‘Applying QI to Care in Nursing Homes’: A Nurse’s Take on the Tools Needed for Change

nursing homeA colleague once remarked, “Isn’t it strange that the universal response to hearing that someone has gone into a nursing home is ‘Ugh’?”  As nurses, we might hazard a guess as to what kind of care the new resident may receive. But is there a way to reenvision the care that we provide in nursing homes?

In AJN‘s April Viewpoint essay, NP Heather Walker argues that there is, and that quality improvement (QI) can be an effective tool for change. Walker suggests that QI can do for nursing homes what it has done for acute care: focus attention on the systemic issues that stand in the way of good nursing. As she says in the article,

“QI doesn’t negate personal responsibility, but it broadens the focus so that systemic problems are taken into account.”

The QI process fosters reflection, accountability, and teamwork, which in themselves can improve the work environment and residents’ living experience. For more information about this approach, read the short article, here.—Betsy Todd, AJN clinical editor, MPH, RN, CIC

 

2016-11-21T13:01:19-05:00March 31st, 2016|career, Nursing|0 Comments
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Latino Nurses in the United States: Numbers Don’t Reflect Demographic Trends

“Increasing [the] numbers of RNs from minority backgrounds is a prime consideration in reducing the substantial racial and ethnic disparities in health.” – National Advisory Council on Nurse Education and Practice

indexThe U.S. Census Bureau estimates that, by the year 2060, Latinos, currently 17% of the population, will make up almost 29% of the total U.S. population. Will the diversity of the nursing workforce reflect the diversity of the populations we serve? The authors of “Latino Nurses in the United States: An Overview of Three Decades (1980-2010)” provide us with a demographic baseline against which to measure our future diversity progress:

“In 2010 (the latest data available), there were 1186 non-Latino white RNs for every 100,000 non-Latino whites in the U.S., yet only 311 Latino RNs for every 100,000 Latinos in the U.S.”

The authors review historical information on Latino nursing in the U.S., offer a state-by-state profile from the five states with the largest Latino populations (California, Florida, Texas, Illinois, and New York), and recommend modifications to existing nursing school recruitment, admission, and retention strategies. […]

2016-11-21T13:01:26-05:00February 24th, 2016|career, Nursing, nursing perspective|0 Comments
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The Bigger Picture: A New Nurse Embraces Her Ability to Still Ask ‘Why?’

Sarah Szulecki, BSN, RN, is a telemetry nurse at a hospital in New York State.

karen eliot/flickr karen eliot/flickr

As a new graduate nurse, I’ve found that adjusting to the microcosm of the hospital floor—its SBAR reports detailing a ‘here and now,’ its constant exchange of admissions and discharges, its wide spectrum of emotional extremes—has been challenging.

The experienced nurses on my telemetry floor tell me that it generally takes about one full year to start feeling as though you know what you’re doing. In the meantime, I find myself catching glimpses of scenes I hope I’ll someday be able to handle with grace—rather than with my current bumbling clumsiness.

A patient’s granddaughter is escorted into the hallway as staff flocks to her grandmother’s code blue, and I think of all the wrong things to say as she starts to cry.

As I examine his excoriated skin, a depressed patient looks humiliated and struggles to tell me that his home is infested with bedbugs—in my gut, I feel a grim helplessness about his future when he’s discharged a few days later.

A patient who has a sky-high hemoglobin A1c level admits that he has neither the desire nor the money to care for his diabetes. My pleas for change sound childish and naive to even my own ears.

These first few months of being a nurse amalgamate feelings of failure […]

2016-11-21T13:01:26-05:00February 17th, 2016|career, Nursing, nursing perspective|2 Comments
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Workplace Bullying: One Medical Center’s Nurses Assess and Respond

photo by Ronald Keller photo by Ronald Keller

Bullying against or by nurses has gotten a lot of attention in recent years. Aside from the suffering bullying inflicts on its victims, research tells us that bullying (which takes a number of forms, from overt insults to more subtle acts that undermine and demoralize) can also endanger patient safety and quality of care.

As described in our February article, “A Task Force to Address Bullying“ (free access until March 1), recently a large Magnet-designated academic medical center in the Northeast developed an initiative to evaluate and address the issue at their institution. In order to first measure the problem, the task force developed a confidential online survey.

The survey had a 38% response rate. Here are some of the findings about who’s doing the bullying, who’s suffering it, and how its victims are affected by it:

 . . . . two-thirds (66%) of respondents reported having experienced or witnessed bullying in the workplace; and ‘bullies’ were most frequently identified as staff nurses (58%), followed by physicians (38%), patient care technicians (34%), and nurse managers (34%). Among the individuals who reported having been bullied, more than half experienced the following personal consequences: loss of confidence (63%), anxiety (59%), and diminished self-esteem (50%); and more than half experienced the following work consequences: decreased job satisfaction (83%), […]

2016-11-21T13:01:29-05:00February 9th, 2016|career, Nursing, nursing perspective|2 Comments
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Hospital Shootings: Unacknowledged Job Hazard?

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. Illustration by the author.

Active_shooter_post_illustrationRecently, while preparing for work, I received the following text from a coworker already at the hospital:

We’re on lockdown
Armed gunman
Stay home, they announced “active shooter now outside building”

Shocked, barely able to comprehend the message, I texted back:

WTF?
Are you safe?

She texted back that she and others were in lockdown in the cafeteria. Numbly, I switched on the TV, looking for more information, but found nothing. Not a single report of the event on any station. Turning to the Internet, I found a single tweet referring to an event in progress. Feeling helpless, I texted my husband and daughter and then called my mom, letting them know I was at home, safe, just in case they heard something. Then I waited.

Within an hour, the same coworker texted again:

All clear!

I stared at my phone, not knowing what to do. I went to work.

The resolution of the shooting situation was heartbreaking. However, no patients or hospital staff were harmed. The outcome could have been much worse.

That evening, local media coverage of the crisis remained scant to the point I nearly felt I’d imagined it. It was as though it never happened.

We were lucky. Our shooting occurred outside, on the hospital grounds—as do 41% of hospital shootings, […]

2016-11-21T13:01:30-05:00February 3rd, 2016|career, Ethics, Nursing, nursing perspective|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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