dreams of radically restructuring the system have, at least for now, bumped up against the reality of Washington politics. But even if Congress manages to overcome the many obstacles and pass some kind of meaningful reform this fall, the goal of covering some 50 million currently uninsured Americans will encounter a whole new range of hurdles. Chief among them is that there almost certainly won't be enough doctors to care for that many new patients."

Click here for the rest of the article.

"...there is an existing group of providers that health reformers are hoping can help fill this gap: nurse practitioners."

Ann Lovegren Conley, a family nurse practitioner at the University of Southern Maine, talks to a patient on the university's Portland campus.

RWJF Senior Advisor Susan Hassmiller Receives Florence Nightingale Medal

Susan Hassmiller, Ph.D., R.N., F.A.A.N., is one of three U.S. nurses chosen by the International Committee of the Red Cross (ICRC) to receive the 42nd Florence Nightingale Medal, nursing’s highest international honor. The medal is awarded every two years, with 28 medals presented this year among 15 nations.

Click here for more information.