TAN Issue: May/June 2002 - In Brief

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ANA supports JCAHO error prevention program

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recently launched "Speak Up: Help Prevent Errors in Your Care," an innovative program backed by the ANA that involves patients in stopping deadly medical errors.

"We support JCAHO for its groundbreaking efforts to 'help patients help themselves' in securing their safety in medical care and in an attempt to reduce the up to 98,000 needless deaths that are caused each year by medical errors," said ANA President Mary Foley, MS, RN. "Encouraging patients to become active, involved and informed participants on the health care team -- by speaking out when they have questions or concerns -- will go a long way in achieving better patient outcomes."

Foley also advised that patients should ask their physicians and nurses about their backgrounds and specialized training, as well as about the necessity of more tests or medications versus alternative therapies.

"Such questioning is particularly important with regard to the issues of inadequate staffing and nursing shortages," Foley said.

Among the other questions patients should be asking about the quality of their nursing care are:

* Will I be assessed and monitored throughout my stay or procedure by an RN?

* How many patients are assigned to each RN on my care unit during the day, at night and on weekends?

* Is my nurse regularly assigned and fully oriented to this unit or specialty area?

* What other health care personnel will be working with my RN, what are their qualifications, and what tasks will they perform?

Foley and ANA also are asking Congress to pass the "Nurse Reinvestment Act," which offer grants and other funding for educating students, and the "Safe Nursing and Patient Care Act," which imposes restrictions on the unsafe use of mandatory overtime. "It is only through this legislation and similar government initiatives that we will achieve true safety and quality of care for patients," Foley said.

Keeping experienced nurses in the labor pool

Forty percent of working registered nurses will be over the age of 50 by the year 2010. This, coupled with the fact that younger nurses are not entering the workforce in numbers adequate to replace those retiring, serves as a driving force in the current and emerging shortage of nurses. To address this, the ANA Commission on Workplace Advocacy (CWPA) is planning to conduct surveys of nurses 41 and older to determine how to keep the mature/experienced nurse actively involved in nursing past the normal age of retirement.

The first survey will be a pilot, issued to nurses in the appropriate age group at the ANA Convention in Philadelphia, PA, June 29-July 2. The nurses will be asked questions about their present working conditions, retirement plans and desired roles or career opportunities after retirement. The data obtained from this survey will be used to develop a more comprehensive survey that is expected to reach a much larger and more diverse population later this year.

The CWPA will use the results of these surveys to develop strategies aimed at retaining nurses in the profession into their retirement years.

Waiting for care

A majority of the nation's emergency departments are full -- often operating at, or over, their capacity, according to a new American Hospital Association (AHA) survey conducted by The Lewin Group, Inc. Further, one-third of hospitals are forced to reroute ambulances to nearby EDs.

The survey specifically found that more than six out of 10 hospitals reported they are filled to capacity and cannot easily accommodate additional patients. More than 90 percent of large hospitals with 300 or more beds report EDs at or over capacity. And nearly nine out of 10 trauma centers reported being overwhelmed.

In addition, a majority of urban and teaching hospitals experience some time when they must divert ambulances to other hospitals because they are full.

Lack of critical care beds was the No. 1 reason cited for diverting ambulances, and the workforce shortage is a contributing factor. Hospitals reporting time on diversion at 20 percent or more had an average RN vacancy rate at 16 percent.

The survey also revealed that these constraints translated into longer waiting times for admission to a general acute or critical care floor. For example, the average waiting time for transfer from an ED to an acute or critical care bed was about 3.2 hours. In hospitals on diversion more than 20 percent of the time, the wait increased to 5.8 hours.

More than 1,500 facilities, representing 36 percent of hospitals with ED services, responded to the survey.

For more information, go to AHA's Web site at www.aha.org.

Strike averted as MN RNs win new contract

The 106 nurses at the Fairmont Medical Center in St. Paul, MN, ratified a new two-year agreement on April 24 that includes key provisions to improve insurance benefits, increase salaries and address staffing issues. Nurses had approved a strike vote taken on April 10.

The Fairmont nurses, represented by the Minnesota Nurses Association (MNA), will receive an employer-guaranteed percentage contribution to the benefits package. In addition, RNs will receive a 14 percent wage increase over two years -- 9 percent in the first year and 5 percent in the second year.

The hospital's abuse of mandatory overtime was also a target in bargaining sessions.

"During our last negotiating session, we got our point across that their behavior of forcing mandatory overtime and intentionally not filling open shifts is no longer acceptable to the nurses," said MNA Labor Specialist Elayne Best.

In some cases, the hospital was forced to close to admissions due to a lack of staff, notes MNA.

As recently as April 8, the critical care unit and medical-surgical unit had to turn patients away because not enough nurses were available to staff beds. The new contract activates a labor-management committee to address short staffing issues.

"The nurses at Fairmont have won the latest battle in our nationwide fight to improve working conditions in hospitals," said United American Nurses Chair Cheryl Johnson, RN. "Improved salaries, benefits and steps to address forced overtime will help attract and retain nurses at Fairmont, and hopefully serve as a model for other hospitals who are serious about listening to their staff nurses in order to improve working conditions at their facilities." MNA is a constituent member of the United American Nurses, AFL-CIO, the labor arm of the ANA.

CRNAs' wages outpace some doctors

A survey released by a Dallas-based health care staffing firm shows that certified registered nurse anesthetists (CRNAs) are paid more than some physicians, according to American Hospital Association News Now.

The survey, conducted by Allied Consulting, shows that salary offers for CRNAs are reaching $180,000 annually, roughly $40,000 more than compensation offered to family physicians and pediatricians. However, anesthesiologists still make much more than CRNAs. "If you are short of anesthesiologists, or if you simply don't have one, then you will do what it takes to attract a CRNA instead because without anesthesia, there's no surgery, and without surgery, there's no hospital or surgical center," Allied Vice President Curtis Pryor said in AHA News Now.

A summary of the "2002 Review of Allied Health Care Professional Recruitment Incentives Based on 2001 Data" is available at www.alliednet.com.

Hospitals hear from nurses on JCAHO staffing standards

As part of a workplace mobilization campaign kicked off during National Nurses Week by United American Nurses (UAN), AFL-CIO, the labor arm of ANA, union RNs are asking hospitals how they will include staff nurses in their plans to implement and comply with new staffing effectiveness standards by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO). The new staffing standards call for hospitals to gather and analyze data on four out of 21 different staffing-related indicators and provide evidence of action taken to correct any staffing problems discovered. Hospitals will be required to comply with the new staffing indicators beginning July 1.

"We hear from nurses that a dangerous lack of adequate staffing -- which jeopardizes nurses and patients -- is the greatest problem nurses face, and the biggest challenge to attracting and retaining RNs in hospitals. The new JCAHO standards are an excellent opportunity for hospitals to involve staff nurses in developing staffing standards where staff nurses traditionally have not been involved," said UAN Director Susan Bianchi-Sand. "In order for staffing problems to be addressed, there must be real input from the nurses seeing patients every day at the bedside."

Read the label

Consumers will see a change in the packaging of their over-the-counter (OTC) medications. On May 16, most drug manufacturers had to begin producing products with a new "drug facts" label, which will help consumers more easily choose the appropriate OTC product and understand its risks and benefits.

Patterned after the "nutrition facts" on food labels, the new drug labels will contain more user friendly information about a drug's "active ingredients, uses, warnings and dosage directions," according to the National Council on Patient Information and Education, whose board the ANA has served on since its inception. The Food and Drug Administration (FDA) developed the drug facts label.

To help Americans understand the new labeling, the Consumer Healthcare Products Association (CHPA) and the FDA produced a brochure called "The New Over-The-Counter Medicine Label ... Take a Look!" The brochure explains what's included on the label, from purpose to directions for use; the importance of reading labels, including the expiration date and what to do if an overdose occurs; and, the reasoning behind tamper-evident packaging.

For brochures, contact CHPA at (202) 429-3529 or go to www.chpa-info.org.

Loan repayment program deadline June 14

Nurses who want to take advantage of the Nursing Education Loan Repayment Program (NELRP) must submit their applications to the U.S. Health Resources and Services Administration (HRSA) by June 14.

NELRP offers RNs substantial assistance in repaying their school loans if they agree to work in eligible health care facilities experiencing a nursing shortage, according to the HRSA Web site.

HRSA's requirements for NELRP participation include:

* RNs must have a diploma or degree from an accredited nursing program;

* RNs must have unpaid, qualifying loans obtained to fund their nursing education;

* RNs must be employed full time at an eligible health facility.

For more information, go to HRSA's Web site at www.bhpr.hrsa.gov/nursing/loanrepay.htm.

New NYSNA agreement limits forced overtime

The 240 RNs at St. Charles Hospital and Rehabilitation Center in Port Jefferson, NY, represented by the New York State Nurses Association (NYSNA), approved a three-year contract on April 19 that significantly limits the amount of overtime the hospital can force nurses to work. The St. Charles facility is a sister hospital to St. Catherine of Siena in Smithtown, NY, where registered nurses recently struck for 104 days before approving a contract that mandates limits on forced overtime.

Effective immediately, the St. Charles contract prohibits the hospital from requiring nurses to stay beyond their scheduled shifts except in well-defined emergencies, and allows for financial disincentives, similar to those approved in Smithtown, to discourage the hospital from mandating overtime.

The agreement also establishes health benefits for retiring nurses, an expansion of flex time schedules and salary increases. NYSNA is a constituent member of the United American Nurses, AFL-CIO, the labor arm of the ANA.

RN killed in California clinic

A California registered nurse was one of three health care professionals killed by an X-ray technician at a health clinic in the City of Commerce April 15.

Registered nurse Patricia Oglesby, 49, was fatally shot, along with another employee and a physician. The gunman then killed himself. The local sheriff's department has not determined a motive.

Strengthening workplace advocacy programs

The ANA's Commission on Workplace Advocacy (CWPA) has launched an educational series to assist ANA's workplace advocacy constituent member associations (CMAs) in developing and strengthening initiatives that will ultimately benefit nurses in their day-to-day work lives. The first two in the series of four educational modules were sent to workplace advocacy CMAs in March: "The Users Guide" and "Empowerment Through Knowledge."

"The Users Guide" provides background information, ANA definitions, the role of the CWPA and strategic planning tools (philosophy statement, needs assessment and environmental scan). "Empowerment Through Knowledge" discusses the sources of power for registered nurses and reinforces the role of the nurse as a powerful and informed advocate. It discusses how professional practice advocacy can empower nurses to appropriately identify problems and issues in the workplace and to develop collaborative, legal and ethical intervention strategies to address them.

The last two volumes of the program will be released in the second half of 2002. "Developing Tools for Professional Practice Advocacy" will provide resources to assist nurses in learning the skills and techniques necessary to promote professional practice advocacy. "Protection for the Nurse Advocate" will supply resources and strategies to promote and secure the passage of laws, regulations and policies that protect nurses in the workplace.

Communication & the nursing shortage

A Missouri Nurses Association member and researcher has discovered that the solution to the nursing shortage lies not in money, but in increased communication between nurses and hospital administrators.

"Despite what people may think, nursing shortages have very little to do with money," said Alice Kuehn, PhD, RN, associate professor of nursing at the Sinclair School of Nursing at the University of Missouri-Columbia (MU). "The main reason we have shortages is because nurses feel they have a lack of control in the practice environment. They are not involved in the decision-making process, and this leads to frustration and burnout early in their careers."

A system relying on shared governance, in which the director of nurses plays a crucial role in hospital administration, is key to improving the lines of communication for nurses, Kuehn said. The systems allows nurses to have an equal say in the management of their practice.

Kuehn added that clearly defined roles among nurses with different educational preparation must be created.

"We want to create a setting in which nurses fill certain roles based on their level of education and experience," she said.

One way to achieve this balance is to educate current nursing students to understand what they are being prepared to do and what they are bringing to their roles. To do this, Kuehn has partnered with Marshall, MO-based Fitzgibbon Hospital and Moberly Area Community College in Moberly, MO. Kuehn attributes the hospital's low turnover rate and no shortage of nurses to its system of shared governance and emphasis on clarification of roles.

Nursing students from MU and Moberly come to Fitzgibbon for a two-day immersion period that allows them to see firsthand how the system works.

"Many nursing students are worried about burnout within the first few years," Kuehn said. "We want students to see there are places where practice is being improved, and show them nursing can be an enjoyable, rewarding and exciting career."

ULP Filed in Michigan

The Michigan Nurses Association (MNA) -- a member of United American Nurses, AFL-CIO, the labor arm of ANA -- filed unfair labor practice (ULP) charges against Trillium Hospital (Albion, MI) and Foote Hospital (Jackson, MI) on behalf of nurses at Trillium in early April.

The ULP charges that Trillium failed to bargain in good faith over the closure of the hospital, where nurses worked their last day on Feb. 5, failed to provide the required 60-day notice for the closure of the hospital and refused to comply with the existing collective bargaining agreement with nurses there.

In addition, the ULP charges that Trillium and Foote hospitals are in fact the same employer, as Foote was the primary source of financial support and management services for Trillium. Foote announced plans to use former Trillium facilities as an urgent care center the day Trillium filed for bankruptcy.

MNA seeks to settle grievances, secure payment for the nurses for the lack of required 60-day notice, and secure the nurses' retirement and other benefits as required by contract.

First contract for Ketchikan nurses

Nurses at the Ketchikan General Hospital in Alaska ratified their first contract in March. The nurses organized in May 2001 with the Alaska Nurses Association, a member of the United American Nurses, AFL-CIO, the labor arm of ANA.

The new contract grants nurses pay raises, with salaries now starting at $20.94 and ranging up to $32.64 per hour. The hospital also will pay all health insurance costs for full-time nurses and 70 to 75 percent of the costs for family members.

Coming to a theater near you

Nurses for a Healthier Tomorrow, a national coalition of 35 organizations, including ANA, has expanded its RN recruitment campaign to include running advertisements in movie theaters this May.

The on-screen ad features real-life nurses from the coalition's print ad campaign. The ad also showcases the "Nursing. It's Real. It's Life" slogan and directs movie-goers to the www.nursesource.org Web site.

The movie ad appeared throughout May on 436 screens -- reaching 2.5 million movie-goers -- in the following major markets: Atlanta, Baltimore, Boston, Chicago, Dallas, Detroit, Los Angeles, Miami, Philadelphia, New York, San Francisco, Seattle and Washington, DC. Coalition sponsor JWT Specialized Communications created the ad and handled distribution.

Converso named to VA commission

United American Nurses (UAN) Vice Chair Ann Converso, RN, was recently named to the National Commission on VA (Veterans Affairs) Nursing by U.S. Secretary of Veterans Affairs Anthony J. Principi. The Commission was established by Congress in part to develop financial and professional incentives to attract and retain a skilled RN workforce during a time of epidemic nurse shortages. The first meeting of the commission, which will generate a report due in two years, was May 8.

"If we are going to address the current shortage of hospital nurses, it is absolutely critical that staff nurses be at the table and involved in developing solutions," said Converso, a 29-year-veteran acute medical-surgical and IV nurse at the Western New York Health Care System in Buffalo. "I am eager to bring the voices of VA staff nurses to this discussion. Without them, we won't solve the staffing crisis."

Converso is one of 12 commissioners who will advise VA leadership on issues affecting VA nurses, and one of two "employee representative" positions on the commission. Other commission members include nursing faculty, veterans, nurse executives and administrators, and economists.

"We owe it to our patients to ensure that our nurses have the tools, training and other resources to provide the best medical care in the world to America's veterans," Principi said.

Breastfeeding resource available

To help new mothers breastfeed longer, a manufacturer of baby feeding products is offering a free Breastfeeding Guide during the month of August -- National Breastfeeding Awareness Month.

Mothers, fathers or even grandparents can request the 24-page resource to learn more about the health and nutritional benefits of breastfeeding and the convenience of breast pumps, as well as get answers to commonly asked questions.

The guide also offers a suggested "food guide pyramid" modified for nursing mothers, tips on proper and comfortable breastfeeding positions and information on returning to work while breastfeeding.

The guide is available from Avent America at (800) 54-AVENT.

NYSNA nurses win expanded whistleblower protections

It's now official: New York now has a measure on its books that expands legal protection for health care workers who blow the whistle.

At the April 2 signing ceremony, New York State Nurses Association (NYSNA) President Robert Piemonte, RN, thanked Gov. George Pataki and state legislators for taking action on this issue.

"Nurses who fight to protect their patients should not have to fight to protect their jobs," he said. "Nurses now have added assurance that the law will be behind them when they report unsafe staffing levels, medical errors and other situations that are detrimental to patient care."

Continuing, he said, "Whistleblower protection is the foundation for NYSNA's continuing efforts to ensure patient safety and better working conditions for nursing." Key features of the bill include:

* Health care employers are prohibited from retaliating against employees who disclose or threaten to disclose to supervisors or public agencies activities that they reasonably believe constitute improper quality of patient care, and who object to or refuse to participate in such activities.

* In addition, "improper quality of patient care" is defined as: any practice, procedure, action or failure to act which violates any law, rule, regulation or declaratory ruling that may present a substantial and specific danger to the public health or safety or a significant threat to the health of a specific patient.

* If employees experience retaliation for these activities, they may seek relief in civil court. If the employer is found guilty, the court may assess a fine, which will be placed in a special state fund dedicated to improving the quality of patient care. The employee cannot be required to pay the employer's attorney and court costs, even if the employee's suit is unsuccessful.