What were the hottest nursing topics of the year? Here's a roundup of our most popular nursing stories.
It's the end of the calendar year and with that comes the tradition of looking back on the year that was. With that in mind, I have compiled a list of HealthLeaders' most-read nursing stories in 2019.
Some of the most popular topics this year include bedside nurse recruitment and retention, advanced practice registered nurses' scope of practice, and workplace violence. The following is a list of the top five HealthLeaders nursing stories, ranked by popularity.
Themed escape rooms for team-building events have become popular over the past few years, and some creative nurses are using the escape room concept to improve healthcare professionals' knowledge of sepsis.
Paula M. Gabriel, MSN, RN, andCasey Lieb, MSN, RN, nurses at Penn Presbyterian Medical Center, a 355-bed acute care hospital in Philadelphia, and members of the Penn Medicine Sepsis Alliance education team, designed an interdisciplinary escape room for World Sepsis Day.
Teams of six to eight people were locked together in a sepsis escape room and were asked to use critical-thinking skills and teamwork to complete a mission to learn about sepsis. The teams had 25 minutes to detect and treat sepsis in a mock patient before they could escape the room. They did this by solving four puzzles and responding to clues.
"The escape room format allows different types of learning, so you have people that are auditory, visual, or kinesthetic learners [and] they can touch things and talk through things. You have to use your critical-thinking skills and think outside the box," Gabriel says. "There's that pressure element of having to escape something in a certain amount of time and you know it's a different way of learning, compared to the traditional, ‘come and sit in a classroom' and have somebody give you information."
Workplace violence against healthcare workers is an issue that's getting much needed attention.
TheOccupational Safety and Health Administrationreports 50% of workplace assault victims are employed in the healthcare industry and, between 2002 to 2013, serious workplace violence incidents were four times more likely to occur to a healthcare worker compared to all other workers in the United States.
Workplace violence can also be deadly. In April 2019, 56-year-old nurse Lynne Truxillo was attacked by a patient in a behavioral health unit at Baton Rouge General Medical Center in Louisiana. Truxillo injured her right leg and struck her head on a desk. She died a week later due to blood clots in her leg and lungs that a coroner determined had resulted from the incident. The patient was arrested and charged with manslaughter.
Physician opposition to regulations that support greater autonomy for NPs is always a story that is followed with much interest by the medical field. This year, the American Medical Association expressed its support again for restricting independent practice among NPs. The advocacy group Physicians for Patient Protection has been outspoken about its safety concerns regarding NPs and physician assistants.
"There are absolutely patient-safety concerns associated with NP and PA care. We don't diminish the fact that physicians make mistakes, of course, but the type of mistake is often very different from those of nonphysician practitioners. We have had many physicians and patients share stories with us of missed diagnoses and misdiagnoses by NPs and PAs, as well as excessive and inappropriate testing, prescribing, and treatment," says Carmen Kavali, MD, of Kavali Plastic Surgery and Skin Renewal Center in Atlanta, and a PPP board member.
And the No. 1 most-popular HealthLeaders nursing story:
There's more to building a strong nursing workforce than just filling open positions. Nurse leaders must also consider whether a nurse has the right skills and work experience to deliver high-quality patient care. Additionally, they must retain and develop the staff they have in order to prevent turnover and loss of talent.
In this article, three nurse leaders share their successes in recruiting and retaining bedside nurses. Their solutions include changing nursing's reputation at the organization and in the community, providing a return to practice program and flexible schedules for nurses interested in coming back to the bedside, and creating a healthy work environment to support nurses in developing resilience skills.
The opioid epidemic has been costly in terms of both lives and economics, but New Jersey's RWJBarnabas Health has taken the initiative to address the epidemic by improving patient access to recovery services at their organization.
"The national opioid crisis has been in the headlines for many years now, and we were seeing more and more patients in our emergency departments with overdoses," says Nancy E. Holecek, RN, MHA, MAS, senior vice president and chief nursing officer, Northern Region at RWJBarnabas Health. "We were able to do immediate treatment but those first few days of support and then long-term support were lacking. It was really a revolving door, and we realized that we needed to do something much more than what we were doing."
From 2015 to 2018, the total economic cost of the opioid crisis reached at least $631 billion, according to an analysis from the Society of Actuaries. And the Centers for Disease Control and Prevention reports that in 2017, 70,237 drug overdose deaths occurred in the United States. Opioids made up the almost 68% (47,600) of drug overdose deaths in 2017.
In 2016, RWJBarnabas Health created a program to provide intervention to patients who presented to the emergency department with an opioid overdose reversed by Narcan. In that first year, the program served 720 individuals.
Thanks to the program's connection with this particular patient population, the program expanded to include all patients who presented to the emergency department with signs of any type of substance abuse disorder.
"We expanded the program in 2018 to be a 24/7 emergency department and hospital-based program that would serve anyone coming in to our facilities with substance use disorder. That would include opioids, alcohol abuse, pain medication addiction, etc.," Holecek says. “Since the program's expansion in 2018, we have served 23,737 individuals.”Holecek recently spoke with HealthLeaders about four key components of the program and how nurses play a role in connecting patients with much needed recovery services.
Immediate peer intervention
Connecting patients facing substance use disorder with an individual who has been in their shoes is an essential part of the program. RWJBarnabas Health hospitals have a 24/7 support team of over 100 Peer Recovery Specialists who are each in long-term recovery themselves.
"The purpose of the program is to provide site intervention immediately. The Peer Recovery Specialists are former substance abusers and have been through recovery, so they provide the immediate connection to the patient," Holecek says. "Because the initial contact comes from someone who is in peer recovery it's much more easily accepted by the patient."
Participation in the program is voluntary, she says, but if a patient is willing, a patient navigator will assist that person in providing appropriate recovery support and placement.
"It is important that Peer Recovery Specialists are always on-site," Holecek says. "When we trigger one of the Peer Recovery Specialists, they come right to the patient's bedside and they make face-to-face contact with the patient and establish a bit of a relationship with them. Then they continue to follow up with that patient."
Additionally, it helps the Peer Recovery Specialists become part of the clinical care team.
"I think that made a big difference that [the Peer Recovery Specialists] go to the bedside. …There's nobody better to relate to the patients that are coming in," Holecek says.
Staff education
Educating the nurses and physicians on how to utilize the Peer Recovery Specialists' services as well as teaching them the clinical aspects of substance abuse disorder is another component of the program.
"The education piece was absolutely key for physician leadership and for our nursing staff. The introduction of the peer recovery support specialists as part of the team [was important] because we wanted to make sure that we just didn't have them in an office somewhere. [We wanted] the nurses and physicians actively triggering them to come and see patients," Holecek says.
In-depth education on the physiological effects of substance abuse disorder as a disease state was also provided to clinical staff.
"It was a scientific, educational program so nurses and clinicians can really understand the etiology of substance abuse in patients and why it's something that [the patients] can't control. This is a physiological illness, a disease for them," she says. "[Clinicians'] knowledge base around substance abuse disorder has increased significantly and that makes them better practitioners and caregivers [who can] better assess and refer folks to the program."
Nurse Autonomy
Nurses have been given greater autonomy in referring patients to the peer recovery support specialists.
"We don't need a physician order to call in the Peer Recovery Specialist," Holecek explains. "Nurses are able to do that using their assessment and critical-thinking skills. That, too, has just made it so easy for us to be able to access help for these patients."
This is an important point because nurses are often the first people interacting with the patient. During their initial assessment, nurses can rely on multiple assessment tools such as the Clinical Opiate Withdrawal Scale to determine whether patients have substance use problems and need intervention, she says.
"If we determine that a patient, for example, is drinking a case of beer a week or may need some intervention, the nurse can, without a physician order, activate a recovery specialist to come and talk to the patient," she says.
Long-term follow up
If a patient is receptive to support for substance use disorder, he or she receives further assistance beyond the emergency department via patient navigators or case managers.
"The Peer Recovery Specialist helps get them into the program, talks to them in the crisis, and then the navigators shepherd them through," Holecek says. "The navigators follow up for eight weeks, and then at three months, six months, and nine months just to make sure that the patient is still following their course [of treatment] or if they need some additional intervention."
The Next Step
Over the first three quarters of 2019, there were 75,730 touchpoints of follow up, according to Holecek, and the nursing staff is anecdotally reporting that they are seeing less of the same people returning to the emergency department.
RWJBarnabas Health is also focusing on decreasing the number of opioid prescriptions given at discharge.
“As of October 2019, only 2.56% of our patients discharged from our emergency departments were prescribed opioids compared to the national average of 17%,” Holecek says.
In the first 18 months after the initiative launched, 25,380 fewer ED patients received opioids at discharge and 21,116 fewer inpatients received opioids at discharge.
"I'm very enthused about the program," she says. "I'm so thankful that we have the Peer Recovery Specialists. It's been such a value add to our clinical teams."
If you look around your healthcare organization, do you see engaged and efficient clinicians? Do you see happy patients? Do your most recent clinician satisfaction scores make you proud? If that's not the case, it's time to think about incorporating a culture of joy and love into your hospital or health system to turn things around.
Many studies on the topic of incorporating joy in the workplace are proving that "soft" skills used in work environments are the new "hard" skills and that, if implemented well, softer skills can help healthcare organizations reap hard results in employee engagement, patient safety, and nurse retention and recruitment.
The value in soft skills
When Perry M. Gee, PhD, RN, nurse scientist at Intermountain Healthcarein Salt Lake City, first heard about the concept of cultivating joy among the healthcare workforce, he was skeptical.
"When I started hearing the term joy a few years ago, it was really frustrating to me," he says. "The frustration was, because I'm an academic and a researcher, joy was not in the literature. It's not something that we had a firm definition of, and I really had a hard time getting my arms around it."
While he eventually came around to the concept, Gee is not alone in his need for the tangible. Even Donald Berwick, MD, president emeritus and senior fellow at the Institute for Healthcare Improvement, a leading proponent of joy in work, acknowledges in the whitepaperIHI Framework for Improving Joy in Work that the idea can sound "flaky" to some.
Given the drive for healthcare organizations to achieve measurable outcomes and return on investment, it's understandable that those in the healthcare industry are focused on concrete concepts.
Yet, skills often labeled as "soft," such as resilience, can impact the "hard" issues like financial goals, patient outcomes, and patient experience that healthcare organizations are eager to achieve.
"The [qualities] that we look for in leaders are what are referred to as 'soft skills.' Yet, when we talk about those skills, we somehow think they are less valuable because they are called soft," says Julie Kennedy Oehlert, DNP, RN, chief experience officer atVidant Health in Greenville, North Carolina. "[S]oft skills, which are communication, listening, empathy, teamwork, problem solving, flexibility; those are things that we need in the healthcare environment today times 10."
Healthcare leaders like Oehlert are starting to get behind the idea that those "soft skills" can yield big results when it comes to achieving organizational goals.
Coming around to joy
Intermountain's Gee began to embrace the idea of joy in work precisely because of research and data.
"I have done research for the last four or five years with nurses in clinical settings looking primarily at burnout and resilience," Gee says. "And what I personally encountered was, even though these people were working in very stressful environments, some of them had some symptoms of burnout, and some of them were using their own personal resilience. You could see the joy on their faces when we would meet during focus groups."
While the nurses did have struggles, Gee says, these clinicians also spoke about times when they learned from another colleague or times when they helped a patient or family member, which gave them joy.
"The nurses really are the ones that convinced me that joy was a very important work concern," he says.
However, he says, "Joy is hard to quantify in one particular term. I think it's a combination of a lot of factors."
Joy in work, Gee says, can be pinpointed by asking the question, "Why do I want to come to work?"
Gee's own model of resilience includes components such as connection with others and a sense of purpose.
"I think joy combines with that sense of purpose," he says. "I came into nursing or healthcare to serve others and to make people's lives better. That gives me some joy. I get joy from my connections with patients and with families. And, personally for me, when I worked at the bedside, I'd have tremendous joy when I would do patient teaching and you see a patient or family 'get it.' "
But, as Gee points out, nurses need work environments that foster joy in work.
"Burnout is really a workplace condition. It's not a psychological condition," he says. "If your work environment is not conducive to joy, lots of things can happen. You may quit the job to leave that work environment. And people who are burned out or working in an environment that is not efficient and conducive to patient care make more errors."
Burnout's high cost
Clinician burnout, compassion fatigue, and moral distress are frequently mentioned issues in today's healthcare industry.
The American Medical Association estimates physician burnout costs range from $500,000 to more than $1 million per physician. In its 2019 National Health Care Retention & RN Staffing Report,Nursing Solutions Inc. estimates the average cost of bedside RN turnover to be between $40,300 and $64,000, resulting in the average hospital losing $4.4 million to $6.9 million annually.
Additionally, when researchers at Penn Nursing's Center for Health Outcomes and Policy Research performed a meta-analysis of 16 years of studies, they found an association between the nurse work environment and nurse job outcomes, nurse assessments of quality and safety, patient health outcomes, and patient satisfaction. In short, the study found that better work environments were associated with lower odds of negative outcomes.
Make joy a strategic priority
Jessica Perlo, MPH, director at theIHI in Boston, says that the work environment is essential to preventing burnout among the healthcare workforce.
"Whether we focus on satisfaction, resilience, or joy doesn't matter as much as not putting the burden solely on the individual, but also the system to improve it," she says. "If 50%–60% of our healthcare team is burned out, we don't have an individual problem, we have a systems problem."
To address these issues at a systemic level, IHI began to make joy in the work environment a strategic priority in 2015.
"Our partner [organizations] came to us because, at the time, they were saying engagement was standing in the way of their achieving Triple Aim results. There was a steady drum beat of news and research on burnout, and that connection between satisfaction and outcomes was becoming clearer to our partners. So, we knew we had to help and that improvement methodologies had a role to play in being part of the solution," Perlo says.
IHI took inspiration from the work of W. Edwards Deming, a pioneer in quality improvement, and began its focus on joy in work.
"[Deming] said management's overall aim should be to create a system in which everybody may take joy in their work," Perlo says. "We define joy in work as an intellectual, behavioral, and emotional commitment to meaningful, satisfying work. Without joy and meaning in work, the workforce cannot reach its potential. We believe that it encapsulates this aspirational goal of true workforce engagement and well-being."
Perlo points out that instilling joy in the workplace does differ a bit from resilience and job satisfaction.
"Oftentimes, interventions that are focused on resilience are for satisfaction of the individual rather than identifying or ameliorating the cause [of burnout]," she says.
Perlo stresses that to achieve joy at work, a systemic approach is needed, which is why IHI created its framework for improving joy at work.
The framework outlines roles for all leaders, from the C-suite to the point of service, in promoting joy in work.
In the framework, IHI encourages a distribution of leadership so there is space for everyone to accept responsibility and act in service of a shared purpose, not just those in nominal positions of authority. Given this broader definition, here are four steps leaders can take to move the workplace culture toward one that supports joy.
Step 1: Ask staff, "What matters to you?"
"The 'What Matters to You' conversations have proven to be crucial to this work," Perlo says.
These conversations can clear up any assumptions or misconceptions leaders may have about what is important to their work colleagues.
"Oftentimes, we assume we know what makes for a good day for our colleagues, but we've never actually asked what they care about and why they got into [healthcare] to begin with," she points out. "When we start to do that and are also given an opportunity to reflect ourselves and can share our interests in a way that helps us connect to each other's shared values, we are more willing to contribute our time, our energy, and our care to a shared goal."
Step 2: Identify unique impediments to joy in work in the local context.
"After we know what makes for a good day, we are better positioned to understand where the pebbles in the shoes are," Perlo says. "Oftentimes, leaders were afraid to ask "What Matters" because the expectation is that we will fix the impediments coming up for our teams. This isn't always feasible. What we're trying to do is shift this mindset from doing 'for' to doing 'with,' which is much more manageable. We ask one another what's getting in the way of more good days and then use improvement science to start with small tests of change. Doing so helps us to address the innate human needs that might not be met in the current environment: things like meaning, choice, camaraderie, and equity."
Step 3: Commit to a systems approach to making joy in work a shared responsibility at all levels of the organization.
Leaders at all levels should look at processes, issues, or circumstances that are impeding what matters.
"Then we're committing to, at all levels, creating partnerships, multidisciplinary when possible, and opportunities for people to come together and share responsibility for removing the impediments to joy," Perlo says. "While it's ultimately senior leaders' responsibility to ensure staff experience joy at work, the second part of the IHI Framework for Joy in Work is about shared and overlapping responsibilities at all levels of the organization. There is a role for everyone to play in finding and creating joy in work and more importantly, tools and resources to help them to do that."
Step 4: Use improvement science to test approaches to improving joy in work at your organization.
"We're encouraging folks to use improvement science to accelerate progress and to help determine whether their changes are actually leading to improvement," Perlo says. "This is also a way for us to address the underlying systems creating burnout. Together with teams, we set an aim for their work, decided on measures that would tell us if we are making progress, and selected components of the Framework for Improving Joy based on conversations and data from our staff. This is where it's also helpful to be a part of a collaborative or community of practice around the work. This is why IHI is launching a results-oriented network focused on supporting teams to work together to test, learn from, and contextualize evidence-backed, high-leverage changes to increase joy at scale."
Perlo also recommends measuring whether improvements are successful. Leaders don't have to reinvent the wheel and can use existing metrics like employee satisfaction, staff engagement, or burnout data, she says. They can also use turnover, retention, and absenteeism data. If leaders choose to use that information, she recommends increasing the frequency of data collection and analysis.
For example, this can include tools like an app that pings employees to ask them if they've had a good day, or something as simple as asking employees to drop dark-colored or light-colored pebbles in a clear container to indicate whether they've seen improvements or setbacks in their work environment, she says.
Love is all you need
At Vidant Health, leaders are using an innovative foundation for their organizational culture—relationships structured around love and empathy.
"We embrace the definition of love used by Dr. Martin Luther King Jr… love is 'an understanding, redeeming goodwill for all men, an overflowing love that seeks nothing in return,' " Oehlert says.
This type of love involves creating a safe, welcoming place where team members care about each other, she says.
"We talk a lot about the importance of empathy. Empathy put into action is compassion, which is one of [Vidant's] values," says Oehlert. "We have decided that if we design educational offerings and leadership development [around] love, and stress that empathy is of key importance in relationships, that even those times that are difficult in the health system or on the unit will be easier with love and empathy."
She continues, "it is very simple: How we treat each other is how we treat our patients, and how we experience each other is how our patients will experience us. We do not look at patient experience and design a good experience for them without thinking about how the providers feel or how the team members feel. When you look at experience in this way, you can positively contribute to both patients and care providers, which helps prevent burnout and shows that the relationship between the two is valued."
Embrace love, improve outcomes
According to Oehlert, systemwide team engagement has been improving steadily since implementing love and empathy into the workplace and has risen 5.4% over the last four reporting cycles, according to the Press Ganey Engagement and Pulse Surveys that Vidant uses to measure employee engagement. From 2017 to 2019, the organization has seen the following increases in engagement:
• Clinical team member: 1.5% increase
• Non-clinical team member: 0.2% increase
• Clinical leader: 11.2% increase
• Non-clinical leader: 4.7% increase
• Supervisor, non-clinical: 12.4% increase
• Supervisor, clinical: 14.2% increase
• Manager, non-clinical: no change
• Manager, clinical: 4.7% increase
• Director, non-clinical: 1.1% increase
• Director, clinical: 10.8% increase
• Executive/VP: 4.7% increase
From 2015 to 2019, the questions pertaining to manager effectiveness saw "problematic" ratings decrease by 4.1%, and managers rated as "excellent" increased by 6.2%.
From 2015 to 2017, physicians rated as "engaged" increased by 6.5%.
Additionally, reporting of near misses has almost doubled over the last few years, Oehlert says. In FY 2019, 19,120 patient events were reported, a 7% increase from FY18. Of these, 4,849 were safety catches, up from 2,760 safety catches in FY18.
Improvements have also been seen in the two Agency for Healthcare Research and Quality questions regarding non-punitive response to error. These questions ask whether team members feel like their mistakes will be held against them, and whether when an event is reported it feels like the person is being written up. The AHRQ question, which highlights a non-punitive approach to safety reporting, is the single most improved question in the last reporting period of the AHRQ survey.
"If you can take the fear and blame out of your culture, what's left is all the good things about healthcare—love, compassion, empathy, shared decision-making, interprofessionality," she says. "When you take fear and shame and blame out, what's left is really good human stuff, which is what healthcare should be about."
Patient experiences continue to trend upward as team engagement improves, Oehlert says.
Also, the nurse turnover rate at Vidant Medical Center for FY19 is 16.33%, compared to the national average of 17.4%.
"We realize that our culture and our engagement impacts turnover. Right now, our RN turnover is 16%, which is below the national average. We had traditionally recruited and hired locally (North Carolina and Virginia), and now we are confident in our strategy and are attracting nurses from a wider demographic," Oehlert says. "Last year, we hired nurses from 10 different states. Our newest RN recruitment campaign (#carelikecrazy) ties together our intention of love and caring right in our recruitment."
Create a strategy 'around culture'
To help measure success, says Oehlert, organizations should create standard definitions of the components of their mission, values, and goals.
"If you don't know how the organization defines something, it's hard to measure it. We measure our definition of engagement on our engagement survey, and we also define culture in a specific way," she says.
For example, at Vidant:
• Culture is defined as, "How relationships are structured."
• Empathy is defined as, "Recognizing and appreciating the feelings, thoughts, and stories of others by connecting and being sensitive to what, how, and why people feel and think the way they do."
• Engagement is defined as, "Our shared commitment and partnership in shaping a positive, motivating, and relationship-focused culture where we can all thrive."
"What that does for the organization is it [allows us to] agree on it so we know what we're going for. I think that is important if you're [creating] strategy around culture," she says.
Additionally, when creating developmental offerings, Vidant leaders rely heavily on design thinking, which Oehlert says includes engaging people, getting their feedback, and trialing ideas and innovations.
And again, what are often considered to be soft ideas can translate into hard results.
"A lot of the wicked problems in healthcare today can be healed when you have a strategy that includes love and empathy. You will not have good quality outcomes if you don't have love and empathy within the culture in good measure, because people will be afraid to report quality and safety issues. You will not have excellent patient experiences unless the teams that care for patients are supported and loved. You will not be successful with recruitment and retention if your team members will not recruit for you and may not choose to stay at an organization that does not care about them," she says.
From addressing workplace violence to fostering mentoring, CNOs are creating workplace cultures that support nurses and enable them to grow in their careers.
What kind of reputation does your organization have when it comes to workplace culture? This is a question to take seriously, as workplace culture can affect everything from recruitment and retention of staff to quality of nursing care.
The nurse work environment, and how nurse leaders can positively influence it, was one of the topics discussed during the 2019 HealthLeaders CNO Exchange at Ojai Valley Inn in Ojai, California, from November 13–15. CNOs are striving to address culture and create workplaces where nurses can excel professionally and deliver optimal patient care.
Here are three ways CNOs are developing healthy work environments and supportive nursing cultures to enable nurses to flourish and achieve professional success.
1. Make personal connections with staff
Today's nursing workforce expects nurse executives to be visible, accessible, and approachable.
"I always say, 'How am I doing? What can I do to support you?' " she says.
These meetings help Carter identify and remove stumbling blocks so her staff can work at an optimal level.
"It's about figuring out the rocks in their shoes," she says.
Leaders must work quickly and efficiently to resolve issues that are throwing a wrench in nurses' workflow, says Katie Boston-Leary, PhD, MBA, NEA-BC, vice president and system CNO at University of Maryland Capital Region Health in Cheverly, Maryland.
"A nurse is only as good as their last shift," she says.
2. Create mentoring opportunities
The retirement of experienced nurses is a real issue facing CNOs. According to the AMN Healthcare 2017 Survey of Registered Nurses, the percentage of nurses planning to retire in less than a year was 27% in 2017.
Many nurse executives are interested in finding ways to help experienced nurses share decades of skills and knowledge with the younger generation of nurses.
Erin LaCross, DNP, NEA-BC, CENP, CNO at Parkview Health in Fort Wayne, Indiana, points to her organization's Emeritus Nurse program that is aimed at mitigating the effects of knowledge gaps as experienced nurses retire.
The program not only provides an alternative to retirement by offering flexible scheduling options, it also serves to create a mentoring environment to transfer knowledge to new nurses. By offering flexible work hours and roles designed to enhance mentorship, Parkview has rehired 21 nurses who retired between 2013 and 2016.
At Woodlawn Hospital in Rochester, Indiana, Paula McKinney, DNP, RN, FCN, NE-BC, vice president, patient services, is teaming up physicians with nurse residents. For example, a nurse resident may be paired with an orthopedic surgeon. The nurse will see patients in the physician's office before surgery, in the operating room, during recovery on the acute care unit, and then during postop follow-up visits in the physician's office. This allows the nurses to dive deeper into understanding the continuum of patient care.
3. Ensure safe workspaces
Workplace violence has been an issue of concern for CNOs over the past few years. And for good reason.
"We need to approach [workplace violence] with more than just force," said Theresa Murphy, RN, MS, CENP, CNO at USC Verdugo Hills Hospital in Glendale, California, says.
Leadership must support employees by crafting policies and procedures to keep them safe. That includes seeking nurse input as CNOs develop these standards.
"There is a critical place at the table for nurses in talking about workplace violence, Murphy says.
In the case of violent attacks on staff members, nurse leaders should connect directly with employees and offer to listen and help them find resources of support if necessary. For example, if an employee is injured as a result of workplace violence, Boston-Leary says she sends a personal note to the employee and extends an invitation to meet with her for coffee.
The HealthLeaders CNO Exchange annually gathers leading hospital and health system CNOs for a custom dialogue on only the critical issues facing the future of nursing. For more information, please email exchange@healthleadersmedia
A bill to improve the safety of healthcare workers is passed by the U.S. House of Representatives.
Workplace violence against healthcare workers is an issue that's getting well-deserved attention.
The Occupational Safety and Health Administration reports 50% of workplace assault victims are employed in the healthcare industry, and between 2002 to 2013 serious workplace violence incidents were four times more likely to occur to a healthcare worker compared to all other workers in the United States.
Now the safety of healthcare workers is being addressed through legislation. On Nov. 11, the U.S. House of Representatives voted to approve The Workplace Violence Prevention for Health Care and Social Services Act of 2019. The bill, which passed by a 251-158 vote, ensures that healthcare and social service employers, including hospitals, take specific steps to prevent workplace violence and ensure the safety of patients and workers. H.R. 1309 directs the Secretary of Labor to require these employers to develop and implement workplace violence prevention plans that are worker-driven and comprehensive.
House passage of the workplace violence prevention act is a major victory for emergency nurses and all health care providers. Today's vote puts us all one step closer to a safer work environment and, ultimately, peace of mind that we can care for our patients knowing that our facility has taken the proper measures to protect us, ENA President Patti Kunz Howard, PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN, says in a news release.
The bill now moves to the Senate for consideration.
ENA supports legislation to address workplace violence in healthcare. During its annual Day on the Hill event in May 2019, nearly 175 ENA members about the issue during meetings with members of Congress.
Additionally, the ENA and the American College of Emergency Physicians recently launched the No Silence on ED Violence campaign – a collaborative effort that aims to support, empower and protect those working in emergency departments by raising awareness of the serious dangers emergency health providers face, and by generating action among stakeholders and policymakers to ensure a violence-free workplace for emergency nurses and physicians.
To address the issue of emergency department violence, the ACEP and ENA have launched "No Silence on ED Violence," a new campaign to help prevent attacks and protect ED professionals and patients. The campaign's goal is to support, empower, and protect ED workers by raising awareness of the serious dangers emergency health providers face every day. The program also aims to spur action among stakeholders and policymakers to ensure a violence-free workplace for emergency nurses and physicians.
"No nurse or physician in the emergency department – or any other health care professional – should feel unsafe. We're there to care for people, not to have to question our own safety. Workplace violence is really important to us in the emergency department because it really impacts the care we deliver," ENA President Patti Kunz Howard, PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN, says in a news release.
Visitors to the campaign's website can find resources and content to support those victimized by workplace violence and explore ways to reduce the frequency of violent incidents. They can also share stories of workplace violence to help raise awareness of the issue.
"If you asked the majority of our nurses and our physicians, they have all been impacted directly by violence – as have I. It goes everywhere from verbal violence, which happens frequently, to physical violence. Ultimately, we hope that in sharing our stories we will gain insight and share resources on how to prevent any future harm to our medical teams and our patients," says ACEP President William Jaquis, MD, FACEP, in a news release.
Through No Silence on ED Violence, ACEP and ENA aim to drastically reduce emergency department violence and allow emergency physicians and nurses to able to focus on providing lifesaving treatment without living in constant fear for their safety. To learn more about the campaign, visitwww.StopEDViolence.org.
The issues of workplace violence and retaining experienced nurses were top of mind at HealthLeaders 2019 CNO Exchange.
Close to 30 nurse executives gathered this week in Ojai, California, as part of the HealthLeaders 2019 CNO Exchange, to share how they are addressing pressing issues facing the nursing profession.
"This forum will again be the opportunity to share ideas, frustrations, and some lessons learned with a network of peers," said HealthLeaders' Leadership Programs Director and Editor Jim Molpus in a welcome to the group.
True to nurses' collaborative nature, the event attendees quickly dove into sharing ideas and best practices during a series of roundtable discussions that began Thursday and will continue Friday.
Topics include how to address workplace violence, retaining the wisdom of seasoned nurses, and fostering positive work environments.
Here are two highlights from Thursday's discussions:
1. Filling the gaps as experienced nurses retire.
Losing decades of skill, knowledge, and wisdom as seasoned nurses begin to retire is of great concern for many nurse leaders. Erin LaCross, DNP, NEA-BC, CENP, CNO at Parkview Health in Fort Wayne, Indiana, shared a presentation on her organization's Emeritus Nurse program that is aimed at mitigating the effects of the retirement of the baby boomer generation.
The program not only provides an alternative to retirement by offering different scheduling options, it also serves to create a mentoring environment to transfer knowledge to new nurses. By offering flexible work hours and roles designed to enhance mentorship, Parkview has rehired 21 nurses who retired between 2013 and 2016.
Additionally, as discussed in one roundtable session, organizations must proactively assess and prepare for future openings rather than being reactive to vacant positions.
"We want to look at how we can strategically hire and 'save a seat' for [future nurses]," says Jean Putnam, DNP, RN, MS, CPHQ, executive vice president and network CNO at Community Health Network in Indianapolis. "Our nursing schools have done a great job ramping up the number of graduates in response to the potential nursing shortage."
2. Addressing workplace violence
"Violence is what happens when we don’t know what else to do with our suffering,"— Parker J. Palmer, author, speaker, and activist.
Debra McQuillen, RN, BSN, MAS, vice president and chief operations executive at Scripps Mercy Hospital in San Diego, California, shared this powerful quote during a presentation on how her organization reduced assault with injury cases by 50% from FY18 to FY19.
During a roundtable discussion, Gloria Carter, MSN, RN, CNO at St. Mary Medical Center in Long Beach, California, pointed out that workplace violence often occurs, "Because patients don't have access to places that can make them whole."
Recognizing patients with the potential to become violent and instituting safeguards is something many of the nurse leaders say they are working toward. They agree that leadership must support employees by crafting policies and procedures to keep them safe. In the case of an attack or injury, leadership should connect directly with the employee and offer to listen and help them find resources if necessary.
The HealthLeaders CNO Exchange annually gathers leading hospital and health system CNOs for a custom dialogue on only the critical issues facing the future of nursing. For more information, please email exchange@healthleadersmedia.com.
NICHE program supports healthcare organizations in caring for older adults.
Healthcare organizations hoping to improve care of older adults may benefit from participation in the Nurses Improving Care for Healthsystem Elders (NICHE) program. A recent analysis of the program found it improves older adult care, including fall prevention,patient safety and quality of care, reduction of potentially inappropriate medications, and support of healthcare providers to care for patients with dementia.
The NICHE program at NYU Rory Meyers College of Nursing is a nurse-led education and consultation program designed to help healthcare organizations improve the quality of care for older adults. When member organizations—which include hospitals, long-term care facilities, and other healthcare facilities—join the NICHE program, they gain access to clinical education and resources, guidelines, and nursing practice models designed to improve nurses’ abilities to provide patient- and family-centered care for older adults.
“Nurses are at the forefront of providing care to complex older adults in the United States and many countries around the world,” says Mattia Gilmartin, PhD, RN, FAAN executive director of the NICHE program at NYU Meyers in a news release. “The NICHE program emphasizes education and practice development for front-line clinical staff through leadership training, mentorship, and educational programming, which promotes the role of the clinician as paramount to implementing high-quality care.”
In the new study published in The Gerontologist, the researchers reviewed 27 years of existing research on the NICHE program to better understand how the program influences patient outcomes, nursing professionals, and the work environment. The collective findings represent NICHE program-related evidence across settings involving 12,254 patients and more than 50,000 nurses and other healthcare professionals.
Four thematic categories were identified in the research:
specialized older adult care
the geriatric resource nurse model
work environment
NICHE program adoption and refinement.
The researchers found specialized older adult care resulted in improved quality of care and patient safety, and decreased complications and length of hospital stay. The studies showed how the NICHE program helps member sites improve the care of hospitalized older adults by addressing issues specific to this population including falls, potentially inappropriate medications, catheter-associated urinary tract infections, and dementia symptom management.
Another theme that emerged was the geriatric resource nurse model, which assists nurses in becoming unit-based leaders through continuing education in order to provide specialized care of older adults. Research showed that implementing the geriatric resource nurse model resulted in significant culture changes within organizations and improved nursing knowledge about specific health issues in older adults, including incontinence and sepsis.
To measure the geriatric nurse work environment, studies looked at perceptions of the quality of care, aging-sensitive care delivery, resource availability, institutional values, and capacity for collaboration. Research shows that after implementation of the NICHE program, these factors improve. “In light of the growing needs in the U.S. and around the world, it has never been more important for NICHE and other programs geared toward improving health outcomes for older adults to have strong evidence on how to empower geriatric specialists to provide the best care,” says Catherine D’Amico, PhD, RN, NEA-BC, director of programs and operations at the NICHE program at NYU Meyers and one of the study’s authors.
I will asknurse leaders to share details on the solutions they are using to tackle the nursing profession's biggest challenges.
What's weighing on the minds of nurse leaders around the country? I'll get to find out during the 2019 HealthLeaders CNO Exchange at Ojai Valley Inn in Ojai, California, from November 13–15.
As a moderator of the event's roundtable sessions, I get to hear firsthand what nurse executives see as the most pressing healthcare issues and how they are navigating those challenges.
Below are three questions I look forward to asking that touch on the most-pressing topics that challenge nurse leaders, plus some of the topics that various nurse leaders will present to fellow Exchange participants.
1. As experienced nurses retire, how do you deal with the loss of skill and knowledge they take with them?
I'm looking forward to hearing about some of the new and innovative ways nurse executives have found to fill those knowledge gaps, particularly the presentation by Erin LaCross, DNP, RN, NEA-BC, CENP, chief nursing officer at Parkview Regional Medical Center and Affiliates in Fort Wayne, Indiana, on the organization's Emeritus Nurse program aimed at providing nurses an alternative to retirement through new work options.
I've also been hearing from nurse leaders that it's getting more and more difficult to recruit nurses with experience, particularly in a nursing specialty.
"A consistent story that seems to be emerging is that, the overall numbers look roughly in balance, but there is an imbalance in what employers seem to be wanting and what they are finding in the workforce," David Auerbach, PhD, director, research and costs trends for the Center for Interdisciplinary Health Workforce Studies at Montana State University, said during the webinar. "You have a lot of very experienced baby boomer RNs who are leaving the workforce. Employers [want] to replace that experience but [have] a large pool of new graduates who don't really have what they want."
2. What strategies have been effective in creating a thriving nursing culture?
CNOs want to develop a culture of nursing that allows clinicians to bring excellence to their jobs. I'm eager to hear the details of effective solutions from different organizations that have created thriving nursing cultures.
During our Exchange presentation sessions, Hofler will share her work on organizational culture at Vidant, whileKatie Boston-Leary, MHA, MBA, RN, BSN, CNOR, NEA-BC, chief nursing officer at University of Maryland Prince George’s Hospital Center, University of Maryland Capital Region Health, will discuss her work on systemic civility and nurse empowerment.
3. What care models or nursing roles has your organization implemented to improve clinical outcomes, quality metrics, and financial measurements?
Because of the many changes taking place in the healthcare industry, particularly the move toward value-based care, the need for nurses to deliver patient care in new ways is imperative. How nurse leaders advance nursing practice and patient care delivery forward will depend on how they tackle multiple factors, including new care models and nursing roles, technology, the use of APRNs, and creative quality initiatives.
I'm interested in hearing about new approaches to achieving these goals. How are nurse leaders questioning existing processes and practices to improve nursing practice and outcomes?
For example, Sue Rees, DNP, RN, CPHQ, CENP, CNO–Inpatient at Wisconsin-based UW Health, will discuss how her organization is trying to reduce excess days among its inpatient population.
The conversations will take place November 13–15 at the Ojai Valley Inn in Ojai, California. If you're interested in joining future CNO Exchanges, please email exchange@healthleadersmedia.com.
Three CNOs share how they've successfully tackled common healthcare problems in nursing such as optimizing technology, developing nurse management, and retaining bedside staff.
Nursing is about identifying problems and creating innovative solutions. As a nurse leader, it is essential to think outside the box to effectively tackle the many challenges occurring in today's healthcare industry. When it comes to issues like technology, staff retention, and nurse manager development, the status quo is no longer enough. Nurse leaders must have a vision for the future and the knowledge and skills to implement solutions that will propel the nursing profession forward.
Below is a roundup of stories HealthLeaders has written about three nursing leaders and how they've overcome challenges facing the nursing profession with the following tactics.
Recruiting and retaining bedside nurses with the right skills and work experience is essential to delivering high-quality patient care. But it is no easy task. Nurses with experience, particularly in a specialty, can be hard to find and newly licensed nurses often have their sights set on the next career opportunity.
In fact,Press Ganey's analysis of 250,000 RNs who participated in the 2017 National Database of Nursing Quality Indicators RN Survey found close to 21% of nurses planned to leave their current jobs within one year, including those retiring. When asked about their job plans over the next three years, 26% said they will pursue other options ranging from new positions in an organization to retirement.
Karen Mayer, RN, PhD, MHA, RN, NEA-BC, FACHE, chief nursing officer and vice president of patient care services at Rush Oak Park Hospital, in Oak Park, Illinois, has seen the challenges of nurse recruitment and retention first hand. When she started at the organization, the nurse turnover rate was about 22%, and some departments had vacancy rates as high as 24%, she says. According to the recruitment firm NSI Nursing Solutions, Inc., the average national turnover rate for bedside RNs was 16.8% in 2017.
"When you have bad outcomes, and leadership is beating you up and telling you how bad you are, as a staff nurse—even if you are a great nurse—you feel hopeless because nobody wants to work in an environment where they feel like they're providing bad care," Mayer says. "There were excellent, excellent nurses working here, yet the punitive environment resulted in a lack of respect [toward nurses] by physicians [and] administrators, and from nurse to nurse."
Through dedication and years of hard work, she was able to drop the organization's turnover rate to 8.3%.
Mayer shares how this was achieved through a combination of solutions, interventions, and change in the organizational culture.
More and more, technology is being incorporated into healthcare, especially as virtual care is on the rise. But having more technology does not always mean healthcare leaders are optimizing its use.
As Ronda McKay, DNP, RN, CNS, chief nursing officer and vice president of patient care at Community Hospital in Munster, Indiana, points out, investing in technology means more than just purchasing it. Rather, leaders must understand various technology's capabilities and think about how it can be used to optimize existing processes.
For example, in 2014 when Community Hospital cared for the first person in the U.S with a confirmed case of Middle East Respiratory Syndrome, McKay utilized her organization's technology, including reports generated from the existing EHR, to determine who had been exposed to the patient while inside the hospital.
"I think that you need to prepare for the unpredictable, invest in technology and services for your organization, and invest in education and collaboration of your employees," she says.
McKay shares how nurse leaders can handle intense situations with the help of technology.
Typically, nurses who were good clinicians moved up the ladder to nurse management. However, they did not usually receive extensive training before they started in the role.
Yet, professional development is essential as healthcare becomes increasingly complex and nurse managers play larger roles in improving financial, clinical, and quality outcomes.
"If they don't learn how to be a good leader, and they're just managing the processes, then they [could] set their unit up to create an unhealthy work environment," says Paula McKinney, RN, DNP, NE-BC, vice president, patient services at Woodlawn Hospital in Rochester, Indiana.
In McKinney's study, "Improve Nurse Manager Competency With Experiential Learning," published in the October 2016 issue of Nurse Management, 86% of the respondents said they had no formal leadership development when they first became a nurse manager.
"If you promote someone to nurse manager and [he or she leaves] you within 12 to 18 months, you're losing a great deal of money. It could be up to $100,000," she says. "I think there's some cost savings involved in better preparing them to be leaders and managers instead of letting them be out there on their own to flounder and then they end up leaving the job."
McKinney discusses how experiential learning improved nurse manager job preparedness.
Nurse executives like these will share their ideas and successes in healthcare at the upcoming HealthLeadersCNO Exchange held November 13–15 in Ojai, California. The CNO Exchange is one of six healthcare thought-leadership and networking events that HealthLeaders holds annually. For more information about the HealthLeaders Exchange program, email us at exchange@healthleadersmedia.com.
