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MAGNET HOSPITALS: How did the idea come about?

During the nursing shortage of the early 1980s, there were an estimated 100,000 vacancies nationwide and inadequate staffing in over three-quarters of U.S. hospitals.  In an effort to alleviate the shortage, the American Academy of Nursing engaged four AAN fellows to choose a topic and conduct research on nurses employed at hospitals.  The author of this brief article – Muriel Poulin – and her colleagues Margaret McClure, Margaret Sovie and Mabel Wandelt, decided to study the characteristics of hospitals that were doing a good job of retaining nursing staff.  They surveyed 41 hospitals and prepared a report that served as the basis of the later Magnet Recognition Program.

When I stop to consider how much the program has progressed, I cannot get over it.  It has been a remarkable evolution that now includes hundreds of healthcare organizations around the world…” (Dr. Poulin, page 73).

Sources:

Poulin, M. (2017, February). A remarkable journey: Why the Magnet Recognition Program continues to resonate today. JONA. The Journal of Nursing Administration, 47(2), 72-73. Click here for publisher’s website: http://journals.lww.com/jonajournal/Abstract/2017/02000/A_Remarkable_Journey__Why_the_Magnet_Recognition.2.aspx

American Nurses Credentialing Center. (2017). ANCC Magnet Recognition Program. Click here: http://www.nursecredentialing.org/Magnet  Posted by AHA Resource Center (312) 422-2003 rc@aha.org

READMISSIONS: What factors influence 30-day pneumonia readmission rate?

Factors associated with either increasing or decreasing the rate of 30-day readmissions for pneumonia patients were studied based on data from 577 hospitals in California, Massachusetts, and New York.  Among the factors that were found to be associated with a lower readmission rate were being hospitalized in California; supplying the patient with instructions about recovering at home; and, hospitalist and RN hours per patient day, among others.  The authors draw conclusions related to the value of nurse staffing, communication, and responsiveness in reducing 30-day readmission rates for pneumonia.

Source: Flanagan, J., and Stamp, K.D. (2016, Feb.). Predictors of 30-day readmission for pneumonia. JONA. The Journal of Nursing Administration. 46(2), 69-74.  Click here for publisher’s website: http://journals.lww.com/jonajournal/Abstract/2016/02000/Predictors_of_30_Day_Readmission_for_Pneumonia.5.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

NURSING UNITS: What are telesitters? Why are they used?

Patient sitters are used in hospitals for patients at risk of falls or other harmful behavior.  Some hospitals have begun to explore the use of virtual sitter technology, or telesitters, to reduce sitter costs while maintaining high quality care.  I thought the following was an interesting breakdown of the reasons that sitters were assigned to patients at one large teaching hospital – UC San Diego Health System (UCSDHS) – a Magnet hospital.  These percentages were based on data collected for one month in 2011:

 

  • 34 percent (risk for elopement)
  • 30 percent (fall risk)
  • 16 percent (pulling out tubes or lines)
  • 10 percent (harm to self)
  • 10 percent (other)

The purpose of this study was evaluate a way to decrease sitter costs while maintaining high patient safety rates by using a video cart-based monitoring system (implemented in 2012) and also by revising the sitter protocol.  Six mobile carts were put into use at an initial start-up cost of about $83,000 in the first two years.  Return on investment and trends in fall rates are discussed in this article.

St. David’s HealthCare (Austin, Texas) has implemented a virtual sitter program, also a cart-based technology with a camera and 2-way audio.  The slide presentation noted below includes a tiered chart that shows the criteria to determine if a patient is in need of a virtual sitter.

Sources: 

[About UCSDHS]  Burtson, P.L., and Vento, L. (2015, July-Aug.). Sitter reduction through mobile video monitoring: A nursing-driven sitter protocol and administrative oversight. JONA. Journal of Nursing Administration, 45(7/8), 363-369. Full text can be purchased here: http://journals.lww.com/jonajournal/Abstract/2015/07000/Sitter_Reduction_Through_Mobile_Video_Monitoring_.5.aspx  Table here: http://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/JONA/A/JONA_45_7_2015_05_27_BURTSON_14259_SDC1.pdf

[About St. David’s]  McCurley, J. (2015). A new approach to fall prevention in inpatient care. Retrieved from http://tdshshealthcaresafetyconference.com/Documents/8-20_1120-A%20New%20Approach%20to%20Fall%20Prevention-McCurley.pdf

[More about St. David’s]  Punke, H. (2015, Apr. 7). Zero injuries from patient falls: One hospital demonstrates how it’s possible. Becker’s Infection Control & Clinical Quality. Retrieved from http://www.beckershospitalreview.com/quality/zero-injuries-from-patient-falls-one-hospital-demonstrates-how-it-s-possible.html  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

How does the physical environment affect nurse turnover?

The role of physical work conditions in influencing nursing turnover was studied on a leukemia unit at one urban hospital in the U.S.  The findings were that a noisy workplace was associated with intention to leave.  Another important factor associated with intention to leave was how well or poorly the hospital physical environment facilitated nursing tasks.  However, nurses’ perceptions of safety hazards or comfortable temperature were not associated with turnover.  The authors note that cancer units are often kept colder than other parts of a hospital to inhibit growth of bacteria and viruses among immunosuppressed patients — and nurses know that below-normal temperature are for the good of patients, so they may be considered “part of the job.”

A conclusion from this study is that hospitals looking to improve their nurse retention might be well served by looking at physical environment improvements that help nurses do their jobs better.

Source:  Vardaman, J.M., Cornell, P.T., and others.  Part of the job: the role of physical work conditions in the nurse turnover process.  Health Care Management Review;39(2):164-173, Apr.-June 2014.  Click here for access to the publisher’s website:  http://journals.lww.com/hcmrjournal/pages/articleviewer.aspx?year=2014&issue=04000&article=00009&type=abstract

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HOSPITAL DESIGN: Patient room of the future

Patient Room 2020 is a futuristic design concept developed by NXT Health with grant funding from the U.S. Department of Defense.  A prototype of the 400-sf patient room has been built in New York at the Corian Design Studio.  The prototype features smooth, streamlined surfaces and concealed technology.  It features an “open bathroom” concept, which allows flexibility in fitting more caregivers and equipment into the bathroom.  The Patient Room 2020 is intended to be prefabricated as pods.

Source: A new vision of care.  Health Facilities Management;27(2):11-13, Feb. 2014.  Click here for access to this article:  http://www.hfmmagazine.com/display/HFM-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HFM/Magazine/2014/Feb/0214HFM_FEA_Interview  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

 

PATIENT FALLS: Happier nurses = lower fall rate

A relationship was found between higher rates of nurse job satisfaction and lower patient fall rates in this study of 2009 data from over 2,700 hospital patient care units (adult only).  The sample had a larger percentage of large hospitals than the nation as a whole.

Fall rates by type of unit were reported as follows:

  • 2.87 (surgical units)
  • 3.3  (step-down units)
  • 3.65 (med-surg units)
  • 4.06 (medical units)
  • 3.53 (overall)

Fall rate was calculated as (the total number of falls / the total number of patient days) x 1,000.

Source: Choi, J., and Boyle, D.K.  RN workgroup job satisfaction and patient falls in acute care hospitals.  JONA. The Journal of Nursing Administration;43(11):586-591, Nov. 2013. Click here to access publisher’s website: http://www.nursingcenter.com/lnc/Static-Pages/The-Presence-and-Roles-of-Nurse-Navigators-in-Acut.aspx   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

NURSE STAFFING RATIOS: financial impact on hospitals

California implemented nurse staffing ratios in 2004.  This article summarizes the findings of a literature review of 10 studies of the impact of the staffing ratios on hospital financial measures.  Labor costs were found to have increased, while some services were reduced.  Overall, a negative financial impact on the hospitals was noted by the author, who is an assistant professor at the Orvis School of Nursing at the University of Nevada.

Source: Serratt, T.  California’s nurse-to-patient ratios, part 2: 8 years later, what do we know about hospital level outcomes.  JONA. the Journal of Nursing Administration;43(10):549-553, Oct. 2013.  Click here for more information: http://journals.lww.com/jonajournal/pages/articleviewer.aspx?year=2013&issue=10000&article=00012&type=abstract  Posted by AHA Resource Center (312) 422-2050, rc@aha.org