No Country for Old People

In my editorial in the March issue, I ask, “Where do we go from here?’” in thinking about what’s next for nursing. In particular, I wonder if we’re going to make any strides in improving the quality of how we care for older adults who need long-term care.

Disasters give rise to assessments of what went wrong.

After prior disasters like hurricanes, heat waves, and flooding, there has often been a flurry of initial concern, with many committees convened to look at the deaths that occurred.

More recently, the New York Times has reported on the fate of nursing home residents during the Covid-19 pandemic in relation to the deterioration of quality in nursing homes once they are owned by for-profit entities—as 70% of nursing homes now are. So here we are once again, this time decrying the conditions revealed by Covid-19. Will things change this time?

In answer to this question, I’m especially pleased with the article in our March issue by 22 nurse gerontology experts. They issue a call (a challenge?) for the Centers for Medicare and Medicaid Services (CMS) Coronavirus Commission for Safety and Quality in Nursing Homes to rewrite standards to finally address under-resourcing and ensure residents get the […]

2021-03-15T15:33:48-04:00March 15th, 2021|COVID-19, nursing roles, patient safety, Patients|1 Comment
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Building Back Better: Constructive Nursing Regulation

As governor of the first COVID-19 epicenter in the country, Andrew Cuomo challenged New Yorkers to think about how the state could “build back better” after the crisis. As registered nurses with experience in health law and policy, we have recommendations for transforming the boards of nursing. The manner in which nurses are regulated must be reformed, not just in New York, but throughout the country. It must begin by understanding the dangerous environments in which nurses are working.

Staffing, safety issues affect both nurses and patients.

In May, for example, Governor Cuomo reported that 12.2% of health care workers in New York city had been diagnosed with COVID-19. Nationwide, more than 164 nurses have died, often because they lacked adequate personal protective equipment. But COVID-19 is not the only dangerous situation. Long-term and psychiatric care facilities, as well as hospitals, are often dangerously understaffed, exposing nurses to violence. Nurses and other workers have been attacked and sometimes killed because they lack necessary resources and protections. Workplace violence is a growing threat which has not been adequately addressed by health care managers and administrators. Danger to patients occurs when nurses are expected to accept assignments outside of their areas of expertise. Nurses cannot care for […]

2020-07-27T07:08:18-04:00July 27th, 2020|Nursing, nursing career, nursing perspective, patient safety|2 Comments
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Thoughts on Preventing Delirium During an ICU Stay

It’s well known that an ICU stay presents several risks to patients, whatever their reason for needing critical care.

  • Various infections are more likely to develop than in other care units.
  • Intense drug therapy can result in adverse drug interactions.
  • The excess stimulation and (often) windowless rooms increase the risk for delirium and its consequences.

Would you do anything to protect your own health if you knew that after surgery you would be spending time in an ICU?

In this month’s Viewpoint column, author Patricia Gavin describes how she coped with her own ICU stay, which she knew in advance would be part of her post-op care:

“…when I realized I would be there for a few days, I decided to create
my own ‘care plan’ to stave off delirium and its adverse outcomes.”

Does it help if the patient knows her own risk factors?

She goes on to explain what she knew about her own risk factors for delirium, and the things she could do to stave off the complication during this stressful time.

And she notes how one nurse made a particular difference in helping her to get through her stay without cognitive complications. Gavin reminds us of the practical strategies that nurses can employ, beginning with, “Extend […]

2019-09-26T10:31:05-04:00September 26th, 2019|Nursing, patient safety|0 Comments
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The ECRI Top 10 Patient Safety Concerns of 2019

A list grounded in data and expert opinion.

Atlantic Training/Wikimedia Commons

Each year, ECRI Institute creates a list of top 10 patient safety concerns in order “to support organizations in their efforts to proactively identify and respond to threats to patient safety.”

The list isn’t generated out of thin air. The ECRI Institute relies both on data regarding events and concerns and on expert judgment. Since 2009, ECRI and partner patient safety organizations “have received more than 2.8 million event reports.”

2019 Top 10 Patient Safety Concerns

  1. Diagnostic Stewardship and Test Result Management Using EHRs
  2. Antimicrobial Stewardship in Physician Practices and Aging Services
  3. Burnout and Its Impact on Patient Safety
  4. Patient Safety Concerns Involving Mobile Health
  5. Reducing Discomfort with Behavioral Health
  6. Detecting Changes in a Patient’s Condition
  7. Developing and Maintaining Skills
  8. Early Recognition of Sepsis across the Continuum
  9. Infections from Peripherally Inserted IV Lines
  10. Standardizing Safety Efforts across Large Health System

[…]

2019-04-15T08:16:15-04:00April 15th, 2019|digital health, Nursing, patient safety, Patients|0 Comments
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A Call to Address Fatigue to Protect Nurse Health and Patient Safety—from 1919

The evidence on nurse fatigue has been there all along.

During Women’s History Month, which is about to end, I’ve been posting (here and here) on nursing history (and in the process exploring its close confluence with women’s history). For this last post, I’m highlighting an article published in the March 1919 issue of AJN—exactly 100 years ago. The evidence on fatigue from long working hours has been there all along.

“The Movement For Shorter Hours in Nurses’ Training Schools” (free until April 15; click on the pdf version in the upper right), was written by Isabel Stewart, who was professor and then director of the nursing program at Teachers College, Columbia University, and coauthor of the National League for Nursing Education (the forerunner of today’s National League for Nursing) Standard Curriculum for Schools of Nursing.

A call for 8-hour work days for nurses.

In this article, which is in some ways disturbingly relevant today, Isabel Stewart notes that major nursing organizations recently met and were seeking “to enlist the support of a great many influential organizations and the general public in establishing an eight-hour day and a fifty-two hour week for pupil nurses.” (As a reminder, hospital nursing staff at that time were mostly nursing […]

2019-03-29T11:07:06-04:00March 29th, 2019|Nursing, nursing history, patient safety|3 Comments
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