Category Archives: Hospitals
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.
Join U.S. News & World Report this afternoon for a Twitter chat about how patients in hospitals can take ownership of their care and become actively engaged and informed about their treatment.
Among the experts participating in the chat is Marianne Weiss, DNSc, RN, a grantee of the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. Weiss is a researcher focusing on improving patients’ experience with hospital discharge and the role nurses play in discharge preparation and the discharge transition. Her research on patient perceptions of discharge teaching, readiness for discharge, and coping difficulty at home following hospital discharge have highlighted the importance of inclusion of patient voice to improve discharge experiences.
She will join representatives from the National Patient Safety Foundation, the Patient Advocate Foundation, and CNN’s Elizabeth Cohen, among others, for the chat.
Date: Thursday, July 25
Time: 2 p.m. to 3 p.m. ET
Experts: @INQRIprogram, @RWJF_HumanCap, @theNPSF, @NPAF_tweets, @TrishaTorrey, @tedeytan, @elizcohencnn
While they make up 73 percent of medical and health services managers, women account for only a small portion of CEOs at hospital and health care organizations, according to a report by RockHealth. The analysis of data from the U.S. Bureau of Labor Statistics and other surveys finds that just 4 percent of health care organization CEOs and 18 percent of hospital CEOs are women.
RockHealth’s report highlights a range of barriers to women’s advancement, including persistent gender roles in the workplace, a lack of mentors and role models for women, and more. To understand what women in the health care workforce thought, RockHealth conducted interviews with 100 women in the field. Nearly half the survey respondents reported that insufficient self-confidence was one of the biggest barriers to their career advancement. Among other reported obstacles: time constraints (45 percent) and the ability to connect with senior leadership (43 percent).
The Robert Wood Johnson Foundation has long championed leadership development, for women and men alike. Many of the Foundation’s programs offer leadership training for nurses, physicians and other health care professionals, to help advance their careers. Learn more about RWJF programs at RWJFLeaders.org.
What do you think? Are females underrepresented in health care leadership? What can we do to increase their representation? Register below to leave a comment.
The U.S. Department of Health and Human Services, Office on Women’s Health has designated May 13 to May 19 as National Women’s Health Week. It is designed to bring together communities, businesses, government, health organizations and others to promote women’s health. The goal in 2012 is to empower women to make their health a top priority. The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is launching an occasional series on women’s health in conjunction with the week. This post is by Rebekah Gee, MD, MPH, RWJF Clinical Scholars alumna and an assistant professor of public health and obstetrics and gynecology at Louisiana State University (LSU). She is director of the Louisiana Birth Outcomes Initiative.
Louisiana is a fantastic place to live. It’s one of the most culturally rich and enchanting places in the United States. The state, however, also faces some of the greatest challenges in our nation.
Louisiana has a long history of poverty, poor education, and social problems that affect the health of too many of its citizens. And for women—particularly African American women—the challenges are even greater. We are 49th in the nation in terms of overall birth outcomes, like infant prematurity and mortality, and we get failing grades on report cards that measure those indicators of health.
In 2010, Bruce Greenstein, Secretary of the Louisiana Department of Health and Hospitals (DHH), recognized the importance of poor birth outcomes as a crucial public health issue—and named it his top priority. We were the first state in the nation to offer birth outcomes this kind of backing from our government officials. In November, 2010, we launched the Birth Outcomes Initiative, which I direct. It engages partners across the state—physicians, hospitals, clinics, nurses—and provides them with the best evidence and guiding principles to achieve change. We have made significant progress already.
We are working with the state’s hospitals on maternity care quality improvements, including ending all medically unnecessary deliveries before 39 weeks gestation. We have partnered with 15 of the largest maternity hospitals to provide them with the support and resources to make this a reality. Now, every maternity hospital in the state (there are 58) has signed on to the 39-Week Initiative.
Soon, we will be publishing perinatal quality scores—available to the public—so hospitals and physicians are held accountable for outcomes. In our pioneer facilities, we have seen the rates of elective deliveries drop by half. Many facilities have had as much as a 30-percent drop in the number of babies who needed to go to the NICU. The efforts of the Birth Outcomes Initiative are improving lives day after day.
An appendectomy in California could cost anywhere from $1,500 to more than $180,000, even at the same hospital or within the same county, according to a study led by RWJF Physician Faculty Scholar Renee Y. Hsia, MD, MSc. The study, published this week in the Archives of Internal Medicine, found wide variations in fees for the routine procedure, about one-third of which could not be explained even after reviewing all the cases and accounting for individual health variations.
“We expected to see variations of two or three times the amount, but this is ridiculous,” Hsia told the New York Times. “There’s no rhyme or reason for how patients are charged or how hospitals come up with charges… There’s no other industry where you get charged 100 times the same amount, or 121 times, for the same product.”
Read a post Hsia wrote for the RWJF Human Capital Blog about ambulance diversion and emergency department crowding.