Healthcare workers around the country say they are being told not to bring and wear their own personal protective equipment (PPE) in the hospital because it might make people who don’t have it feel bad or even panic. Some are even being told that they will be fired if they wear their own masks. They are also told not to share stories about the dire conditions publicly.
These are people who risk their lives to be there for us. They are working in battlefield conditions. They are terrified not only of getting the deadly disease but also of unknowingly passing it on to their patients or their families.
They don’t have the PPE that they need to keep themselves safe so they are wearing the same gear all day long. And then, they reuse it on the next shift and the next.
Here’s a sampling of their stories:
The American College of Emergency Physicians responds
Finally, I just received a press release from the American College of Emergency Physicians expressing outrage over hospitals retaliating against frontline health workers who are speaking out about the lack of personal protective equipment (PPE). It is worth reading the entire statement. I have highlighted key points:
“The American College of Emergency Physicians (ACEP) is shocked and outraged by the growing reports of employers retaliating against frontline health workers who are trying to ensure they and their colleagues are protected while caring for patients in this pandemic—including an emergency physician in Washington State who was recently terminated after he spoke out about his hospital’s lack of personal protective equipment (PPE).”
William Jaquis, MD, FACEP, president of ACEP, said: “Emergency physicians are prepared to handle virtually anything thrown at us as we seek to treat and heal our patients, however, we should not be forced to put our own lives at risk and have our jobs threatened simply for wearing our own supplied protective equipment.”
The growing outbreaks of the novel coronavirus, COVID-19, have already begun to strain our nation’s emergency departments causing a severe shortage of protective gear for emergency physicians and millions of other frontline health care workers. This dearth of hospital-supplied PPE, like N95 masks and face shields, has led to some buying their own or using donated equipment.”
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“Efforts to silence, penalize or unjustly terminate health workers simply for wearing their own makeshift PPE can have catastrophic consequences for trusted institutions, their staff and the communities they serve. Not only does this type of retribution remove healthy physicians from the frontlines, it encourages others to work in unsafe conditions, increasing their likelihood of getting sick.
“As we combat this pandemic, emergency physicians and other health care workers on the front lines must be appropriately armored for the battle ahead. We need every qualified physician and health care provider we have available and healthy. We are in unchartered waters, and health care workers are doing the best they can to protect ourselves and our communities. Now is not the time to be blindly adhering to outdated or irrelevant policies—lives are on the line,” said Dr. Jaquis.
ACEP will continue to fight for its members and stand in full force behind its statements on PPE and physician protections. PPE guidelines from the Centers for Disease Control and Prevention (CDC) continue to change as conditions evolve. While they should be followed, these guidelines should be considered the bare minimum for allowable protective gear. ACEP is calling on the Trump Administration to use its authority to allow emergency workers to wear their own personal protective equipment (PPE), especially when protection is otherwise unavailable from the hospital.
Each day thousands of emergency physicians work under unthinkable conditions as they bravely battle the public health crisis of our lifetime. We must do everything we can to protect those on the frontline and ensure they have the resources and support they need.”
This sad news is what those who are speaking out are trying to prevent (from a Press Release on April 1, 2020)
“About learning of the passing of an emergency physician from East Orange General Hospital in New Jersey due to symptoms consistent with the novel coronavirus (COVID-19), William Jaquis, MD, FACEP, president of the American College of Emergency Physicians (ACEP) released the following statement:
We are deeply saddened to learn that a former ACEP member and our current colleague on the frontlines—an emergency physician—has lost his fight against this virus. Emergency physicians understand that sometimes in our efforts to save your life, we may end up sacrificing our own. This is not a decision made lightly or a post abandoned in times of need. We know the risks of the job we signed up for, but we are on the frontlines in this historic war against COVID-19 with insufficient protection.
There are dire shortages of personal protective equipment (PPE) in emergency departments across the country, and despite efforts to ramp up production, we do not see significant relief in the near future. America can’t afford for more emergency physicians and other frontline health care providers to get sick or worse due to PPE shortages.
In times of loss, emergency physicians take what’s called ‘the pause,’ a moment shared between health professionals meant to halt the fast pace of emergency medicine and provide a chance to reflect. The pause gives everyone a chance to honor the significance of the day’s work and the solemn responsibility of holding a life in your hands. This is never easy. It is especially difficult when the loss is one of your own, part of your family. Tonight, we pause and invite you to join us.
We recognize that the stress of living and working in this environment is without precedent and can be difficult to manage. This evening at 8 PM EST, while many of you are safe at home, please stand with emergency care teams and take the pause in honor of a life lost on the frontlines. And remember, you can do your part to help emergency physicians by staying home and take the appropriate steps to protect yourself and your loved ones.”
This is an outrage and it needs to stop. Copy and paste this story into a letter to the editor and send it to your local paper together with a personal comment. You don’t want this to happen in your community. And, this should not be happening in our country. Never. Ever.
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COVID-19 ANNOUNCEMENT FROM THE DOCTOR WEIGHS IN:
**We’ve changed the focus of our newsletter to focus on providing daily reliable, usable information to help you deal with the challenges of the #COVID19 Pandemic. Stay safe. Stay informed.**
Nursing is a very rewarding occupation. However, nurses are at high risk of catching viral illnesses, such as colds and flu, because of their continuous exposure to infected patients. These infectious diseases are spread widely throughout our communities. particularly during the winter months.
This year there is an added risk, the novel coronavirus, Covid-19. It is already on the verge of achieving pandemic spread throughout the world despite only being identified in Wuhan, China at the beginning of 2020.
Covid19 appears to spread as easily as flu. But unlike many other viral illnesses, it seems capable of being transmitted by asymptomatic people. This article will not dive into the epidemiology, diagnosis or treatment of any of these viral diseases. Rather we refer you to the CDC.gov website for the latest updates.
That being said, thankfully, there are plenty of simple lifestyle changes that can be made to help people stay healthy during the time frame when viral illnesses are dominating our thoughts.
It can be hard to get enough sleep when you’re working 12-hour shifts and have a home or a family to take care of when you get home, but getting a sufficient amount of sleep is actually essential in staying healthy.
Research has shown that your T-cells are reduced when you are sleep-deprived. This makes it easier for a cold or flu virus to take hold. It also makes it more difficult for your body to fight off these infections if you do get sick.
It even puts you at a higher risk of dying from heart disease in the long run. On average, you should try to get a minimum of 6-7 hours of sleep every night.
In addition to the damage to your immune system, not getting enough sleep can slow down your reaction times and make it harder to care for patients, potentially increasing the risk for contamination, needle sticks, and other injuries.
Studies have shown that not getting enough sleep is the equivalent of a high alcohol level—24 hours without sleep is the equivalent of 0.1% blood alcohol level. While this might not directly result in a doctor or nurse becoming ill, the slowed reaction time could result in an infection.
They say you are what you eat, so eating junk is definitely not a good thing for your immune system. You don’t need to change your entire diet but you can help to improve your immune systems by eating a little better. There are also some foods that help to bolster your immune system. Garlic, for example, has been shown to produce an immune response to strengthen your own immune system.
Peppers have high levels of vitamin C which is essential for a healthy immune system and poultry, specifically chicken soup, can help you recover from illness more quickly. That’s not an old wives tale—hot chicken soup is actually good for you when you’re sick.
We should all be getting more exercise—most professionals recommend at least 30 minutes of cardio every day to keep your heart and body healthy—but did you know that it also has an effect on your immune system?
Exercise helps to strengthen your immune system, as long as you’re not overdoing it. When tested in mice, researchers found that moderate exercise helped to reduce the effects and fatality rate of the flu in the infected mice. Excessive exercise, on the other hand, actually made the effects of the virus worse.
Don’t overdo it, but make sure that you’re getting at least 20-30 minutes of exercise a day. Moderate exercise is important. If you don’t have the time to get to the gym, try to incorporate moderate cardio exercise into your daily routine. Park further away and walk to work, or take the stairs instead of the elevator.
Getting your flu shot might seem like a hassle since you have to get a new one every single year, but it is your first line of defense against the constantly changing flu viruses.
They’re often marketed to the elderly and those with compromised immune systems, but they are also essential for nurses and anyone in the medical field. You don’t want to catch the flu, obviously, but you also don’t want to spread the flu virus to your patients if you do get sick.
If your workplace doesn’t provide flu shots, you can usually get one at your local grocery store pharmacy; the goal is to make them as accessible as possible after all, so they’re not terribly hard to find.
We all wash our hands after we use the restroom or handle raw food. But you should be washing your hands much more often, especially during cold and flu season. It is even more important in the age of coronavirus (COVID19) as there is no vaccine nor curative treatment.
Even if you’re not using antibacterial soap, washing your hands with hot water and soap cuts down on the bacteria and viruses that you can possibly transmit to other people or surfaces.
According to the CDC, washing your hands reduces your risk of catching a respiratory illness like a cold or flu by up to 21%. It is probably true for COVID as well.
Staying home when you’re sick isn’t always an option. This is especially true if you are in a demanding job like nursing.
When it comes down to it, it can be the best way to recover and keep others from getting sick at the same time. When should you stay home?
It’s not always an option, we know, but if you’re truly feeling under the weather, your best option is to stay home.
It doesn’t take much to catch a cold or flu or other viruses, such as the recently circulating novel coronavirus. However, there are plenty of things that you can do to bolster your immune system and make it harder for the infection to get a foothold.
You don’t even have to wait for cold or flu season to start these steps. In fact, we don’t yet know if COVID19 will have a season. So, from a practical point of view, the sooner you start preparing, the sooner you’ll be ready for those inevitable viruses that crop up every single year.
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This post was first published on January 11, 2018. It was reviewed and updated for republication on March 4, 2020.
Medical careers require dedication, a competent attitude, and a lifestyle fashioned around long hours and overnight shifts. The latter can cause both physical and emotional stress. Most healthcare professionals can regularly be found running to their next emergency, managing a busy ward, or tirelessly overseeing bustling outpatient and waiting areas. With today’s fast food options and easy access to processed foods, developing a healthy eating routine can be difficult even in the best of circumstances. For healthcare providers like doctors and nurses, it can seem nearly impossible.
However, with these healthy eating tips and tricks, you can stay on track with your diet and manage your nutrition for a healthy, happy work week at the hospital.
Downtime in the healthcare field is hard to come by and even harder to enjoy. Doctors and nurses don’t often receive long meal breaks, if at all. And, they are understandably exhausted from long shifts. Most healthcare providers work inconsistent schedules, alternating day and night shifts. This disrupts the circadian rhythm, which can cause headaches, gastrointestinal issues, fatigue, and other problems.
Because mealtimes are often irregular, busy schedules can lead to snacking on quick processed foods like chips or unhealthy fast foods. Consuming these high-calorie low-nutrition meals can lead to a bevy of health issues down the road, including weight gain, fatigue, and heart health issues.
Irregular schedules also lead to missed meals. When we skip meals, our blood glucose levels drop. Skipping meals can cause tiredness, irritability and force the body to convert energy from less efficient sources. This equates to difficulty in thinking clearly and dizziness, which can impair performance and working ability. Skipping meals also leads to overeating when you do finally find time for a meal.
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Staying hydrated is an essential part of overall nutrition for everyone, but, for individuals with high-intensity work shifts, it is even more critical. Keeping your body hydrated helps to decrease the likelihood of headaches and diminish fatigue, as well as improve digestion, circulation, and body temperature.
Drinking water also helps us to feel fuller for longer, which means you are less likely to reach for snacks when you are well-hydrated. Always aim for the recommended eight 8-oz. glasses of water every day. You can easily monitor your water intake by packing a reusable water bottle for work.
Pro Tip: Add slices of cucumber, lemon, mint, or other fruits and berries to your water bottle to infuse it with a refreshing taste.
Many of us fall into the trap of reaching for sugary and caffeinated drinks when we need a boost of energy to get through a long shift, but caffeine might be sabotaging your efforts. While coffee is a natural stimulant that will increase your alertness and ability to concentrate in the short term, it also has long-term addictive qualities that can lead to caffeine dependency, nervousness, restlessness, muscle tremors, increased heart rate, upset stomach, and even insomnia.
Caffeine addiction is a vicious circle: The more tired you are, the more you drink, and the more you drink, the more incapable you become of getting a good night’s sleep and the more reliant you become on the effects of caffeine. As an alternative, reach for water instead. Or, if you are partial to the taste of coffee and tea, insist on the decaffeinated varieties. Green tea is an excellent option because it is low in caffeine and contains an amino acid called theanine which is said to improve mental alertness.
Pro Tip: If you do continue to consume caffeinated drinks, try to limit them to the first half of your shift, so the effects of the caffeine wear off before you go home and sleep.
No matter what shifts you are working, make sure to maintain a regular eating schedule. Even if your “morning” is at 3 p.m. when you wake up, make sure to have “breakfast” and base the timing of your following meals and snacks off this first meal. Aim to eat your meals every four to five hours with small snacks in between.
Pro Tip: Remember, eating regular, small amounts of food is better for maintaining a healthy weight then eating one large meal to get all of your nutrition and calories, as this often leads to overeating and weight gain.
When we think of the word “diet,” we conjure up images of people unhappily restricting themselves to small amounts of tasteless and unenjoyable foods. What “diet” really refers to is our pattern of food consumption.
Eating a healthy diet does not mean you restrict yourself entirely. Instead, you seek to maintain a balanced eating routine that includes items from all the basic food groups to ensure your body is getting the daily nutrients it requires.
Doing so is rare when your food sources are limited to take-away and the hospital vending machine. Eating healthfully does not mean eating bland foods; it means you make informed (but still delicious!) choices when it comes to your foods. Make sure meal times include some form of protein like eggs, grilled chicken, beef, or Greek yogurt. Vegetarians should look for sources of protein from the vegetable kingdom, such as tofu or nuts or the many new plant-based products, such as Beyond Meat coming to supermarkets these days. Protein helps you to feel fuller for longer and provides the body with much-needed energy during busy shifts.
Vegetables and greens provide essential vitamins and minerals that enable the immune system and metabolism to function correctly and prevent deficiencies, such as anemia. At each meal, aim to have vegetables taking up at least one half of your plate, with the other half divided between protein and carbohydrate sources. You can easily ensure your nutrition is en pointe by taking the time on your off days to meal prep for the week.
Pro Tip: For healthy snacks between meals, pack protein-heavy items such as nuts, healthy protein bars (check the label for calories and sugar), and yogurts that will make you feel full and provide much-needed energy. But remember, snacks cannot and should not replace full meals.
Developing a healthy eating routine takes a little bit of preparation and dedication. With a little bit of will power and commitment to your new healthy lifestyle, you’ll notice you feel more energized and capable, and that your favorite pair of scrubs fit a little bit better than they used to. Use these essential nutrition tips and tricks to take charge of your nutrition and invest in a healthier, stronger you today.
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Once upon a time finding the right candidate for an open position in healthcare meant placing an ad in a newspaper or medical journal. It involved paper applications and in-person interviews. Credential and reference checks were done by mail or telephone. It was a time-consuming and expensive process.
Luckily, that has all changed. Healthcare recruiting, is now largely driven by technology. That’s good because it is critically important for organizations to build strong healthcare teams and hire outstanding healthcare professionals. Recruiting professionals must be skilled in HR basics but also have a high level of engagement, emotional intelligence, and other soft skills. Because of this, it is imperative that hiring personnel are well-versed in technology-based recruiting tools that are designed to help them succeed in the digital age.
Healthcare staffing shortages can be critical to the success of any healthcare system. It doesn’t matter if you work at a large academic institution with thousands of employees or a critical access hospital. Not having enough doctors, nurses, respiratory therapists, or patient care assistants can be devastating.
The importance of recruiting in healthcare goes far beyond filling staff vacancies. As experts predict that the physician shortage will peak at around 122,000 physicians by 2032. More institutions are looking to fill their openings, often strategizing innovative ways to retain staff members into the future.
Physicians aren’t the only ones short in numbers. Nursing has been experiencing a shortage for several years. And is projected to peak by 2030 as more baby boomers enter retirement. Experts and lawmakers have turned to advanced practice nurses to fill the physician shortage. But with the current state of affairs, nursing is struggling to recruit and retain skilled employees.
You may feel that effective recruiting is paramount due to the lack of qualified applicants or the dire consequences of having open positions. However, it’s clear that healthcare institutions must look to cutting-edge technology when finding new clinical and technical staff members. This also means that candidates need to have a good understanding of how these recruiting practices can impact their ability to get hired.
For human resources (HR) and other recruitment professionals, cloud computing has become a way of life for finding top healthcare professionals. Some of the best medical facilities are using cloud technology to access data on demand without the need for on-site storage. This means they can access applicant information anytime and from anywhere.
Not only do human resource departments take their operations to the cloud to store information about candidates, but they can also post positions from one portal that can touch multiple platforms to reach both active and passive talent pools. This increases the likelihood of finding the right person for the job.
This is true even if that professional is not actively searching for a new position at the time. Therefore, if a recruiter contacts you via LinkedIn or another platform, you might want to respond and learn what the opportunity is all about. Your skills may be a good fit for the job they’re trying to fill.
Creating a well-written job description is the first step in recruiting and hiring the right healthcare professional for the job. HR departments outline the scope of work in detail so that the applicant knows whether or not they can fulfill the role duties and responsibilities. Technology can help to create engaging descriptions of open positions whether they are for front-line clinicians, support staff, executive level management, or healthcare consultants.
Some tech platforms can even analyze job descriptions to find a potentially biased language. It can then suggest alternatives to the recruiters. Other platforms might work with job postings to optimize the job description and the career pages for search engines. Once the recruiter uploads the information to the platform, it can provide a list of possible keywords so that job seekers can know if they’re a qualified applicant.
It seems everyone is active on multiple social media channels these days. If you’re looking for a new position and you’re coming up empty-handed, consider searching social media sites for employer pages. This is an excellent method employed by large and small healthcare facilities who want to use social media to recruit and hire. Look for videos of current staff sharing testimonials about their job and the company culture. You might also be able to find the name of the HR staff or recruiter so that you can contact them directly to find out what positions they have open.
Artificial intelligence (AI) is used in healthcare to treat patients. However, recruiters and human resources staff have also turned to AI to improve candidate sourcing. Instead of spending hours manually screening resumes and searching for new platforms, the HR team can find a large applicant pool in no time, especially for high-volume positions.
Some tech tools can even predict if candidates will fit into the company culture by using analytics and machine learning techniques to project your success in their workforce. The use of AI means that the HR staff spends less time search through profiles and resumes. But it also means a better hiring experience. AI can decrease the number of days it takes to fill a position. And it gives the hiring team more time in the day to build relationships with qualified candidates.
Once a job seeker has been identified as a qualified candidate, they have to start the tedious and anxiety-inducing task of interviewing. This might mean scheduling and rescheduling appointments, traveling to the potential employer, and multiple hours in face-to-face interviews.
However, technology can automate your interview scheduling and allow you to choose the best time slot from the beginning. Job seekers might also be invited to use digital video technology to conduct the interview when it’s most convenient for them. This technology uses a set of pre-arranged questions while recording the video on a cloud-based application. The HR staff and other hiring team members can review your video when they have time and get back to you with the next steps.
If you’re not located in the same state or country as your potential employer, you may also be asked to conduct an interview over a live video platform. This speeds up the process and minimizes the cost and time spent flying you to the facility until both you and the hiring managers know that you might be the best fit for the job.
Filling vacant roles from the top of the healthcare staffing continuum to the bottom is challenging. By using cutting-edge tech, HR departments decrease dollars spent and minimize the number of days positions go unfilled. And, it might even find out if a potential top performer is a toxic employee before they’re even hired.
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Medical science has always embraced advancing technology. And, it continues to do so today, changing nursing practice in ways that would have been unimaginable in the past.
Here are just a few of the ways that technology is being used in nursing:
It is no wonder that new technologies are guiding more and more of what we do.
Good nursing practice is based on the provision of timely, evidence-based care including for monitoring, diagnosis, and treatment. This ensures the best possible patient outcomes and experience.
It is important to note, however, that the way this nursing care is actually delivered evolves with advances in technology. Technological advances and resultant changes in day-to-day nursing practice are happening faster than ever, bringing benefits (and occasional problems) to everyone.
This is the information age and there is a lot of it out there. Medical knowledge is no longer the arcane dominion of the professional few.
Everyone now has the ability to easily access information about symptoms, conditions, and medications, and other treatments. There is, in fact, an overwhelming amount of medical information on the Internet.
Nurses with direct patient contact, therefore, have an important new aspect to their role. That is to empower patients to locate and learn from reliable, credible sources.[mfn]Finding Credible Medical Information Online. OpenMD. https://openmd.com/guide/finding-credible-medical-sources[/mfn]
Many healthcare professionals are finding that their patients know more than ever about their medical conditions. It is expected that this will continue to increase over time as access to medical information becomes easier and easier.
Many clinicians have found that it can be a very positive experience to work with informed patients and families. This is because it leads to a more equal professional-patient relationship and a more cohesive approach to care and treatment.
Advances in technology are already enabling real-time, remote monitoring and investigations. Here are some examples:
Tracking activity and vital signs has become a part of everyday life for many people. One measure of its popularity is the fact that manufacturers of wearable activity and heart rate trackers. These include Apple, Samsung, and Fitbit, who are reporting huge profits. Fitbit alone has sold more than 76 million devices.[mfn]https://www.statista.com/statistics/472591/fitbit-devices-sold/[/mfn]
Many of the blood tests traditionally processed in labs can now yield almost instant results with just a finger prick at home. For example, in addition to well-known home tests such as blood glucose and pregnancy tests, people can also do home-testing for cholesterol, prothrombin time for blood thinning, hepatitis C, and some drug tests.
The use of these technologies can influence individual diagnoses and treatment plans. It can also show trends and collect demographic data on a scale greater than ever before.
Remote diagnostic tools mean less time in clinics because results clinicians have ready access to results from these monitors. They can then respond to them via virtual consultations by telephone or online.[mfn]Powell, J. et al. (2009) ‘Pilot study of a virtual diabetes clinic: satisfaction and usability’, Journal of Telemedicine and Telecare, 15(3), pp. 150–152. doi: 10.1258/jtt.2009.003014.[/mfn]
Remote healthcare will never replace the need for an acute hospital setting. However, with quicker diagnosis and treatment in the community, a reduction in unplanned admissions to hospitals can be expected.
Electronic clinical observations have been rolled out on a massive scale in hospitals around the world. These can take the form of individual patient monitors, which record and store all data that was traditionally recorded on paper. These include regular blood pressure readings, heart rate, respiration rate, and temperature. This data can be accessed by remote hand-held devices carried by the healthcare team.
With built-in protocols for alerting members of the team when results are out of a set range, the right people can converge on a sick patient in seconds.[mfn]Peters M, Moore P (2018) Using quality improvement methodology to implement an electronic pediatric early warning system (PEWS) across Great Ormond Street Children’s Hospital (GOSH) Archives of Disease in Childhood[/mfn] This technology also allows clinicians to prioritize their workload and request assistance from specific services at the push of a button or the tap of a screen.
The use of remote patient monitoring devices in hospitals can mean getting the right help for your patients without even leaving their side.
Patient safety is always top priority for nurses.
Electronics devices have long been used to improve patient safety. These range from chair sensors to alert staff when a confused or unsteady patient has stood up to wristband barcode scanners to ensure the right medications get to the right patient.
The World Health Organization has long championed the use of emergent technology to improve patient safety [mfn]https://www.who.int/patientsafety/en/brochure_final.pdf[/mfn] For example, electronic reporting of incidents aids in the understanding and prevention both at a local and global demographic level. One study found a 250% decrease in drug errors following the implementation of electronic incident reporting in one hospital.
As always, with such a paradigm shift we are met with bumps along the way. Further, much of the technology we’re using is still in its infancy.
With remote and mobile healthcare, we have a huge increase in the amount of cloud-based and remote data storage of sensitive patient information that is, by necessity, identifiable, accessible, and retrospective.[mfn]Dixon J. F. Going Paperless with Custom-Built Web-based Patient Occurrence Reporting. Joint Commission Journal on Quality Improvement. https://www.ncbi.nlm.nih.gov/pubmed/12101550[/mfn]
Legislation exists across the EU[mfn] Health and Social Care, Information Commissioners Office, UK https://ico.org.uk/for-organisations/in-your-sector/health/[/mfn] and US[mfn]Health Information Privacy, U.S. Department of Health & Human Services https://www.hhs.gov/hipaa/index.html[/mfn] in particular, that aims to govern the use of medical records. Governing in a way that balances privacy concerns with the sharing of information necessary to prove high-quality care. A robust system for informing patients and gaining consent for any projected use of their information is essential.
As the public becomes more aware of the cybersecurity and privacy issues faced by organizations that hold large amounts of valuable data, the use of this data will be informed by evolving ethical standards.
We are undoubtedly in the middle of a technological revolution, nowhere so much as in medicine and nursing. But medical technology is only a tool to make patient care more efficient and effective, to improve safety and speed.
Robots are not going to replace nurses anytime soon.
One potential benefit of new technologies is that they may eventually free up nursing time for more traditional care and patient-centered activity.
Whatever happens, one thing is clear. Technology is poised to change nursing practice into something that would have been unrecognizable by our predecessors.
 Peters M, Moore P (2018) Using quality improvement methodology to implement an electronic paediatric early warning system (PEWS) Across great Ormond Street children’s hospital (GOSH) Archives of Disease in Childhood
 Health and Social Care, Information Commissioners Office, UK https://ico.org.uk/for-organisations/in-your-sector/health/
If your nursing units don’t function well together, it not only makes work frustrating for your nurses, it can literally affect patient outcomes for the worst.
Cultivating a strong nursing team takes a lot of time and effort. However, it pays dividends down the line.
Rome wasn’t built in a day and neither were good nursing relationships. It takes time to figure out the personalities of all your teammates and to establish rapport.
Trying to artificially rush things can make your working relationships incredibly awkward. It can even backfire altogether. (HINT: there’s a reason people hate icebreaker games so much).
Start small, such as grabbing lunch or coffee with a couple of coworkers. Then, build the relationships from there.
Whether it’s a marriage or a nursing unit, good communication is the foundation of any solid and successful team. Whether it’s written or verbal, always strive to be clear and understandable as you communicate with your coworkers. Encourage them to reach out for clarification if needed. Be sure to demonstrate your willingness to answer legitimate questions.
It can be tricky to hit the balance between these two important attributes. On one hand, you want your nurses to feel comfortable discussing important topics, such as unfair workplace treatment or difficult patients. This will help you to craft solutions together.
On the other hand, however, you don’t want the culture to be so open that gossip quickly spreads. This will undermine trust and make people feel like they can’t say anything if they don’t want the entire hospital to know.
If you’re a nurse manager, your nurses will look to you to set the tone for the unit. So do your best to be candid with your staff (when appropriate). And don’t perpetuate gossip no matter how tempting it might be.
If it’s everyone’s responsibility, then it’s really no one’s. Either the task won’t get done because everyone thinks someone else is doing it or the same few overachievers will end up picking up the slack, eventually burning out from all the extra work and maybe even hanging up their scrubs for good as a result.
To avoid this scenario, make sure that roles are clearly defined and that each person knows what their job is and how to do it. Again, it all goes back to clear communication: Broadcasting expectations for roles keeps nurses from having to guess what their job is or what their supervisors want.
Dealing with conflicts can be messy, dramatic and emotionally exhausting. Sometimes, it feels easier to just sweep things under the rug rather than address the dispute head-on.
But ignoring conflicts will just set you up for even bigger arguments in the future. And lead to festering tensions that can impair the quality of nurses’ work. If you have an issue with a coworker, try to address it with them directly rather than involving a supervisor, at least at first.
If you are the supervisor, encourage your employees to stand up for themselves and talk things out in a measured, adult way. However, do let them know you’re willing to act as a third-party mediator if they can’t resolve the conflict on their own.
Whether it’s large or small, every single nurse is going to make a mistake at some point in their career. Rather than punishing or shaming them for their slip-up, seek to understand why it happened. More importantly, seek to find ways that your team can avoid repeating the error in the future.
Practice empathy and put yourself in their nursing shoes. How many errors have you made during your nursing career? Every mistake is a potential teachable moment. Remember, nurses won’t improve unless they have someone to gently point out where they went wrong and show them the right way to do things.
Oftentimes in teams, people clamber to take credit for a successful project. Or they point fingers at everyone else when something goes wrong. Rarely, however, is only one person responsible for either the credit or blame when it comes to working in teams. Of course, the same is true when the team is a nursing unit.
Show your team this in action by sharing in both their triumphs and failures. Don’t throw anyone under the bus when something goes wrong. After all, they are probably looking to you to see how they should act.
Every nurse, yourself included, cannot deliver 100 percent perfection 100 percent of the time. Mistakes will be made. Life gets in the way and people can’t stick to agreements they previously made.
Encourage your team to be upfront when this happens to them. The sooner people know what’s happening, the sooner they can make a contingency plan.
Yes, it’s uncomfortable when you can’t come through as you promised. But it happens to everyone and delaying the inevitable will only make things worse.
People know when they’re being complimented for something that wasn’t actually a big deal. And they definitely know when they’re not being recognized for a hard job well done.
Recognize your nurses when they truly go above and beyond, whether that’s just a heartfelt “thank you” or handing out fun awards to people in your unit. Keep in mind that this recognition may look different for each person. Some people love being applauded in front of the whole team, while others prefer to receive a nice card with little fanfare.
Building a strong nursing team takes a lot of work, but it’s far from impossible. Follow these nine tips to make sure your nursing unit is working together to reach its full potential.
Stress is a fact of life for many of us in today’s high-stress and performance-based society. However, high-stress levels permeate healthcare and nursing professions perhaps more than any other work environment.
Stress is how the body responds under high-intensity situations, which activate the fight or flight response.
Nurses are responsible for the lives of their patients. This means they work in a consistently high-stakes environment, which leads to high levels of stress.
When nurses succumb to stress, not only does it affect their well-being but also their ability to care for their patients. Because of this, it is important that nurses working in the ER or other high-pressure situations are familiar with methods and techniques for dealing with stress.
Signs of stress are exhibited differently by everyone, but some of the most common symptoms of stress for nurses include anxiety, mood swings, loss of appetite, and difficulty sleeping.
Stress can also manifest in physical ailments, including
The longer a person feels overwhelmed by stress, the worse it becomes, and some nurses can even become mentally and physically burnt out if stress is not dealt with once the symptoms have been recognized.
Unfortunately, stress is a natural part of life, and there is no way to avoid it entirely. However, it is possible to manage stress levels so that it does not take over your life. The following techniques and tricks can help nurses feel less stressed in the workplace:
Though it may seem redundant, one of the most effective stress relief techniques is to simply pause and take deep breaths. Deep, slow, and easy breathing can be performed anywhere at any time.
When you feel overwhelmed, take a deep breath in through the nostrils for four seconds, hold for five seconds, and then breathe out through the mouth for five seconds. Deep breathing releases endorphins into the bloodstream, which can help you feel calmer.
What you eat and how often you eat can affect your stress levels. Some nurses have such a large workload that they skip meals. This can make your body more susceptible to stress.
Eating a healthy combination of fruits and vegetables, as well as staying hydrated, can assist in reducing stress levels.
You may also want to limit your intake of white carbohydrates, fried foods, and unnatural sugars, as these can make you feel sluggish and tired, which will intensify your levels of stress.
Make sure you are getting eight hours of sleep per night. Stress can lead to a lack of sleep, which causes more stress. Set a time to turn off all electronics and go to bed and a time to wake up and stick to a schedule.
One symptom of stress is a loss of humor and, when you are feeling stressed, the last thing you probably want is to be told is to laugh. However, laughter can make you feel better immediately by releasing feel-good endorphins into the bloodstream.
Whether you feel like it or not, putting some comedy on and laughing until your stomach hurts is a great way to relieve stress.
Your thoughts control your emotions. Try to be aware of when you start to feel the emotions related to stress and change your mindset to think of something positive. This will boost your mood and help to reduce stress levels.
Due to the shortage of nurses working today, they are often overworked, and this in itself causes stress. On days you are given a long to-do list, try to focus on one thing at a time. Break each task down into a manageable, step-by-step process. Move on to the next step only after completing the one that comes before it.
Research has found that being outside in nature can have a positive effect on your mental health. It relieves stress, lowers blood pressure, and intensifies feelings of well-being.
A messy work environment can increase stress levels. Always keep your work area neat and tidy. If things start to get messy throughout the day, take a minute to straighten things out.
It is best to tidy your desk at the end of the day so you do not walk into a messy environment first thing in the morning. Always start off the day in an orderly, calming environment.
Be prepared for the day of work ahead. The night before, lay out your favorite pair of scrubs, tools, and everything you might need for a successful day at work.
Hospitals have a very specific, unpleasant smell that nurses are exposed to daily. The smell of essential oils, on the other hand, is uplifting and purifying.
Pour a few drops of lavender, sandalwood, lemon, tangerine, or rose oil onto a handkerchief and smell it as you go throughout your day. Another option is to pour the essential oil of your choice into a diffuser and inhale it at home.
No matter how much work you have left to do, always make sure you take breaks throughout the day to recharge.
Taking a break doesn’t mean having a cup of coffee over paperwork
Leave everything behind, and relax and unwind for the full duration of your break. You will return to work feeling refreshed and re-energized.
You might find it useful to take a warm bath for an hour, spend time with friends and family, or listen to music to relax after a long day at work. Incorporate whatever method makes you feel the most relaxed into a daily routine. It is important to invest in what makes you feel good during your downtime.
Several studies have found that exercise is a powerful stress reliever. Intense physical activity releases endorphins into the bloodstream, which is why healthcare professionals recommend at least 30 minutes of exercise per day.
Nurses tend to build up concerns due to the emotional demands and requirements placed upon them. A mentor is someone you can speak to during these tough times who can offer advice based on their own experiences.
If you are still feeling overwhelmed because of your nursing job, you might need to seek professional help. Stress built up over the long term can cause health problems such as heart disease, high blood pressure, personality disorders, anxiety, or depression. It is best to take the time to invest in your mental health and mitigate these issues before they develop.
There is a nursing shortage with no end in sight. As a result, nurses are becoming some of the most sought-after professionals in today’s job market, according to The American Association of Nursing Colleges.
Many people get into the nursing field because they want to make a difference. However, sometimes the careers we choose don’t always pan out the way we think they will.
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Other times, it’s just easy to get burnt out on doing the same things day after day. While the daily tasks of a nurse may change, as will the patients they see, they can still feel a desire for a career change.
Depending on the type of nurse you are, maybe you’re hesitant to change directions. Some nurses go through quite a bit of schooling. They may be wondering “would those years of education be a waste”? Absolutely not!
In any career, the decision to make a change is a personal one. Whether it has to do with your overall happiness, money, or scheduling. Everyone has their own specific reasons for wanting to try something different.
If you’re a nurse and just don’t feel as though your job is right for you anymore, it might be
time to discover a different path.
The 2018 National Healthcare Retention and Staffing Report found the rate of turnover for bedside nurses in was 16.8% in 2017, up 2% since the prior year. A quarter of hospitals in the study reported a vacancy rate exceeding 10%. Recruiting nurses for these positions is both costly and time-consuming.
Despite the need for clinical nurses, it is reassuring to know that there are also many non-clinical nursing jobs available that if bedside nursing is not your cup of tea.
Non-clinical jobs are perfect for:
First of all, it’s okay to be a clinical nurse and not like blood. As long as you have a passion for providing care to others, there are options for you.
Because of the great demand in the healthcare industry, thanks in large part to the aging baby boomer generation, there is an ever-growing need for nurses for all sorts of jobs.
Non-clinical nursing jobs may be the perfect compromise for introverted individuals. Hospital environments can be overwhelming and they require constant interaction between other nurses, doctors, and patients. With multiple health professionals caring for patients in clinical settings, communication is vital to ensure things are done right.
Maybe it’s the long, odd hours of traditional clinical nursing that concern you. Maybe you are fed up with working nights, weekends and holidays.
Or, maybe you just prefer working individually at your own pace. Some non-clinical nursing jobs allow you to set your own hours and work independently.
Whether you are simply looking for a slight change of pace, or you are looking to explore your entrepreneurial nursing options, there is a myriad of non-traditional nursing jobs to explore. Here are some:
If you don’t want to give up your nursing skills or don’t want to stop taking care of people, but you need a less-hectic pace, consider making house calls. There are multiple agencies you can work with to make house calls. They deal with homebound patients that often require special care or a certain number of hours by a healthcare professional.
Once you’ve received training in a traditional nursing position, you may be able to find telehealth positions that allow you to work from the comfort of your own home!
You might also be eligible to work for places that provide in-home care for elders or sick children, where you can help improve their quality of life and ease the stress on their families at the same time.
As an RN case manager, you would be responsible for organizing and managing all aspects of your patient’s care throughout the stages of their hospital experience. This means using the nursing process to access, implement, and utilize the resources at your disposal to ensure the quality of care.
As a patient’s case manager, not only would you would work closely with the patient and their family, you would also be collaborating with the physician and health care institution, as well as social workers. This is especially needed if a patient is expected to have a lengthy stay in the hospital. A case manager is an integral part of the modern hospital system.
If you’re passionate about helping people, but you don’t want a hectic, difficult work schedule, consider getting a job in the research field. As a clinical analyst, you can use your nursing know-how to evaluate data, gather information and research technology to help improve healthcare in many different sectors.
Selling medical devices is another non-clinical career option for nurses. It’s a complex industry, requiring substantial knowledge of healthcare and technology. Typically, careers in medical device sales are highly lucrative and rewarding – with significant opportunities for advancement.
Medical sales professionals often work directly with operating room personnel, selling new surgical products and demonstrating their use to surgeons, nurses, and technicians. Requirements for medical device sales positions may include a bachelor’s degree; some employers prefer previous sales experience.
Nurses with years of clinical experience have amassed a tremendous body of knowledge, and many find it rewarding to share it with nursing students.
If you want some variety in your career, consider getting a job as a healthcare educator. Even if you’re still practicing, you can spend your nights teaching other healthcare pros. This also helps to keep your nursing skills updated because you’ll have to stay up on the latest trends, research, and technology.
If you think your skills might be better suited for administrative work, consider becoming a medical secretary. A medical secretary does much more than answer phone calls.
They must have specific medical knowledge that can offer support to a healthcare team, and patients. This includes managing medical charts. If you’ve had experience in nursing, you many of the qualifications necessary to be outstanding in this position.
If you want to look into a more specialized career in healthcare, consider becoming a surgical technologist. You’ll be responsible for preparing operating rooms and assisting surgeons. It allows you to remain in a hospital atmosphere, but work in a department that more condensed and focused on one particular thing.
There is a huge market for health topics on the Internet. If you’re a nurse with years of experience, your expertise and opinion can turn into a lucrative career for healthcare blogs, medical websites, etc.
Healthcare recruiters generally work for hospitals or healthcare companies, or for general staffing or recruiting firms. They may be also be employed by nurse or physician staffing firms, which place doctors and nurses in temporary or contract positions.
Healthcare recruiters search out qualified candidates, then prequalify and move them toward the hiring process.
Because it involves a great deal of verbal and written communications, healthcare recruiting is a great fit for nurses with these abilities, as well as strong interpersonal skills.
Self-motivation is also vital for a successful career as a healthcare recruiter, as many recruiting firms offer performance commissions or bonuses along with a base salary.
Healthcare organizations such as hospitals, drug companies, and labs may bring in a nursing consultant to help address issues such as marketing plans, internal organization, quality assessment, or finance. Healthcare consultants research and analyze a company’s finances to find their strengths and weaknesses.
Once a nursing consultant has identified these, they can propose solutions to streamline economic processes. Because healthcare consultants are chiefly concerned with the business side of healthcare, their skill set tends to have plenty in common with what’s needed to succeed in business.
It is time to celebrate the versatility of nurses. The days where nurses were limited to jobs in patient care are long gone. There are plenty of alternative careers for nurses to put their skills to good use outside the hospital walls.
The healthcare industry continues to grow and thrive. It’s showing zero signs of slowing down in the near future, so there should always be a job available in your area of interest.
No matter the role you have, you can still help to improve the quality of someone’s life – or, even save it!
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On Saturday, the 5th of November, 2011, my life fell apart when my only son Tyler left this world. Nursing errors led to his unexpected death.
One week before, on the morning of October 28, I received a phone call that no mother ever wants to receive. I was asked to go immediately to the hospital. And when I arrived, I was told that Tyler was found unresponsive and had suffered two cardiac arrests. I never got to speak to Tyler again.
Those days will forever be etched in my memory. While my heart will always ache from the loss of Tyler, I am telling his story in the hope that it will help prevent similar tragedies and that no parent will have to endure the pain of losing their child to nursing errors and unmonitored use of patient-controlled analgesia (PCA) pumps.
In October 2011, Tyler’s lung collapsed for the second time that year. A collapsed lung occurs when air or gas leaks into the pleural space that separates the lung from the chest wall, and which may interfere with normal breathing.
The first time it happened, he was hospitalized, had a drain inserted, and that fixed the problem. The doctors, who performed this procedure, said that as Tyler was tall, young, slim, and male, it could happen again as his body type can be prone to this condition.
Unfortunately, it did happen again. However, this time, Tyler was not in as much pain and knew the signs of a collapsed lung. A visit to the local emergency department confirmed that he indeed had suffered another lung collapse.
After an overnight stay, the doctors said that Tyler would probably again suffer from this condition. So, they advised a procedure to prevent this from continually happening. This procedure, called pleurodesis, is a common procedure that permanently obliterates the pleural space and attaches the lung to the chest wall, thus preventing the reoccurrence of a lung collapsing.
The operation took place on the 26th of October. After the successful operation, Tyler was being cared for in the high dependency unit. That unit is where patients can be cared for more extensively than in a normal ward, but not to the same extent as that in the intensive care unit.
In order to manage the pain from the operation, Tyler was placed on a patient-controlled analgesia (PCA) pump. A PCA pump delivers the amount of opioids prescribed by the doctor—no more or less. I was told PCA would allow Tyler to obtain relief when he felt that he needed it. In Tyler’s case, it was morphine, a narcotic pain reliever commonly used to treat moderate to severe pain.
Tyler was doing so well that the very next day (the 27th of October), he was transferred to the general floor of the hospital and it was here that the nightmare began to unfold which led to the worse tragedy.
The very next morning, Tyler was found unresponsive and suffered two cardiac arrests.
How could such an event have happened? Aside from the collapsed lung, Tyler was young and in excellent health.
I understand that death from a collapsed lung is extremely rare. Researchers say the annual mortality rate is 1.26 and 0.62 deaths per million person-years in men and women, respectively. Yet, the coroner declared Tyler died from “natural causes” and “sudden adult death syndrome” (SADS).
According to Cardiac Risk in the Young, SADS can be described in these words:
“After an unexpected sudden death, it is usual that the coroner of the area, where the death has happened, will ask for a post-mortem to be performed. This involves the body being examined by a pathologist. Small samples of tissue from organs including the heart are often taken and examined under a microscope. Usually, the pathologist can easily detect any abnormality like significant coronary artery disease (furring of the arteries) or pulmonary embolus (a clot on the lung). The coroner will take into account the circumstances of the death and, if necessary, will do tests for signs of any medications, or drugs in the body. If it is difficult to assess the heart or to detect any abnormality in it, the pathologist may ask for the help of an expert cardiac pathologist (one who specializes in the heart) to determine the cause of death.”
None of this fits and explains what happened to Tyler; nor did the coroner describe it in this way. I feel that this is an absolute insult to Tyler and that he has been let down by our healthcare system. Why do I say this?
The hospital has made a “partial admission” that the nurses failed to care for Tyler in the correct way. The nurse that was caring for Tyler the night of October 26 and into the morning of October 27 was not adequately trained to care for a patient using a PCA. She had only completed half of the required one-day training.
Moreover, an internal investigation has shown that this nurse did not check on Tyler since 9 PM that night nor did she check on him two more times as she was required to do after that. However, the nurse did notice that Tyler was speaking on his cellular phone at midnight.
Tyler’s girlfriend has confirmed that it was with her that he was speaking, but that Tyler seemed confused and disoriented. The nurse also noticed that when Tyler fell asleep, he snored so loudly that the other patient in his room complained of the noise. I have since learned that what this nurse clearly missed was the onset of opioid-induced respiratory depression.
Tyler had never before received opioids in his life, and The Joint Commission (the hospital accreditation body in the United States) recommends taking “extra precautions with patients who are new to opioids or who are being restarted on opioids.” His dosage of morphine had just been increased and, surely, that would have been a change in treatment that would have required her taking extra precautions.
Additionally, patients who receive opioids are particularly vulnerable when they sleep because health experts say that “the protective wake mechanism for airway support and respiratory drive is absent.” This placed Tyler particularly at risk when he fell asleep after midnight.
Although Tyler’s snoring was bothering his roommate, it was also a sign that he might have had obstructive sleep apnea, which occurs when breathing is interrupted by a physical block to airflow despite the patient’s attempt to breathe, and snoring is a common symptom.
There were also obvious signs overnight that Tyler was suffering from respiratory depression but nothing was done.
Moreover, I now know that there exist electronic monitors that would have alerted Tyler’s nurse and other caregivers to his declining respiratory state.
The Anesthesia Patient Safety Foundation (APSF) was established by the American Society of Anesthesiologists to “improve continually the safety of patients during anesthesia.” APSF’s president, Robert Stoelting, MD states:
APSF recommends that monitoring be continuous and not intermittent, and that continuous electronic monitoring with both pulse oximetry for oxygenation and capnography for the adequacy of ventilation be considered for all patients.
Pulse oximetry monitoring would have determined that the oxygen saturation of his blood was declining. Capnography monitoring would have measured that the carbon dioxide level in his blood was rising. Both signs of impending respiratory depression.
I fully believe that if Tyler had not been on morphine or using a PCA that he would be here with me now.
If Tyler’s nurse had received complete training on PCA, perhaps he would be alive today.
Had Tyler’s nurse checked on him as she should have between 9 PM that night and the following morning, he might still be alive.
However, even though she didn’t check on Tyler, had he been monitored continuously with oximetry and capnography, as the APSF recommends, this nurse would have been alerted to his declining state and might have saved him.
I do not believe that Tyler’s nurse meant him harm, yet, this is what happened.
I implore hospitals to train your staff properly. Make sure they know fully how to operate the equipment they connect and use on patients. Make sure that they have the tools like pulse oximetry and capnography to monitor patients receiving opioids.
Above all, make sure that another mother does not suffer the anguish and grief over the loss of her child, all because you failed to train and use the technology available today.
Thanks to Michael Wong, Executive Director of the Physician-Patient Alliance for Health & Safety for sharing Victoria’s story. This story was first published on March 13, 2017.
The Doctors Company recently analyzed 67 malpractice claims* against nurse practitioners (NPs) that closed over a six-year period from January 2011 through December 2016. These claims arose in family medicine (FM) and internal medicine (IM) practices. To provide context, we compared the NP claims with 1,358 FM and IM claims that closed during the same time period. If a claim was against both the FM or IM physician and the NP, we eliminated it from this study to avoid counting the same claim twice.
We included cases that closed within the study’s time frame regardless of how the claim or suit was resolved. This approach helped us to better understand what motivates patients to pursue claims and to gain a broader overview of the system failures and processes that resulted in patient harm.
Our approach to studying these malpractice claims began by reviewing plaintiffs’/patients’ allegations, giving us insights into the perspectives and motivations for filing claims and lawsuits. We then looked at patients’ injuries to understand the full scope of harm. Physician and nurse practitioner experts for both the plaintiffs/patients and the defendants/nurse practitioners/physicians reviewed claims and conducted medical record reviews. Our clinical analysts drew from these sources to gain an accurate and unbiased understanding of the events that lead to actual patient injuries.
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Nurse practitioner or physician reviewers evaluated each claim to determine whether the standard of care was met. The factors that contributed to claims included clinical judgment, patient factors, communication, clinical systems, clinical environments, and documentation. Our team studied all aspects of the claims and, using benchmarked data, identified risk mitigation strategies that nurse practitioners and their physician partners can use to decrease the risks of injury, thereby improving the quality of care.
We did not take the following state differences in NP scope of practice (SOP) into consideration because the number of claims in each category would likely lack statistical significance:
When NPs worked in FM and IM practices, the three most common claim allegations against NPs accounted for 88% of their total claim allegations. The top three allegations in claims filed against FMs and IMs accounted for 89% of their total claim allegations.
The diagnosis- and medication-related allegation percentages were similar for both NPs and primary care physicians, while medical treatment–related allegations were more common for primary care physicians (see FIGURE 1). The small number of NP claims may lack statistical significance.
The adoption of the electronic health record (EHR) has negatively affected physician satisfaction and practice workflow. As a consequence, physicians are increasingly using medical scribes to untether themselves from their EHRs, enhance efficiency, and reduce burnout. Patient satisfaction also increases with the use of scribes due to improved physician-patient interactions during office visits. A growing body of evidence indicates that NPs provide similar benefits (i.e., they provide high-quality patient care, with patient satisfaction scores similar to those of physicians), which allows physicians to see more patients and focus on those with complex management or diagnostic problems.
Increasingly, the growing need for primary care services will be filled by NPs, not primary care physicians. Subject to individual state regulatory guidelines, NPs may take patient histories; conduct physical examinations; order, supervise, perform, and interpret diagnostic and laboratory testing; prescribe pharmacological agents; and render treatment. In 2017, there were approximately 234,000 licensed NPs in the United States, with 86.6 percent certified in primary care and 95.8 percent prescribing medications.1
Approximately 8,000 new primary care physicians enter practice each year. By 2020, it is estimated that about 8,500 will retire annually. As the number of primary care physicians declines, their services will increasingly be provided by NPs.2 An estimated 23,000 new NPs completed their academic programs in 2015–2016.1 It is projected that by 2025, physicians will represent 60% of the family practice workforce, and NPs will represent 29% (almost one-third).2
For these reasons, it is appropriate to review NP medical malpractice claims and compare them with those of primary care physicians to see if any unique NP risk management issues need to be analyzed. Although this NP claims analysis is statistically limited by the relatively small number of NP claims, it shows that diagnosis-related and medication-related allegations are similar for NPs and primary care physicians—as are the final diagnoses in claims with diagnosis-related allegations.
Medical treatment–related allegations are more frequent for FM and IM, while patient assessment issues, patient injury contributing factors, patient injury-related diagnoses, and injury severity are similar. The key differences are that NPs have lower claims frequency, and their medication-related and medical treatment–related claims have lower indemnity payments. The indemnity payments for diagnosis-related claims are similar for NPs and physicians.
An allegation of failure or delay in obtaining a specialty consultation or referral often occurred when an NP managed a complication that was beyond his or her expertise or SOP.
The alleged failure to perform an adequate patient assessment often occurred when an NP relied on the medical history or diagnosis in a previous medical record rather than performing a new, comprehensive exam.
Many NP malpractice claims can be traced to clinical and administrative factors:
Many of these factors can be remedied if physicians are clear about the nurse practice laws and regulations within their state and they support the NP in providing care within the SOP. The quality program within the practice should monitor the practice of the NP to ensure compliance with the laws and regulations of that particular state.
*A written demand for payment
This post was sponsored by The Doctors Company.
No matter why you are there, to have a baby or recover from a heart attack, nobody really likes being in the hospital. Unfortunately, patients sometimes take out their frustrations about a hospital stay on the nursing staff.
Sometimes, no matter how hard they work to provide good care, nurses are treated with indifference or even disdain by their patients. The truth is, though, people in hospitals don’t always understand the work and sacrifice of nurses nor do they understand how dangerous a job it can be.
It’s not the first profession that comes to mind when people think of dangerous jobs, but it is inherently risky—and not just from frustrated patients. In fact, an NPR report called nursing one of the most dangerous jobs in America.
Forbes listed nursing assistants as the third-most dangerous field. Like other jobs that may seem more obviously dangerous, nurses must deal with the unexpected.
Whether working as an E.D. nurse or a nurse at an OBGYN practice, the work is hard on the body and mind. Mistakes mean endangering someone’s life. So, the mental pressure is a huge weight. Here are a few of the elements that make nursing so dangerous.
Nurses are on their feet all day and that is tough. But it is only the beginning of the strain they put on their bodies.
They transport patients, sometimes having to physically move them from bed to bed. Even when using proper lifting techniques, the weight and occurrence of lifting put nurses at serious risk for back strain. And back pain is certainly painful enough to miss work when shifts are demanding.
When there aren’t enough people to help run the ship, patients suffer. Nurses, often dealing with less help than they need, are forced to do more of the work.
Though most states regulate just how long a nursing shift can last when there’s more work than people, those who are working often have a day that’s too full.
Nurses are natural caregivers, and most will sacrifice their own well-being to care for their patients. When that happens, they become overworked and overtired. Yyet they are still trying to help cover missing shifts. One nurse’s mistake after such a day can lead to hazards for others.
A chronic shortage of nurses means chronic overtime. Nurses who are already overworked due to staff shortages are often asked to work overtime. In some places, overtime is mandatory. Working too much for too long during a day can have dire consequences on someone’s health.
Hospitals are filled with workplace hazards. From exposure to highly contagious illnesses to their work with dangerous medical devices and the little-known hazard of surgical smoke, nurses are constantly in close proximity to danger.
Radiation, surgical smoke, and flawed equipment are just a few of the hazards nurses face in their daily jobs.
There are myriad reasons why patients act in a hostile manner toward nurses and hospital staff. Some are mentally unstable, some may be having reactions to medications, and some are simply confused.
Whatever causes a patient to become violent or abusive, it’s most often his or her nurse at the receiving end of it. Unfortunately, the rate at which nurses are being injured by patients is on the rise, according to U.S. News and World Report.
With all the issues nurses must contend with, patients, despite their own discomfort and suffering, must see nurses as people and treat them respectfully. A few things to keep in mind about nurses when you or a loved one is in for a hospital stay are:
They have your best interests at heart. When nurses refuse a patient another coffee or insist on prescribed medications, it’s because they’re invested in their patients’ recovery.
They want to see people in their charge recover and get home as soon as they can.
A nurse likely has responsibility for anywhere from 2 to 8 patients at a time. If they seem brisk, it’s because they are taking care of a lot of people.
Don’t blame them for not spending more time with you. Another nurse or staff member is always a button-press away if you need it.
You may need extra pain meds, but getting them to you may not be within the power of your nurse. Similarly, you may be constantly cold or too hot. They can bring you blankets and cups of ice, but they can’t make the hospital’s temperature change.
Nurses can take care of many things for their patients, but there are limits to their powers. Be considerate by understanding those limits.
Patients are in the hospital because they’re suffering. That suffering can make people anxious and sometimes even mean.
It’s easy to blame the nearest person in the room for that pain, even if you don’t do it on purpose. It may take some effort but think of nurses as your friend and advocate, not your adversary.
It makes it much more difficult to blame someone when you see them trying to help you.
After an experience in the hospital, many people say that, without the nurses, they don’t know how they would have made it.
Such sentiments often are realized in the comfort of home, when patients are feeling back in control of their lives. It may help to consider the work of the nurse before leaving the hospital, and take a minute to appreciate what nurses do to serve others.
Nurses are bound to treat their patients with dignity and respect, even when those sentiments are not reciprocated. Treating them with similar kindness should be a priority for all patients and the loved ones who visit them. After all, our lives depend on them.
A 2017 study concluded that elderly hospitalized patients treated by female internists have lower mortality and fewer readmissions compared with those cared for by male internists. But does this study really reflect the most important factors that should be considered when choosing a primary care provider?
Stories in the media about this study have been making the rounds online. It is the latest way that we oversimplify the complicated process of selecting a primary caregiver.
It ignores the fact that the study focused on elderly patients admitted to a hospital. Instead, its conclusions have been generalized to doctors at large.
Every year, more and more people turn to the Internet as their primary source of health information and advice. Already nearly half have adopted this habit, leaving just 14% of all patients looking to actually talk to a doctor before Googling symptoms or lurking through health-related forums.
Now, according to the pop science, Cliff Notes addendum to the clinical study, the informed consumer can confidently eschew male physicians in favor of female doctors.
Popular reporting on the JAMA story fed right into the notion that patients are (or should be) consumers of healthcare. The message is that you should:
It may be tongue-in-cheek, but the catchphrase has already emerged: Ask if there’s a female doctor available, and you (or an elderly family member) might live longer.
If we are going to fully commit to this “informed shopper” approach to pairing people with primary care providers, it may be worthwhile to suggest that selecting the right flat-screen TV isn’t a more nuanced decision than connecting with the right provider.
Suppose we accept the premise that gender is a reliable predictor of quality of care—among physicians. How about a Medical Assistant (MA), Physician’s Assistant (PA), or a Nurse Practitioner (NP) compared to any physician?
In the “patients are consumers” model, these mid-level providers are taking on more primary care roles and responsibilities to meet the rising caregiver demand as well as to save costs.
Compared with physicians, “mid-levels” all require less total time in school (reducing input costs) and are reimbursed at lower average levels (reducing payer expenses), making it easier for more people to receive basic care (reducing collective waste in the healthcare system).
We already know that having nurses of any designation in greater numbers provides superior outcomes in hospitals and clinics.
If we limit the assessment of nurses to those working in a primary care environment, the scales even out. Nurse Practitioners (some of whom, it should be noted, have earned their Doctor of Nursing Practice, confounding the provider naming game) provide equal care to patients as physicians.
If we’re going to continue to play the gender card in assessing providers, it should be acknowledged here that the nursing profession is about 90% female.
Whether that supports the premise of seeking out female caregivers or just reflects some other variable is open for debate.
Gendered care adds another wrinkle. Women’s health presents a unique need even at the primary care level.
Meeting demand further strains the already stretched supply of primary care physicians. It adds the need for OB-GYN physicians into the equation.
Even with the added specialization in women’s care, a Certified Nurse Midwife acting in a primary care role can generally match General Practitioner physicians in quality of care while beating them on costs.
In fact, seeing a Nurse Midwife for primary care saves female patients especially, as they can feasibly eliminate the need to pay for a GP and an OB-GYN specialist; one doctor is always cheaper than two.
Given the influx of digital technology in the healthcare space, it may be worth controlling for provider age as well as gender and specialty.
On the one hand, age might come with experience—that’s generally how we assume wisdom gets packaged.
But in medicine, with its constant stream of innovation and development and technology and science in constant flux, you might just as well see age as a hindrance to keeping up, rather than an indication of accrued wisdom.
By some measures, younger providers do look like the safer, smarter bet.
Doctors and nurses alike stand to benefit from modern advances in simulation during their schooling today. It allows them to come face-to-face with real-world challenges. They can experience specific patient encounters, diseases, and varying patient profiles before they even begin their clinical internships.
They also have the benefit of learning to work with on-the-job technology like EHRs right from the start rather than having to shift workflows and break habits to accommodate new standards.
Taken together, all the evidence so far points to a young, female nurse as the best possible option for patients shopping around to find a primary care provider.
As is typical of such assessments of care quality and outcome statistics, all this accounting treats patients like objects, rather than partners in their own care.
Following the breadcrumb trail of provider gender and credential to the cheapest, highest-quality option available does nothing to prepare patient/consumers to be present and engaged with their primary caregiver.
But I would like to suggest that the real variable for patients to consider in primary care is communication.
A patient’s ability to speak and be heard, to listen and understand, will ultimately determine his or her outcomes in primary care.
As noted before, gender and credentials can play into this. Female patients may feel more comfortable receiving primary care from a Nurse Midwife—even for non-reproductive health issues. Evidence suggests that NPs spend more time on average with each patient, listening and speaking.
Communication skills extend beyond the bedside. Along with annual physicals and recording encounters, part of the responsibility of anyone in a primary care role today is providing context to patients on the uses and limitations of Google and the Internet generally as a health information resource.
This isn’t just a question of tech-savvy or familiarity with the web, but a matter of instilling confidence and providing a human context behind the 1s and 0s.
As much as we talk about using data to inform decisions, most patients will still have a biased perception of both their experience and their care outcomes. What patients want may not be precisely what the data leads them to.
Whether their search is online or in person, they need to feel connected to the people giving them answers. That can be achieved through traditional appointments as well as teleconsultations or even question and answer sessions conducted through a patient portal.
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The better the relationship between provider and patient, the better the chances that patients will be able to balance the impulse to seek medical advice online with the professional insight of his or her primary care professional.
Technology doesn’t just keep providers on the cutting-edge of care, it keeps them in contact with patients navigating an intimidating ecosystem.
If communication can foster a stronger relationship, make patients feel more comfortable seeing a doctor, and yield results that patients are satisfied with, does it really matter whether the provider is male or female, doctor or nurse?
That, I think, is the most important question posed by the results of the study.