Thursday, June 30, 2011

CNAs to Help with Nursing Shortage?

Check out a new opinion piece on EndoNurse.com which suggests that certified nursing assistants can help addresss the nursing shortage.

What do you think about this idea? And how does this relate to the Future of Nursing committee's recommendations regarding increasing the number of RNs with Bachelor's degrees? Share your thoughts below.

Wednesday, June 29, 2011

Critical Conditions: Preparing the 21st-Century Nursing Workforce

Last week, the University of Phoenix Research Institute sponsored an event, "Critical Conditions: Preparing the 21st-Century Nursing Workforce," at the National Press Club in Washington, DC.  The event was hosted by The Chronicle of Higher Education and brought together leaders from industry and academia to discuss strategies to confront the nursing shortage, reach the Future of Nursing Committee's goal for 80% of registered nurses to hold baccalaureate degrees by 2020 and more.

To learn more about this event, please click here.
To read a research brief prepared about this event, please click here.

Tuesday, June 28, 2011

Five Steps to Implement Patient Safety Programs

John F. Collins, president and CEO of Winthrop-University Hospital in Mineola, NY has written a five step plan to implementing patient safety programs.  Since 2000, Winthrop has been implementing automation systems with the goal of improving patient safety.  Collins provides tips that healthcare leaders could use to implement similar patient safety initiatives.

Check out the plan here.

Monday, June 27, 2011

The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2011

Representative Jan Schakowsky (D-IL) has introduced legislation to establish federal standards for hospital nurse-to-patient ratios. Schakowsky hopes that passage of the bill will help to prevent errors caused by understaffing of nurses.

“Nurses are overworked and hospitals are understaffed, leading to disastrous results for patients everywhere,” said Schakowsky said. “By creating a workplace in which nurses are asked to do the impossible, we drive nurses away and jeopardize the quality of patient care. The bill is a common-sense solution to improve the quality of patient care and address the nursing crisis in our hospitals.”
Click here to read more about the Nurse Staffing Standards for Patient Safety and Quality Care Act of 2011.

Friday, June 24, 2011

Confidence in Smoking Cessation Counseling Skills Key to Nurses’ Providing Effective, Evidence-Based Counseling

INQRI Study Highlights Need for Smoking Cessation Education and Training for Hospital Nurses

Tobacco use is the number one preventable cause of death and disease in the U.S., causing 440,000 deaths per year. Research has shown that not only can health care providers increase the chances of a smoker quitting, but they are uniquely positioned to do that successfully in a hospital setting. Recognizing the important role nurses play in smoking cessation, the U.S. Department of Health and Human Services published guidelines specific to nurses in 2005, to encourage this activity.

A new study published in the current issue of American Nurse Today, finds that nurses who are less confident in their smoking cessation counseling skills are less likely to engage in specific cessation counseling activities that are supported by research. This includes referring patients to smoking cessation resources (such as the toll-free National Quitline or Web sites like the Tobacco Free Nurses Initiative), advising patients on how to handle relapse and recommending quit strategies (including over-the-counter and prescription drugs or behavioral strategies). Nurses who were more confident about these skills were more likely to provide this kind of counseling regardless of level of education, race, age or gender.

The study involved a survey of 591 registered nurses (R.N.s) in 23 rural hospitals. Far more R.N.s reported that they always assessed and documented whether patients smoked (which are part of standard hospital processes), than engaged in cessation counseling activities that require more detailed knowledge of smoking cessation research such as developing individualized quit plans. Results of this study indicate that implementing strategies to improve nurses’ comfort with evidence from research studies (evidence-based practice) can increase their use of evidence in patient care.

Robin Newhouse, Ph.D., R.N., assistant dean for the Doctor of Nursing Practice Program and associate professor in the Department of Organizations Systems and Adult Health at the University of Maryland School of Nursing, is one of the lead investigators of the study, which was funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI). She led an interdisciplinary team that included:
  • Laura Morlock, Ph.D. and Kevin D. Fick, Ph.D., professors of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health;
  • Cheryl R. Dennison, Ph.D., R.N., associate professor in the Department of Health Systems and Outcomes at Johns Hopkins University School of Nursing;
  • Yulan Liang, Ph.D., associate professor in the Department of Family and Community Health and biostatistician for the Office of Research of the University of Maryland School of Nursing; and
  • Peter Pronovost, M.D., Ph.D., professor in the departments of Anesthesiology and Critical Care Medicine and Surgery at the Johns Hopkins University School of Medicine, and in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, medical director for the Center for Innovation in Quality Patient Care, and director of the Quality and Safety Research Group.
“In many ways, hospitals are the ideal settings for encouraging people to quit smoking,” said Newhouse. “They are surrounded by health professionals, they cannot smoke while in the hospital and if they were admitted for a condition or disease related to smoking, they may be more likely to want to quit. Since that’s the case, we need to ensure that all hospital nurses are prepared and willing to provide the best possible evidence-based smoking cessation counseling. This study shows that we still have work to do.”

While roughly two-thirds (65.7 percent) of the R.N.s surveyed reported assessing patients’ tobacco use “all the time” and nearly as many (61.9 percent) reported advising tobacco users to quit “all the time,” only one in five (20 percent) said they always advise their patients who smoke to set a quit date and even fewer (16.6 percent) always advise patients that drinking alcohol is strongly associated with relapse. More than half of the nurses surveyed (50.9 percent) said they never refer patients to the Tobacco Free Nurses Initiative Web site resources.

The study’s authors suggest that smoking cessation training be included in nursing education coursework and continuing education and that researchers and guideline developers package smoking cessation interventions so that they are easy to implement. They also suggest that rural hospitals work to find creative ways to educate nurses in cessation counseling, possibly through collaboratives or networks.

The full study is available online at http://www.americannursetoday.com/Article.aspx?id=7902&fid=7870.

INQRI supports interdisciplinary teams of nurse scholars and scholars from other disciplines to address the gaps in knowledge about the relationship between nursing and health care quality. It is helping to advance the recommendations of the Institute of Medicine’s landmark report, The Future of Nursing: Leading Change, Advancing Health, which include fostering interprofessional collaboration and preparing and enabling nurses to lead change. By requiring research teams to include a nurse scholar and at least one scholar from another health care discipline, INQRI not only fosters interprofessional collaboration, the Initiative also ensures that diverse perspectives are brought to bear in research.

The Interdisciplinary Nursing Quality Research Initiative is funded by the Robert Wood Johnson Foundation. To learn more, visit http://www.inqri.org/, or follow on Twitter at @INQRIProgram.

 

Thursday, June 23, 2011

The First I in INQRI

INQRI co-director Mark Pauly often talks about the importance of the "first I in INQRI," which is interdisciplinary.  We believe that there is much to be gained by colleagues from different backgrounds collaborating to advance the science and improve care for patients.

So, we were pleased to read about two Robert Wood Johnson (RWJF) alumni teaming up to emphasize the importance of interprofessional collaboration.  A physician, Sara Pendleton, M.D., is an alumnus of the RWJF Clinical Scholar program, and Charlotte Mather, M.B.A., R.N., Interim Vice President of Nursing, is an alumnus of the RWJF Executive Nurse Fellows program.

Their practice at Genesys Regional Medical Center in Michigan features new outpatient breastfeeding clinics, where Pendleton, the center’s pediatric medical director, works with nurses who are lactation consultants to treat mothers and babies at the same time. The hospital benefits from the partnership through increased revenues associated with providing physician services to mothers and babies.

Click here to learn more.

Wednesday, June 22, 2011

Nurses and Cancer Treatment

The Institute of Medicine (IOM) has issued a report on improving the quality of oncology care through patient-centered treatment planning. Marie Bakitas, APRN, DNSc, AOCN, FAAN, associate professor of anesthesiology at Dartmouth Medical School, noted that a systematic review of 46 studies found that nurses are prominent information providers for cancer patients, especially after the initiation of treatment.

Click here to learn more about the report.

Indicative of the role nurses serve in providing care to cancer patients is the work conducted by an INQRI team at the University of Utah.  Led by Susan Beck, this interdisciplinary team has designed a robust measure to assess adult patients’ opinions about how nurses manage cancer-related pain.  Although nurses are the frontline providers of pain management in hospitals, pain goes unrelieved which affects patient outcomes, length of stay and costs a great deal. Beck and her team developed an instrument using qualitative and quantitative data to elicit patients’ opinions about how their nurses and other members of their care team managed their pain and, ultimately, to help patients select hospitals based on this dimension of their care experience. For example, the surveys asked patients whether nurses believed them when they said they were in pain and evaluated whether the team involved patients in decisions about their pain management. The Pain-CQ survey tools will let patients rate their experiences and help hospital administrators and policymakers who want to improve the care provided by nurses and other health team members. The initial tool was developed with the help of cancer patients. The tool is now being tested at a Veterans Administration hospital with patients who have a number of different diagnoses. The research may eventually spark the creation of a nurse-performance measure related to pain management.

Tuesday, June 21, 2011

Nurse.com to Host Panel Discussion on the Future of Nursing Report

Save the date on June 29, 2011 from 1pm - 3pm for an expert panel discussion regarding the IOM report, The Future of Nursing: Leading Change, Advancing Health.  Hosted by Nurse.com, this session will be known as the first National Day of Dialogue.  The panel will be held before a live audience in McLean, VA and livestreamed at Nurse.com/FutureofNursing.

Panelists will include:
  • Mary Wakefield, RN, PhD, FAAN, administrator, Health Resources and Services Administration, Washington, D.C.
  • Susan Hassmiller, RN, PhD, FAAN, senior adviser for nursing, Robert Wood Johnson Foundation, Princeton, N.J. (via telephone)
  • Carol Porter RN, DNP, chief nursing officer and senior vice president, Mount Sinai Medical Center, New York
  • Muriel M. Shore, RN, Ed, dean and professor, division of nursing and health management, Felician College, Rutherford, N.J.
  • among others.
Click here to read more.

Monday, June 20, 2011

Hospital-Wide Initiative Cuts Falls by 30%

The Community Medical Center (Toms River, NJ) has made an incredible advance in increasing patient safety.  Within one year, the center decreased patient falls by 30%.  They have labeled their initiative a "three-ingredient recipe for success."  Their recipe containes three main ingredients: education, assessment and intervention.

The center's success has been profiled in a recent article for Nurse.com by Mary D. DeLima, RN-BC, BA, BSN.  Nurses have been key to the success of the initiative.  As DeLima writes:
"Each patient presents a unique combination of safety risks that could result in a painful, life-changing fall. Nurses understand the importance of reducing falls, but as patient advocates also respect the importance of patients’ independence."
Click here to read the article.

INQRI researchers at Brigham and Women's Hospital have also found success in reducing patient falls.  This research team focused on the characteristics unique to each patient to create a tailored intervention. 

Click here to learn more.

Friday, June 17, 2011

Webinar on Avoidable ER Visits

A collaborative effort among five regions of Ohio is targeting the key reasons for avoidable ER visits among Medicaid beneficiaries and rolling out test interventions in a rapid cycle quality improvement approach.

The Implement Medicaid Programs for the Reduction of Avoidable ED Visits (IMPROVE) Collaborative partners the Ohio Medicaid program with Medicaid managed care plans in the five regions to identify priority populations and develop quality improvement interventions for these patients.

The collaborative is sponsoring a webinar on June 23rd at 1:30pm entitled, "Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions."
For more information or to register, please visit: http://store.hin.com/product.asp?itemid=4182.

Thursday, June 16, 2011

New Patient Safety Webinar Series

Recently, the Department of Health and Human Services launched the Partnership for Patients initiative to dramatically improve patient safety across the country. This initiative will engage stakeholders from the private and public sectors to reduce all cause harm and hospital readmissions. To reach this goal, the Centers for Medicare and Medicaid Services requested the National Quality Forum to convene the National Priorities Partnership (NPP) to launch the Partnership for Patients – National Priorities Partnership Patient Safety Webinar Series. This series will bring together thought leaders in the field of patient safety and members of the NPP to discuss strategies for starting and sustaining meaningful execution of change in organizations across the country.

Click here for more information.

Wednesday, June 15, 2011

Campaign for Action Research Agenda - Presentation Now Available

As mentioned on this blog last week, the Robert Wood Johnson Foundation (RWJF) is coordinating a multi-funder initiative to uncover and spread evidence essential to informing efforts to implement the recommendations outlined in the Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health” and to contribute to The Future of Nursing: Campaign for Action’s goal of advancing comprehensive change in health care for patients and the country.

Mary Naylor recently gave a presentation about the Campaign for Action research agenda at AcademyHealth's Interdisciplinary Research Group on Nursing Issues (IRGNI) meeting.  During the presentation, Dr. Naylor provided some possible topic ideas and also explained the process that RWJF and the Funders' Community will use when assessing proposals.

To download the slides from her presentation, please click here.

For information on how to submit a brief proposal in response to the Campaign for Action research agenda, please click here.

Tuesday, June 14, 2011

The Tenth National Quality Colloquium

The Tenth National Quality Colloquium will be held on August 15 - 18, 2011 on the campus of Harvard University. This is a hybrid event: an in-person conference for those who can attend and an internet event and training tool for those who cannot. The colloquium will feature an executive education course on patient safety, healthcare quality enhancement and medical errors reduction.

Click here to view the colloquium brochure.
Click here for more information.

Monday, June 13, 2011

Nights and Weekends... Dangerous Times to be in the Hospital

In a new Washington Post article, writer Sandra Boodman discusses a series of studies which all demonstrate that being in the hospital at night or over the weekend can be "hazardous to your health."

INQRI researchers at Midwestern State University agree with that assessment. Led by Patti Hamilton and Gretchen Gemeinhardt, the team learned how and why off-peak work environments are different from those of peak times and how they affected nurses' work and patient care.

Click here to view a presentation of the Hamilton-Gemeinhardt team's findings.

Click here to read the Washington Post article.

Friday, June 10, 2011

The Future of Nursing: Campaign for Action Research Agenda

The Robert Wood Johnson Foundation (RWJF) is coordinating a unique, multi-funder initiative to identify, generate, synthesize and disseminate evidence essential to informing efforts to implement the recommendations outlined in the Institute of Medicine (IOM) report, “The Future of Nursing: Leading Change, Advancing Health” and to contribute to the Future of Nursing: Campaign for Action’s goal of advancing comprehensive change in health care for patients and the country. The purpose of this activity is to increase and focus national attention on a common research agenda related to the IOM recommendations and to facilitate and coordinate funding activity across a range of funders of nursing research. Please visit www.thefutureofnursing.org/research to view a comprehensive list of national research priorities to accomplish this goal.

Proposals submitted in response to this opportunity will be reviewed by RWJF based on: 1) consistency with the research agenda; 2) potential to advance knowledge to support implementation of the IOM’s recommendations and 3) methodological rigor. Proposals that meet established criteria will be shared with members of the Funders’ Community for funding consideration. Applicants will be informed of the status of their proposal within one month of submission.

Proposals will be accepted on a rolling basis from June 10, 2011 – January 3, 2012. Information about this opportunity is available on the Robert Wood Johnson Foundation’s website at www.rwjf.org/cfp/hc1 and on the Future of Nursing: Campaign for Action website, www.thefutureofnursing.org/research, or by calling (215) 573-2981.

Thursday, June 9, 2011

INQRI at AcademyHealth

This year, INQRI grantees will be well-represented at AcademyHealth's Annual Research Meeting.  If you are in Seattle, be sure to check out these presentations and events:

Sunday, June 11

5:00 p.m.-9:00 p.m.

The AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Interest Group will be meeting in the Sheraton Seattle's Willow Room on June 11, prior to the Annual Research Meeting. Join health services researchers, policy professionals, and practitioners during this year’s IRGNI Meeting to hear research presentations and engage in discussion on related topics.  INQRI grantee Patricia Stone will chair this year's meeting which will feature INQRI director Mary Naylor speaking about a new research opportunity and a panel on Comparative Effectiveness Research, featuring INQRI grantees Mary Blegen, Robin Newhouse and Nancy Dunton.

Sunday, June 12

9:00 a.m.–10:30 a.m.

A New Research Agenda on the Future of Nursing in America
Convention Center Room 4C-4

Chaired by Lori Melichar, Robert Wood Johnson Foundation Senior Program Officer for the INQRI program.  Panel includes INQRI director Mary Naylor.  In this session, panelists will assess the changes underway and examine the research gaps exposed by a recent IOM report on the Future of Nursing. Two speakers will focus on changes in roles of nurses that are currently underway and two speakers will discuss the need for monitoring and evaluation. The session will conclude with a discussion of new research priorities for the field.

11:00 a.m.–12:30 p.m.

Controversies and Innovations in Quality Measurement Convention Center Room 611

The panel includes INQRI grantee Jack Needleman.

Primary Care and the "Medical Neighborhood"
Convention Center Room 617

This panel includes INQRI director Mary Naylor.
2:30 p.m.–4:00 p.m.

POSTER SESSION A
Convention Center 4 A/B (Level Four)

“Twenty-Four/Seven: Nurse Perspectives of Off-Shift Care” – Pamela de Cordova, a doctoral student from the INQRI team led by Patricia Stone and Ciaran Phibbs.

“Exploring Infection Prevention: Policy Implications from a Qualitative Study” – May Uchida, a doctoral student from the INQRI team led by Patricia Stone and Ciaran Phibbs.

Monday, June 13

9:45 a.m.–11:15 a.m.

POSTER SESSION B
Convention Center 4 A/B (Level Four)

“Development and Validation of a Model for Predicting Present-on-Admission in Estimates of Failure to Rescue” – INQRI grantees Marcelline Harris, Jack Needleman and team.

“Measures of Discharge Preparation in Cardiac Patients” – INQRI grantee Marianne Weiss.

11:30 a.m.–1:00 p.m.

Caring for Complex Patients: Understanding Barriers to and Facilitators of Effective Management
Convention Center Room 611

This panel includes INQRI grantee Ciaran Phibbs.

3:00 p.m.–4:30 p.m.

Implementation Context: Measuring and Understanding Differential Performance
Convention Center Room 617

This panel is chaired by INQRI grantee Jill Marsteller.

4:45 p.m.–6:15 p.m.

Transitions Across and Within Long-Term Care Settings
Convention Center Room 609/610

This panel includes INQRI grantee Gerri Lamb.

Tuesday, June 14

8:00 a.m.–9:30 a.m.

Integrating Qualitative and Quantitative Methods
Convention Center Room 605/606

This panel is chaired by INQRI grantee Shoshanna Sofaer.

9:45 a.m.–11:15 a.m.

State and Regional Efforts to Improve Quality and Efficiency
Convention Center Room 607

This panel includes INQRI grantee Patricia Stone.

Wednesday, June 8, 2011

Involve Hospital Nurses in Nursing Research

Lora Bognar, ANP-BC, and Gladys Reyes, ACNP-BC, CCRN-CSC, have recently published a piece on Advance for Nurses regarding a topic we hold dear: "Putting the Nurse in Nursing Research."

Bognar and Reyes explain that hospital nurses' involvement in research benefits everyone. They note that although hospital nurses may feel that they are too busy to be involved in conducting research, they do follow evidence-based practices that have been proven effective in research trials.

Click here to read the article.

Tuesday, June 7, 2011

Johns Hopkins Creating Patient Safety Institute

According to Dr. Edward Miller, dean and chief executive of Johns Hopkins Medicine: "Fewer things are more important in health care right now than improving patient safety and the quality of health care. All of us acknowledge these imperatives, but few of us have taken the steps to formally erect a framework that will tackle these issues head on."

To that end, Johns Hopkins plans to use a $10 million gift from C. Michael Armstrong, chairman of Johns Hopkins Medicine's board of trustees, to launch an institute for patient safety. The Armstrong Institute for Patient Safety and Quality will develop quality improvement methods for worldwide use that could be used to prevent medical errors.

Click here to learn more.

Monday, June 6, 2011

Unique Uses of Technological Advances

Technological advances offer much opportunity to enhance patient care in new and very dynamic ways.  For example, ICU patients at the University of Massachusetts Medical Center in Worcester have recently benefited by the center's trial use of a new tele-ICU system.  This system allows off-site doctors and nurses to remotely monitor their patients and direct on-site staff.  During the trial, the ICU experienced fewer patient deaths and patients experienced shorter ICU stays.  Using tele-ICU, intensive care specialists can not only access medical records remotely, but they can also see and hear patients while monitoring vital signs.

Another example resides in Barbara McLean's use of social media to improve bedside nursing.  McLean, MN, RN, CCRN, CCNS, CRNP, FCCM, uses Facebook, Twitter, podcasts and her own interactive website to educate nurses all over the world. 
“I saw, early in my career, that hospitals didn’t always have the experts they needed in house to take practice to a higher level,” McLean said. “I was fortunate to have a gift for public speaking and to possess the ability to put complex issues in a form that people can understand.”
In addition, she uses her online network to support philanthropic activities, mission trips to Haiti and Africa and much more.

Click here to learn more about tele-ICU.
Click here to learn more about Barbara McLean.

Friday, June 3, 2011

Nurse-Run Clinics Provide Cost-Effective, High Quality Care

The American Nurses Association has recently issued a statement commending the Joint Commission for their recognition of nurse-led clinics as primary care medical homes. The Commission's accreditation standards define primary-care clinicians in primary care medical homes as “a doctor of medicine or doctor of osteopathy, advanced practice nurse or physician assistant.”

This accreditation is in line with the scope-of-practice recommendations in the IOM report, The Future of Nursing: Leading Change, Advancing Health. In addition, the Affordable Care Act recognized medical homes as a good way to provide cost-effective, high quality patient-centered care.

The federal health care reform law recently provided a $1.5 million grant to Sheridan Health Services outside Denver. Sheridan Health is one of the first nurse-run primary care facility in the country to be set up under the new law. Accepting fees on a sliding basis, the clinic provides much needed care to a low-income area. In the first month of operation, the nurses had seen 200 patients.

Wednesday, June 1, 2011

Nevada Learning the Merit of Checklists

Sponsored by Assembly Speaker John Oceguera, the Patient Protection Checklist bill (AB 280) faced little opposition in either the Assembly or the Senate and was recently signed into law by Nevada's Governor Brian Sandoval. This bill requires Nevada hospitals and other medical facilities to develop state-mandated patient safety checklists.

Click here to read more in a piece authored by Margaret Dick Tocknell, for HealthLeaders Media.