Post-Acute Care Transitions Should be Facilitated by Rehab Nurses

A new white paper asserts that successful post-acute care (PAC) transitions for individuals with disabling conditions must be facilitated by nurses with rehabilitation nursing training, knowledge, and experience. The Association of Rehabilitation Nurses (ARN) released "Essential Role of the Rehabilitation Nurse in Facilitating Care Transitions" in November and it was recently covered by Advanced Healthcare Network for Nurses.

According to the white paper, rehabilitation nurses are defined by a unique skill set, which includes knowledge and understanding required to manage the care of patients with acute or chronic illnesses and conditions that cause disability. Their expertise in leading teams that develop and implement patient/family-centered interventions and evaluate outcomes is vital to providing the care these patients need, according to the paper.

Recommendations include:

• Involving rehabilitation nurses in national policy decisions, including as members of committees and technical expert panels.
• Conducting studies to evaluate the impact of rehabilitation nurses on the health care delivery system. Research funded by federal agencies that compares payments and quality models, and evaluates of value-based payment models. 
• Including rehabilitation nurses on Technical Expert Panels that assess ideas for developing new care coordination measures, including transitional care, to evaluate the quality of care coordination for individuals with disabilities.

An INQRI-funded study, “Nursing Care Quality in Acute Care Hospitals: New Linkages to Patient Outcomes,” examined whether increases in nurse staffing and skill mix improve hospital performance, enhance patient perceptions of nursing performance, and improve overall nursing performance. The study found that when patients were asked about aspects of care in which nurses functioned independently, there were more consistent, statistically significant correlations between patients' assessments of the quality of their hospital care and nurse staffing. The study was led by Arlyss Anderson Rothman and Adams Dudley.

Research Brief: Quality of Nursing Care on Acute Inpatient Units

Does the composition of hospital nurse staffing levels matter when it comes to preventing costly complications and death following those complications? A team at the University of California, led by Mary Blegen, Tom Vaughn (from the University of Iowa) and Colleen Goode (from the University of Colorado), examined the extent to which nurse staffing levels affected the incidence of complications and the failure to rescue from those complications, (i.e. death following complications). Their examination showed that nursing hours per patient day were strongly associated with lower rates of pressure ulcers and hospital acquired infections, and fewer deaths from complications. Further, more RN hours in the mix had additional benefit with still lower rates of failure to rescue and hospital acquired infections. Their work shows that higher levels of nursing hours per patient day and RN skill mix in intensive care units and in general units will lead to better patient outcomes, information that can guide states considering regulation of nurse-patient staffing ratios to address patient safety gaps.

Access the research brief.

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Medical-Surgical Nurses Week

The Academy of Medical-Surgical Nurses (AMSN) has designated a special week, November 1-7, to honor the ways that medical-surgical nurses make a difference.  As stated by the AMSN, these nurses:

• Build the profession of nursing and the medical-surgical nursing specialty
• Mentor and nurture each other
• Advocate for patients and families at the local and national levels
• Serve their communities through care and education
• Promote medical-surgical nursing certification, resulting in better and safer health care
• Improve patient care through evidence-based practice
• Speak, write, and conduct research to inspire and educate others

For more information about Medical-Surgical Nurses Week, please visit the AMSN website.

Reducing Central Line Infections

Researchers at the Johns Hopkins Children's Center recently found that hospitals can use a set of basic precautions to reduce the number of dangerous central line infections in pediatric cancer patients.  Their new article, scheduled for publication next month in Pediatrics, encourages family members to serve as patient advocates when they witness noncompliance with the protocol.  The research team also suggests that an honest evaluation be conducted regarding each infection to determine cause.

A team of INQRI researchers at Johns Hopkins University conducted the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. This study, conducted in ICUs in 12 states, has shown that substantial reductions in infections can be widely achieved and this project did so with nurses leading the infection control efforts. 

Click here to learn more about the pediatric study on Nurse.com.

Click here for more information about the INQRI team at Johns Hopkins University.

California Nurses' Union Advocates for Setting Minimum Charity Care Levels for Non-Profit Hospitals

Over the past few decades, many health care professionals have expressed their concern regarding non-profit facility's tax-exempt status and the amount of charitable care they deliver. To this point, the California Nurses Association has called for California legislatures to institute a minimum level of charitable care non-profit institutions must deliver if they are to continue receiving government financed subsidies and benefits. With much of the charitable care delivered in California falling on financially restricted public hospitals, the CNA has requested for stringent requirements for non-profit hospitals to utilize at least 8% of their revenue for the delivery of charitable care.

To read more about the CNA's efforts, click here.

Nurses Save Patients Time and Hospital Money

The local CW affiliate for the Dallas Fort-Worth area, KDAF-TV, detailed how a group of nurses tasked with obtaining detailed history for patients has helped improve care and patient satisfaction. The team of five full-time nurses, better known as DART (discharge, admission, resource, transport), also play a crucial role in the discharge process, ensuring patients understand the medications and instructions given to them by hospital physicians.

To read more about the DART team, click here.

Inside an Award-winning ED's Nursing Department

Yesterday, Alexandra Wilson Pecci, reporting for HealthLeaders Media, gave a glimpse of specific programs and initiatives being implemented in one of the most innovative nursing department within an emergency department at Boston Children's hospital. One such program focuses on improving the assessment of pain among children, a topic area that has also been focused on in previous INQRI research.

To read more of Ms. Pecci's description of the fabulous care being provided at Boston Children's hospital, click here.

How to Better Motivate Nurses and Cut Costs

Yesterday, Karen Minich-Pourshadi, Senior Editor for HealthLeaders Media, published a fascinating piece that discussed innovative ways for hospital systems to cut costs while motivating their nursing workforce. Ms. Minich-Pourshadi recommends that hospitals take a cue from airline companies and utilize a point system, similar to 'travel miles', that rewards nurses for covering their colleagues shifts or providing exemplary care. The case study presented by Ms. Minich-Pourshadi demonstrates how hospitals are looking at other industries to solve some of their workforce issues that previously was viewed as unfeasible.

To read more about this innovative program, click here.

Significant Rise in Ohio Nurses Seeking 4-year Degrees

In response to growing demands by hospital systems and ambulatory practices, more Ohio registered nurses are enrolling in bachelors of science programs to enhance their skill-set and improve their desirability in the touch job market. Many of these nurses are seeking to obtain their BSN as part of their job requirements, which require nurses without a bachelors degree to obtain one within five years of employment. These efforts support one of the recommendations made by the Institute of Medicine (IOM) report, "The Future of Nursing: Leading Change, Advancing Health" which seeks to improve the number of registered nurses with BSNs to 80% by 2020.

To read more about Ohio's efforts to improve its nursing workforce, click here.

To read more blogposts relating to the IOM's "Future of Nursing" report, click here.

New Coverage on INQRI Study re: Nurse Depression

INQRI grantees, Susan Letvak, Christopher Ruhm, and their team are receiving a lot of attention for a new article they published recently in Clinical Nurse Specialist which focused on depression among nurses in hospitals.

Check out their recent clips:

• 1 in 5 Nurses is Depressed - Health Leaders Media
• Why So Gloomy?  Nurses Twice as Depressed as the General Public - Nurse Zone
• Study Looks at High Rate of Depression Among Nurses - Cleveland Plain Dealer

Learn more about their INQRI study, "The Effects of Nurse Presenteeism on Quality of Care and Patient Safety."

Did You Miss Monday's Webinar?

If so, you can catch it right here.  We were joined by INQRI grantees, Linda Flynn and Suzanne Gordon for the seventh session in our series on the Institute of Medicine report, "The Future of Nursing: Leading Change, Advancing Health."

This webinar focused on Recommendation 2: "Expand opportunities for nurses to lead and diffuse collaborative improvement efforts."

"Expanding Opportunities for Nurses to Lead: Impact of a Nurse Manager Development Program" - Presented by Linda Flynn, PhD, RN, FAAN & Suzanne Gordon, Journalist & Advocate.

Depression in Hospital-Employed Nurses Is Double The National Average

An INQRI supported study, published in the May/June edition of Clinical Nurse Specialist and led by INQRI grantees Susan Letvak, PhD, RN and Christopher Ruhm, PhD, has found that hospital-employed nurses demonstrated a depressive symptom rate of 18%, double that of the national average (9%). The authors of this study also expressed their concern with depression among nurses as it may result in difficult with concentration and limiting nurses ability to perform mental and interpersonal tasks to the best of their ability. Thus, depression could be linked to not only lower total work output, but negative patient outcomes.

You can access the abstract (free) and the full-text (subscription required) of this study, here.

New INQRI Article on Delirium Treatment & Prevention

INQRI grantees Michele Balas and William Burke recently concluded their study focused on implementing, analyzing and disseminating an evidence-based, nurse-led, inter-professional, multi-component program focused on improving the care and outcomes of critically ill adults.  Their study focused on applying the ABCDE bundle (developed at Vanderbilt University) which is a program of delirium screening, prevention and treatment.*

To learn more about this very important work, check out the team's new article, recently published in Critical Care Nurse: "Critical care nurses' role in implementing the 'ABCDE bundle' into practice."

*Awakening, and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility bundle (ABCDE bundle).

2012 AAN Fellows Announced... with an INQRI Grantee Among Them!

INQRI congratulates all of the American Academy of Nursing's 2012 Fellows, but we would like to especially congratulate INQRI grantee Susan Letvak, University of North Carolina at Greensboro.

Dr. Letvak co-led her INQRI research team with Christopher Ruhm, evaluating the influence of presenteeism (decreased productivity due to health problems) on hospital registered nurses' quality of patient care. This study focused on presenteeism among RNs suffering musculoskeletal pain and/or depression. They assessed the economic costs to the health care system associated with presenteeism. Using a mixed methods approach, including a survey and focus groups of RNs in North Carolina, researchers documented a depression prevalence of 18% in hospital nurses. Seventy-one percent of nurses interviewed reported working with some pain and the majority of nurses interviewed reported that a health problem had negatively affected their productivity on the job in the previous two weeks. The team found that pain and depression were significantly associated with presenteeism and that presenteeism was significantly associated with patient falls, medication errors and the perceived quality of care. Finally, the team found that the productivity loss due to pain and/or depression was $14,339 per nurse and $876.9 million for the state of North Carolina. If these numbers were extrapolated to the nation, the productivity loss would be $22.7 billion.

Congratulations, Dr. Letvak - we look forward to your induction as an AAN Fellow in October!

It is National Nurse Week!

With Sunday, May 6th kicking off National Nurses Week, we believe it is appropriate to highlight news stories that celebrate this annual week of recognition.

On Sunday, Brittany Tyner, reporting for local CBS affiliate, WLFI 18, highlighted an annual reunion that allows for children who were once cared for in Indiana University Health Arnett's neonatal intensive care unit to meet the caregivers that greatly contributed to their childhood well-being. The annual reunion also allows for the parents of children who were cared for in the NICU to continue to express their gratitude to the nurses and physicians that helped their children start life out on the right foot.

Click here to read more about this great tradition.

Nursing Excellence Improves Outcome for High-Risk Infants‎

We are pleased to share with you a recently published study in JAMA conducted by INQRI cohort 2 grantees Dr. Eileen Lake, Dr. Jeannette Rogowski and colleagues, which found hospitals designated by the American Nurses Credentialing Center as a "RNE" hospital provide high quality care in three quality measurement areas. These hospitals, who have obtained the "RNE" designation by achieving exemplary practice or leadership in five areas, had significantly better outcomes than hospitals without this designation in rates of hospital infection, severe intraventricular hemorrhage, and death after seven day. Surprisingly, this study found no significant difference in the death rate of low birth weight infants after 28 days of birth between those hospitals with "RNE" designation and those that did not receive this credential.

Click here to read more about this study.

Click here to read the actual study (subscription required). 

Upcoming IHI Seminar: Rethinking Critical Care: Reducing Patient Harm from Sedation, Immobility, and Delirium

On May 15th and 16th, the Institute for Healthcare Improvement will be hosting a symposium in San Diego, CA addressing critical care and cutting edge ICU practices aimed at improving care for elderly patients. The symposium will specifically focus on innovative ways for health care practitioners to monitor patient sedation, immobility, and delirium. Since these areas of care are strong predictors of length of stay, increased morbidity and mortality, long-term cognitive impairment, and high cost of care, this symposium offers a great way for health care practitioners to expand their skill-set and improve the quality of care they deliver.

Click here to read more about this upcoming symposium.

Nurse Staffing Mandates Debated at Hospitals

Over the weekend, Ben Sutherly, staff writer for the Dayton Daily News, reported on the different viewpoints hospital administrators and nurses have on nurse staffing mandates in the state of Ohio and around the country. Mr. Sutherly cites the work of renowned nursing workforce scholar and INQRI NAC member, Linda Aiken, to support the argument that nurse staffing levels should be mandated at the state level. Dr. Aiken's research found that there would be 14% fewer surgical deaths in Pennsylvania if the state were to adopt nurse staffing mandates that are similar to those in California, the only state that has mandated nurse-to-patient ratios. However, Mr. Sutherly also presents the case for hospitals as they argue that the quality of the health care workforce is much more important than having a minimum nurse-to-patient ratio in order to provide the highest quality of care.

Click here to read the whole article.

Click here to read more blogposts relating to nurse staffing.

Hospital Efforts To Keep Elderly Strong

Yesterday, Lindsey Tanner, reporting for the Huffington Post, described new initiatives being implemented by hospitals to encourage elderly patients to be more active and improve their quality of life. Ms. Tanner detailed how hospitals are utilizing nurses and volunteers to facilitate simple walking exercises that result in patients being just as healthy when discharged as they were on arrival.

Does this initiative sound familiar to you? It should!

Previous INQRI grantee Dr. Barbara Resnick focused her INQRI supported research efforts on Function Focused Care in assisted living communities that resulted in improved well-being for geriatric participants, in addition to improving the culture of safety for staff at the facilities that implemented the program.

Click here to read the HuffPost article.

Click here to read more about Dr. Resnick's work, including a video of a recent lecture she presented at the University of Pennsylvania's Institute of Aging.

Minimum Nurse Staffing Level Legislation Introduced In Minnesota

Last week, Renee Passal, of local ABC affiliate WDIO, reported that the Minnesota House and Senate has introduced legislation aiming to establish minimum nurse staffing levels at hospitals. The article also features a video snippet further detailing the proposed bills.

Click here to read the article and watch the video.

Click here to read other blogposts relating to nurse staffing.