Category Archives: Hospitals
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
Changes in hormone levels during early menopause could be linked to an increased risk of heart disease, finds a new study co-authored by RWJF Health & Society Scholars program alumna Rebecca Thurston, PhD. Health Canal covers the study, describing it as a first-of-its-kind evaluation because it used nuclear magnetic resonance spectroscopy to assess the lipoproteins that carry cholesterol through the blood, rather than relying on conventional blood tests. Thurston’s study was published in the Journal of Lipid Research.
For Alice Goffman, PhD, an RWJF Scholars in Health Policy Research alumna, an undergraduate assignment turned into a six-year study of a low-income Philadelphia neighborhood in which, she concluded, “the young men in this community feel hunted.” In the resulting book, On the Run: Fugitive Life in an American City, Goffman says that a “climate of fear and suspicion pervades everyday life” in the community. The New York Times Sunday Book Review calls Goffman’s work “riveting” and her ability to understand her subjects “astonishing.”
The Colorado Department of Health Care Policy and Financing has received a $13.6 million grant from the federal Centers for Medicare and Medicaid Services to integrate and coordinate physical, behavioral, and social-health needs for people enrolled in both Medicare and Medicaid, reports the Northern Colorado Business Report. The story quotes Susan Birch, MBS, BSN, RN, executive director of the department: “This grant allows Colorado to coordinate our members' care, while achieving greater value and health outcomes for our citizens who are on both Medicare and Medicaid.” Birch is an RWJF Executive Nurse Fellows alumna.
In 1986, Scott Armstrong, MBA, joined Group Health Cooperative to manage the Washington- and Idaho-based health care organization’s hospitals. But as he explains in a new Robert Wood Johnson Foundation (RWJF) Clinical Scholar Policy Podcast, in his role as President and CEO of Group Health, he has led the organization in shuttering those same hospitals. He tells RWJF Clinical Scholar Elizabeth Brown, MD, that the move followed a successful push to reduce per member hospital utilization. Group Health now relies heavily on community hospitals, and focuses its providers’ attention on caring for patients leading up to hospital admission and after discharge. The move, he says, has lowered Group Health’s costs while helping local hospitals put otherwise unused capacity to work. Armstrong believes the Group Health experience foreshadows changes for the health care industry more broadly.
The video is republished with permission from the Leonard Davis Institute.
This is part of the April 2014 issue of Sharing Nursing’s Knowledge.
ICU Staffing’s Impact on Patient Outcomes
A nurse-led study from the United Kingdom has found that higher numbers of doctors and nurses in intensive care units (ICUs) have a positive effect on survival rates for high-risk patients.
A research team led by Elizabeth West, PhD, MSc, RN, Director of Research in the School of Health and Social Care at the University of Greenwich, used data on 38,000 patients in 65 ICUs in the United Kingdom, correlating patient outcomes with staffing levels for doctors, nurses, and support staff. They found that “higher numbers of nurses per bed ... and higher numbers of ‘consultants’ [senior hospital-based physicians or surgeons] were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death.”
“It seems reasonable to argue,” the researchers conclude, “that skilled nurses, who have the time to observe patients closely, to intervene or mobilise the team if they begin to deteriorate, would be most important to patients who are at the greatest risk. This study is the first to produce evidence that this is the case.” Their findings are published in the May 2014 issue of the International Journal of Nursing Studies.
This is part of the March 2014 issue of Sharing Nursing’s Knowledge.
Comparing Nurse and Physician Performance on Colonoscopies
A new study finds that colonoscopies performed by nurse and physician endoscopy trainees are comparable in terms of quality and safety.
Researchers in The Netherlands studied 15 endoscopy trainees—seven nurses and eight physicians—at two medical centers over the course of three-and-a-half years. At the beginning of the study, none had experience in endoscopy. All were trained according to the applicable regulations of the Dutch Society of Gastroenterology, performing a minimum of 100 colonoscopies. After completing their training, each performed 135 consecutive colonoscopies under the supervision of a gastroenterologist, with their work evaluated for safety and quality.
The nurse group and the physician group had comparable results on both measures, with the nurse group producing marginally better scores in some areas. Each group detected the same percentage of adenomas (benign polyps), and had the same low rate of complications. The nurses had slightly higher rates of cecal intubation (successfully passing the colonoscope to a key part of the colon), and slightly higher rates of completing the procedure without assistance.
This is part of the January 2014 issue of Sharing Nursing’s Knowledge.
Hush!!! Testing nurse-designed noise-reduction strategies for hospital wards
A common complaint of hospital patients is that just when their bodies need it the most, they can't get a good night's sleep because of noise and interruptions. A new initiative of three nurses at Beth Israel Deaconess Medical Center in Boston takes direct aim at the problem.
In response to patient satisfaction surveys that highlighted the problem of nighttime noise, Gina Murphy, BSN, RN, Anissa Bernardo, LCSW, and Joanne Dalton, PhD, RN, studied existing literature on the topic, developed a program they call Quiet at Night, and tested it on a 44-bed medical-surgical unit. The program includes a number of strategies for reducing noise, including closing doors at night when medically appropriate, supplying earplugs to patients, keeping patients by themselves in semi-private rooms when the census permits, using mini-flashlights when performing overnight checks to avoid turning on the lights, performing change-of-shift conversations in the break room rather than in hallways or at the nurses' station, providing headphones to patients who need the television on at night, and using beep-free keypads on doors. In addition, after 9 p.m., they implemented a number of “quiet hours” practices, including dimming lights, turning pagers to vibrate, avoiding overhead pages and hallway conversations, and more.
After implementing the strategies, the trio compared before and after surveys. In the three survey periods before the program, 43 to 47 percent of patients reported that their rooms were “always” quiet at night. After the program was in place, that jumped to 60 percent, which is the goal the nurses had set.
Doctors, nurses, and other health professionals are increasingly taking on top leadership positions at hospitals, Fierce Healthcare reports, likely because of the changing health care delivery system.
The trend is taking root in several states. In Texas, Baylor All Saints is headed by a former surgeon. The president of Texas Health Harris Methodist Fort Worth is a former intensive care unit nurse, and her immediate superior who oversees operations for 12 regional hospitals is a physician, the Forth-Worth Star-Telegram reports.
Presence Saint Francis Hospital and Presence Saint Joseph Hospital in Illinois announced this month that a physician and board-certified specialist in infectious diseases would take over as president and CEO, according to Fierce Healthcare. Portsmouth Regional Hospital in New Hampshire is run by a registered nurse, Foster's Daily Democrat reports.
Among the Robert Wood Johnson Foundation (RWJF) scholars in top leadership positions at hospitals is RWJF Executive Nurse Fellow Kim Moore, RN, MSN, FACHE, the president of Saint Elizabeth Regional Medical Center in Lincoln, Nebraska.
Three years ago this week, the Institute of Medicine issued a landmark report, Future of Nursing: Leading Change, Advancing Health. Its recommendations include increasing the proportion of nurses with baccalaureate degrees to 80 percent by 2020. Jerry A. Mansfield, PhD, RN, is chief nursing officer at University Hospital and the Richard M. Ross Heart Hospital, and a clinical professor at Ohio State University College of Nursing. He is an alumnus of the Robert Wood Johnson Foundation Executive Nurse Fellows program (2005).
Lifelong learning has always been a value in my personal and professional life. I fully support the national goal of increasing the number of RNs holding a minimum of a bachelor’s degree in nursing (BSN).
My personal dilemma is that I once could not gain entrance into a 4-year baccalaureate program. I will never forget my meeting with the dean, who shared that I should “pick another major” since my mid-quarter pre-nursing grade point average was not competitive with more talented constituents!
As I withdrew from that university, I was determined to follow my dream and become a registered nurse. I learned of a program (i.e., “Diploma in Nursing”) that would allow me to become an RN in the state. I am a proud graduate of St. Vincent Hospital School of Nursing, Toledo, Ohio; a once thriving program that has since closed.
Without any regret, I have continued my formal education in nursing, and recently graduated with a doctorate in public health from Ohio State University. No one knows my obsession with life-long learning better than my family!
Three years ago this week, the Institute of Medicine issued a landmark report, Future of Nursing: Leading Change, Advancing Health. Its recommendations include increasing the proportion of nurses with baccalaureate degrees to 80 percent by 2020. Charleen Tachibana, MN, RN, FAAN, is senior vice president, hospital administrator, and chief nursing officer at Virginia Mason Medical Center in Seattle, Washington. Tachibana is a Robert Wood Johnson Foundation Executive Nurse Fellow (2009 – 2012).
Virginia Mason Medical Center began a bachelor of science in nursing (BSN)-only hiring guideline in the summer of 2012. The change in hiring guidelines for our staff followed a decade of having educational guidelines in place for our nurse leaders. This was a critical step in our success, as our leaders were able to support and understand the need for this change. It’s important for leaders to model lifelong learning, including advancement with formal education. So, last August I also began my Doctor of Nursing Practice (DNP) program.
The publication of the Institute of Medicine (IOM) report on the Future of Nursing really provided the momentum to move to another level. The prominence of this report has made this a relatively easy transition and provided the clarity on why this is critical for our patients and for our profession at this point in time.
Although we have focused this requirement on new hires, it’s been impressive to see the wave of staff RNs returning to school, many for their master’s or doctorate degrees.
Although more hospitals and health care systems have been hiring physicians in recent years, more than half of the nation’s physicians are still self-employed. A survey from the American Medical Association finds that 53.2 percent of physicians were self-employed in 2012 and 60 percent worked in practices that were wholly owned by physicians.
The survey also found that only 5.6 percent of physicians were directly employed by a hospital. Twenty-three percent worked in practices that were at least partially owned by a hospital.
Although the researchers conclude hospital employment is part of a national trend, the data “offers an update on the status of physician practice arrangements, and allows for a nationally representative response to the numerous articles of the past several years that have highlighted a surge in the employment of physicians by hospitals and the ‘death’ of private practice.”
The data comes from the 2012 Physician Practice Benchmark Survey, a nationally representative random sample of post-residency physicians who provide at least 20 hours of patient care per week.
The Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, recommended that nurses be empowered and prepared to take leadership roles, becoming full partners in hospitals and other health care settings to redesign health care in the United States.
In this video, produced by the New Jersey Action Coalition, Dave Knowlton, president and CEO of the New Jersey Health Care Quality Institute, and Robert Wise, president and CEO of the Hunterdon Healthcare System, talk about the importance of having nurses in leadership positions on hospital boards.