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 […]

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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If We Know How to Prevent Falls, Why Are Our Patients Still Falling?

Falls: at least ‘theoretically preventable.’

Sometimes it can feel as though managing fall risk takes up a big part of the day. You do your regular risk assessments, put safety measures into place, and still—patients fall.

Considering the frailty of some patients, the many meds that contribute to falls, and the fact that even mild cognitive impairment can be made worse by a hospitalization, it’s a tribute to good nursing care that there aren’t more falls.

But because falls sometimes cause serious injury and are, at least theoretically, preventable, it always feels like we’ve failed when a patient ends up on the floor.

A checklist for high-risk patients.

Nurses at one hospital decided that they needed a new way to approach fall safety. In “Using a Fall Prevention Checklist to Reduce Hospital Falls,” authors Madeline Johnston and Morris Magnan describe their use of a 14-item change-of-shift checklist based on the hospital’s existing fall prevention protocol. For a patient known to be at high risk for falls, oncoming staff went through the checklist to be sure that all prevention interventions were in place before taking responsibility for the patient. […]

2019-03-01T11:40:56-05:00March 1st, 2019|Nursing, patient safety|2 Comments
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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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