Hospitals are bending over backward to increase their patient satisfaction scores, and, especially now, as it may affect their ability to bill patients.  Hospitals are adding room service, suites, and even “care guides” to help patients meet health and recovery goals.

The answer to patient satisfaction isn’t a new piano in the lobby, it’s right inside each patient’s room.  It’s the nurse.  Nurses say they’re often asked, “can you just sit with me a while?” by a patient.  Or the patient will even ask a nurse who’s charting if he or she can just turn around and face them while they have to also look at the computer.  It’s the caregiver interaction that patients need and, yes, crave when they’re vulnerable, and it’s the one-to-one contact that will make patients happy.

Some hospitals seem to get it.  Sort of.  One hospital just boasted that it had increased nurse-to-patient contact time by double-digit percentages as a show of progress, but what this hospital didn’t mention is that they did it by moving computers into patient rooms so nurses had to chart while sitting next to a patient, not with a patient.  That’s called abiding by the letter of the law but not the spirit.

Other hospitals, however, continue to understaff nurses in critical areas.  Even where a nurse needs to watch over a patient, comfort then, or explain how their care will continue at home, nurses are shaving time with each patient so they can get to the next.  A nurse blazing through discharge instructions doesn’t make patients feel satisfied or cared for, it just makes them feel like a number.

Rather than poll patients to determine their satisfaction, hospitals ought to be keeping track of how many patients each nurse is spending time with.  That’s the simple and effective formula for figuring patient satisfaction.

Bravo to Theresa Brown, RN, for writing an eye-opening Op-Ed, exposing the dangers faced by patients when not enough nurses are on duty.  The New York Times published her opinion on Sun., Aug. 18, which puts this issue front and center, where it should be.   Read the OpEd here.  
We encourage you to read the entire piece, along with the Comments Section AND participate in the online discussion.
Brown mentions only one piece of legislation being considered by Congress to address the issue of poor staffing levels, but it is important to know that efforts are being led by nursing communities (including National Nurses United) to advance other bills on the federal and state levels as well.
In April of this year, U.S. Sen. Barbara Boxer (D-CA), introduced the National Nursing Shortage Reform and Patient Advocacy Act, (S 739) and its companion bill in the House, authored by Rep. Jan Schakowsky,  Safe Nurse Staffing for Patient Safety and Quality Care Act (HR 1907).
If passed, the legislation would protect the rights of nurses to advocate on behalf of their patients, establish minimum nurse-to-patient ratios in hospitals and invest in training and retaining nurses to address the nationwide nursing shortage.
“I am proud to introduce legislation that will help save the lives of countless patients by improving the quality of care in our nation’s hospitals,” Sen. Boxer says. “We must support the nurses who work tirelessly every day to provide the best possible care to their patients.”

Specifically, Boxer’s bill would:

• Establish minimum nurse-to-patient ratios that will save lives, improve the quality of care and help to address the nursing shortage by creating a work environment that encourages nurses to remain in the hospital workforce.
• Provide whistleblower protections to protect the right of nurses to advocate for the safety of patients and report violations of minimum standards of care.
• Invest in nursing mentorship demonstration programs to better prepare nurses for work in a hospital setting.

A new exercise product came out this week.  The Garmin bicycle pedal actually measures the force of each foot as a rider pedals his/her bicycle and relays power, speed, distance, and even calories burned to a computer unit on the handlebars or an enabled smartphone.  The pedal will retail for about $1700 and connect the user to other people in the network, such as coaches, teammates, or competitive friends who can also monitor the workout.

It’s a continuation of a trend of more products coming out that can monitor a person’s health remotely and send the data back to someone else, such as this one made by Cardiocare that allows a patient can step onto a scale and have readings relayed to Essentia St. Mary’s Hospital in Duluth (link here).  The video boasts that they helped a CHF patient avoid a hospital stay and maybe even death after a spike in weight.

What’s missing from the gee-whiz part of the conversation is that there’s a trained nurse on the other side of the data who is looking out for the patient.  That nurse is looking for red flags to determine if the patient is in trouble.  The technology is good, but the gadgets can’t ask questions that can save a patient’s life.  Even the Essentia video above mentions that a nurse had to call the patient at home and ask if they were feeling ok.

As hospitals try to be more efficient and fall for the latest technology, they can’t forget that it’s the trained nurse who’s in charge of a patient’s recovery at the hospital or at home.  Nurses are looking after patients, not toys.

MNA nurses march on the boss at Sanford Bemidji Medical Center.

By Linda Hamilton, RN, BSN

It’s a great day for workers. With one fight won at the linen workers union Local 150 and one fight not won, YET. After a strike that lasted only one day the workers who launder our hospital scrubs and linens successfully secured their pensions and restored sick time benefits the management sought to steal from their workers.   President Jean Ross joined MNA leaders as well as Speaker of the Minnesota House Paul Thissen and Minnesota Senator Tom Bakk to rally together with many unions to support the striking LIUNA laborers at Cretex as they also fight for to keep their pension, affordable health care and a safe workplace. One thing became clear the same fight we had in 2010 continues. Corporations seek to squash the workers and their right to collective bargaining to boost their profits.

Congratulations and thank you to all workers who stand up and fight for a fair wage, safe working conditions, health care, and a secure pension. We celebrate with SEIU workers and support the laborers today tomorrow or until the war is won.

Next fall, patients will be able to report adverse events in a limited time.  They’ll be able to initiate an investigation with the Agency for Healthcare Research and Quality if they feel they were given the wrong medication or suffered a negative patient outcome.  The report will then go to the RAND Corporation and the ECRI Institute, which investigates medical errors.

While originally supportive of the idea, the American Hospital Association touted the empowerment of patients when the idea was originally proposed last year.  Original story is here.

Now that the program is about to begin comes the warning that patients don’t have the background to assess what’s an adverse event and may merely complain when they’re not satisfied.  Another objection is the time it would add to facilities and physicians to answer questions by investigators about these reports.  The agency says it would only add 28 hours in administrative time.  Response is here and here.

In Minnesota, there is no such avenue for consumer complaints, but healthcare professionals can report an adverse event after it’s happened to the Office of Health Facilities.  This office however, while tasked with protecting vulnerable patients, is limited in its power.  It can’t, for example, investigate incidents where a lack of nurse staffing resulted in a “near-miss” or a fear of an adverse event.

As hospitals continue to cite industry studies that cite excellence in healthcare, there are few places to create a more realistic view of the quality of care patients receive.  Consumers need to join nurses at the Minnesota legislature and on-line forums to detail cases where they or their loved ones received poor quality care.

Patients’ voices should be heard.  Patients should join the chorus of nurses who cry for minimum standards of care to ensure that nurses have the time to provide safe care to patients.  Nurses have been clamoring for safe staffing levels for decades, but they’ve nearly always been rebuffed by administrators who cry out for lower costs instead.

Nurses won’t be surprised to hear another study that finds health care workers suffer more injuries than in any other sector in the United States.  Nurses know friends and colleagues who have lost work days and income to injuries, some who even had to give up their career of bedside nursing.  The corporate focus on the bottom-line puts more weight on our shoulders, literally, as we are told to “make do” without enough hands or resources to move a patient or perform a procedure.

The proof is in the numbers.  In 2011, injuries to healthcare workers went up 6 percent while construction and agriculture-related injuries actually went down.  Work-related injuries for these workers is nearly 8 times greater than for other workers.  Injuries related to workplace violence is 7 times higher than for other types of workers.

What’s even more surprising is the extent of the problem and the lack of government regulation of health care worksites.  If you ask the general public which occupation has the most workplace injuries, most would guess construction trades, and that seems to be the assumption OSHA (Occupational Health and Safety Administration) works under as well.  A new report by Public Citizen finds that while health care workers greatly outnumber construction workers (and we suffer more than double the number of injuries annually), OSHA conducts nearly twenty times as many inspections of construction sites as they do of health care facilities.

OSHA does have a good track record of success in enforcing existing standards for health care facilities (the Bloodborne Pathogens standard, for example, has dramatically decreased the rates of Hepatitis B and HIV/AIDS infections among health care workers).  However (and it’s a big however), there are no OSHA standards for two of the worst safety hazards in health care today:  unsafe ergonomic conditions and workplace violence. Without specific standards to address these common hazards, OSHA is extremely limited in their ability to protect health care workers.

Does your workplace have strategies to protect you from ergonomic hazards or workplace violence? Are nurses involved in planning and implementing these programs? Would you like to work on these issues from a statewide perspective? The MNA Health and Safety Committee is seeking new members to educate nurses about these issues and many more in our workplaces. Please contact Geri Katz at 651-414-2855 or geri.katz@mnnurses.org if you are interested in learning more about joining the committee.

Learn more:

Read the report:

http://www.citizen.org/documents/health-care-workers-unprotected-2013-report.pdf

NNU Co-President Karen Higgins interview: http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=10452

Huffington Post: The Hidden Health Care Problem

http://www.huffingtonpost.com/taylor-lincoln/the-hidden-health-care-pr_b_3611970.html

Dear Brett and Judith,
The 20,000 nurses across the state of Minnesota in the United States proudly hail our courageous sisters and brothers of the NSW Nurses and Midwives Association.  You are boldly calling for a solution to the unnecessary risk to patients you witness every day in the 160 hospitals throughout NSW.

We are with you in your strike; we are with you at the table; we are with you in the halls of your government as you demand the ratios the vulnerable patients of Australia deserve.

Carry on, knowing you have the support of colleagues around the world.

MNA President Linda Hamilton and
Executive Director Walt Frederickson

Linda Hamilton, RN, BSN
President, Minnesota Nurses Association

Walter Frederickson, RN
Executive Director, Minnesota Nurses Association

More here:

http://www.southcoastregister.com.au/story/1657305/nurses-strike-over-ratios/?cs=202

http://au.news.yahoo.com/latest/a/-/latest/18121519/nurses-strike-in-nsw-over-safety-concerns/

http://au.news.yahoo.com/video/national/watch/18134116/nsw-nurses-strike/

Scholarships are available for Rutgers University’s Global Women’s Health Leadership classes.

Nurses often take their skills beyond the bedside.  They travel the world showing compassion for the world’s sick and suffering, spreading a single-standard of care for all people, and ensuring a just distribution of life’s basic necessities.  However, saving the world can mean starting with the questions, “where do I go?” and “what can I do that will actually make a difference?”

Nurses can answer those questions in classes offered through the Institute for Women’s Leadership at Rutgers University.  The Global Women’s Health Leadership certificate program was developed with National Nurses United, and enrollment is open for classes in the fall of 2013.

The instruction is all on-line, and no attendance at Rutgers is necessary.  Future classes will include:

Impacts of Economic Inequality on Women’s Health

Domestic and global economic inequality place significant numbers of people at high risk for health crises even as they are denied access to care. This course investigates the “pathogenic” aspects of economic inequality. It examines how systems of unequal resource distribution contribute to wide disparities of health risk, access to healthcare, and clinical outcomes.

Debt, Crisis, and Women’s Health

Growing national debt has become a feature of increasing numbers of nations over the past 60 years, heightening dependence on international financial institutions and restricting the sphere of freedom of national policy makers. Healthcare provision has been subjected to severe cuts as nations struggle to meet their debt obligations and stabilize their economies.

Gendered Health Impacts of Structural Adjustment Programs

Since the 1980s, the World Bank and the International Monetary Fund have conditioned loans to poor countries on implementation of economic policy requirements known collectively as structural adjustment. This course considers the gendered health effects of structural adjustment. It investigates why women are over-represented among those most negatively affected by cuts in public services, how their caretaking burdens increase and their paid employment decreases disproportionately with privatization.

Health Consequences of Global Trade in Food Commodities

Close to one billion people suffer from malnutrition and many more from food deprivation in the twenty-first century.  This course investigates shifting modes of food production as local practices of subsistence agriculture have been replaced by export agriculture and global commodities markets. The course compares the consequences of these changes for women as consumers in the global North as well as for women as producers of subsistence in the global South. Examining impacts of global commodities markets on food distribution, diet, and health, the course also analyzes the health effects of the creation of consumer markets for processed foods.

Health Consequences of Global Trade in Pharmaceuticals

Multinational pharmaceutical companies remain the primary developers of new drug regimens. The health effects of drug research and development, however, vary markedly from one region of the world to another. This course explores the political economy of the global pharmaceutical industry, analyzing the distribution of burdens and benefits. It examines ethical issues, such as clinical trials on populations in the Global South; continuing sales of drugs across the Global South after they have been banned in the global North.

Gendered Professions and the Transnational Care Economy

Nursing lies at the heart of the “care economy.” Involving work that requires intensive physical labor, person-to-person communication, and spatial proximity, the intimate nature of care work resists mechanization. In contrast to the production of commodities, the highly personalized labor of care is driven by human need rather than profit maximization.

Tuition for courses is currently $2,304. NNU is in the process of negotiating tuition rates with Rutgers. NNU’s disaster and community relief program, the RN Response Network (RNRN) will offer a limited number of scholarships each term to RNRN members who are interested in taking courses. The scholarship will provide the opportunity for RNRN members to enhance their fundamental understanding of global health conditions, as well as the connection between disaster relief, the core mission of RNRN, and the global conditions that contribute to the ability or inability of health systems to properly respond when disasters occur.

Nurses must be RNRN members to qualify for scholarship opportunities. To apply for a scholarship or for information on how to join the RN Response Network, contact Alice Grubb.

Current and upcoming courses will be continually updated on this website. If you are interested in taking a course offered during the fall semester, please contact Janelle Fine before August 15th, 2013, and if you are interested in taking a course offered during the spring semester, please contact Janelle before December 15th, 2013. Please check back for a schedule of current and future course offerings.

Hint: them

Recently, US News & World Report released its “Best Hospitals” list.  What’s interesting is what criteria a national news magazine uses to judge what’s “best.”  Link here.  

The criteria seems to favor reputation versus results.  Note that patient safety only counts five percent toward the total score and ranking.  Of course, many hospitals rank themselves based on patient satisfaction scores.  The patient survey affect hospital quality ranks, which have many variables including when did the patient fill out the survey or what patients filled out the survey.   New parents, for example, are prime targets for a patient survey score.

Kaiser Health News noted the patient satisfaction scores drive hospitals in the story they did about hospital food going gourmet.  Link here. 

Hospitals are introducing upscale food on-demand just like a hotel’s room service not only to boost scores, but also to raise revenue.  Uneaten food is wasted money in terms of disposal costs.  Better food, as Kaiser reports, means patients don’t complain when they’re told to stay an extra day.

Meanwhile, a non-profit organization, The Leapfrog Group, ranks hospitals as well as states based on patient safety and patient outcomes, which they term “never events,” as they should never happen.  This includes falls, infections, surgical items left inside patients, etc.  Link here.  

Much of this data, however, depends on hospital self-reporting, including an annual hospital survey that Leapfrog send out.  Some hospitals, even in Minnesota, do not return the survey.

Considering the link between nurse staffing and patient safety, it will be interesting if the media and watchdog groups, such as Leapfrog, pick up on this reporting data and include it as part of their future hospital rankings.