Nurses

Disruptive doctor behavior causes mistakes, intimidates workers

Anne Zieger — Tue, 02 Dec 2008 09:27:12 -0500

We've told you about the Joint Commission's new rule requiring hospitals to have rules and consequences to prevent disruptive behavior from physicians. And subsequently, the AMA asked for a one year hold on that rule so they could have time to consider how best to prevent disruptive behavior.

How often does it happen? There is anecdotal evidence--stories of nurses and other healthcare workers being yelled at and humiliated after they, say, saved a patient's life by noticing a mistake--but it's hard to tell whether these are unusual situations.

Now, however, we have results from a survey to show how big a problem disruptive behavior really is in hospitals. The number of doctors who appeared to be disruptive seems to be relatively low, perhaps only 3 to 4 percent, but the problems that these doctors can cause belie their low numbers.

Dr. Alan Rosenstein performed a survey of healthcare workers from 102 non-profit hospitals between 2004 and 2007. What he found was that 67 percent of the respondents thought that disruptive behavior contributed to medical mistakes, and 17 percent had actually seen at least one mistake as a result of disruptive behavior.

To learn more about the survey:
- read this New York Times piece

Nurses want protection against ED violence

Anne Zieger — Tue, 11 Nov 2008 10:01:12 -0500

Nurses in Massachusetts have finally had enough of violence in emergency departments. They want a law passed to make it just as illegal to assault nurses and doctors as it is to attack ambulance crews, firemen and women, and police officers.

Stephanie Embrey had enough after being punched in the stomach, subsequently becoming more afraid to go to work for fear of being hurt again. She and other nurses are concerned that the state's attempts to make the emergency room more comfortable by making security officers less obvious has also emboldened upset patients and their families.

The anecdotal evidence is clear: In 2004 half of nurses surveyed had been punched in the last two years, and 25 percent said they had been frequently punched, kicked, scratched, or even bitten. However, the state only keeps track of assault cases in which the employee is injured badly enough to miss one or more days of work.

Nurses want to see conditions improved before the first day of the new year, when a law goes into effect prohibiting Massachusetts hospitals from redirecting ambulances when their emergency rooms are full. They fear that overcrowded waiting rooms will only exacerbate the problem.

To learn more about the legislation that is being proposed:
- read this Boston Globe piece

Related Article:
MA hospital struggles with patient violence

PA bill would end required overtime by health workers

Anne Zieger — Thu, 09 Oct 2008 12:48:07 -0400

A new bill working its way through the Pennsylvania legislature would ban the state's hospitals, ambulatory surgery centers and long-term-care providers from demanding nurses and other clinical workers to work overtime.

The bill, which has passed both chambers of the state's legislature, includes clinical workers who aren't considered supervisors in union contracts, and those who earn hourly wages and those who are temporary workers. On the other hand, it excludes doctors, physician assistants and dentists, as well as other jobs not directly related to care such as clerical and maintenance functions.

The rules aren't without exceptions, included to mollify the Hospital & Healthsystem Association of Pennsylvania. The measure includes language which allows healthcare employers to require overtime under certain specific circumstances, including unforeseeable declared emergencies, unforeseen or extraordinary events (read disasters, terrorism or the like) that impact their staffing needs or big vacancies that substantially affect patient safety. (The bill specifically notes that chronic short-staffing won't cut it as an excuse for mandating overtime.)

To learn more about this bill:
- read this Modern Healthcare article (reg. req.)

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Trend: Hospitals lure nurses with better working conditions

Anne Zieger — Mon, 15 Sep 2008 13:22:30 -0400

In the past, hospitals fought pending nursing shortages by waging a bidding war for nursing staffers. However, this wasn't accomplishing their long-term goals, as turnover remained high. They found that while such strategies attracted nurses, the same nurses would often quit promptly when the hospital across town bid higher. Such losses were disastrous over time, given that it costs $50,000 to $100,000 to replace a nurse given overtime payments to cover shifts, temp staffer pay, recruiting and training costs.

These days, however, many hospitals have shifted strategies, hoping to attract and retain nurses by providing better working conditions than their peers. They're taking a wide variety of steps to do this, including using technology to cut paperwork, offering flexible hours, reducing caseloads and paying for training.

Equally important, progressive hospitals are giving the nurses more input and authority. For example, they're asking nurses what type of equipment is needed and whether patient-nurse ratios are adequate. Other facilities, such as Georgetown University Hospital, are encouraging nurses to conduct new research project, the results of which often become new care plans for the institutions.

Research says that "magnet" hospitals, which offer more training programs and ability for nurses to have more say in patient care, are finding that their flexibility and investment in nurse satisfaction is paying off. For example, the Center for Health Outcomes and Policy Research at the University of Pennsylvania found that nurse satisfaction is significantly higher in magnet hospitals, and just as tellingly, that patients have significantly lower mortality and fewer complications in these facilities.

To find out more about these trend:
- read this Washington Post piece

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Staff at NC mental accused of leaving patient to die

Anne Zieger — Wed, 20 Aug 2008 14:53:03 -0400

Nurses at Goldsboro, NC-based Cherry Hospital have been cited for leaving a patient sitting in a chair for more than 22 hours without feeding him or helping him get to the bathroom. Federal officials say that the death of 50-year-old Steven Sabock at the facility is part of why they may decertify the psychiatric hospital for federal funding. Sabock, most of whose ordeal was recorded on video, sat in the hospital's busy day room through four work shifts. During that period, he ate virtually nothing, according to an investigative report. Also, investigators found no evidence that the nurses had evaluated his nutritional status. Despite the severity of this event, the hospital may be able to keep its federal income if it files an improvement plan that addresses these and other problems.

Other than the fact that the patient had been admitted, this incident bears an uncomfortable similarity to the death of a patient in a New York city psychiatric facility. As in this case, the staff at Kings County Hospital had largely ignored patient Esmin Green for a considerable period, approximately 24 hours.

To learn more about this incident:
- read this McClatchy/Chicago Tribune report

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Joint Commission issues rules designed to stop bad behavior by doctors

Anne Zieger — Thu, 10 Jul 2008 12:38:52 -0400

The Joint Commission has issued a safety alert announcing new requirements for preventing intimidating behavior by doctors. In its statement, the Joint Commission noted that physician threats, outbursts and the use of condescending language, among other behaviors, can make nurses afraid to challenge doctors when they're concerned about potential problems. This can lead to increased medical errors, the group said. (Readers of this publication have all heard tales of, for example, wrong-side or wrong-organ surgery that went ahead because Dr. X wouldn't listen to nurses.)

Nurses who feel bullied aren't just afraid to challenge doctors they feel are making mistakes. They may even be afraid to call them with routine questions, which can lead to patient care problems, researchers have noted. Worse, nurses may make mistakes themselves, due to stress, after having a particularly stressful encounter with a bullying doctor.

However, the Joint Commission hopes to reduce these incidents dramatically. By next year, hospitals will be required to have codes of conduct and processes in place for managing inappropriate behavior by medical staff, including a policy specifically defining acceptable and unacceptable behavior. If they don't, the penalties will be stiff. Hospitals without appropriate anti-bullying systems in place could lose their all-important Joint Commission accreditation.

To learn more about the Joint Commission's ruling:
- read this Associated Press piece
- read the Joint Commission statement

Case study:Houston hires tele-nurses to boost 911 dispatch

Tue, 10 Jun 2008 06:59:55 -0400

Far too often, 911 operators are forced to dispatch ambulance crews who later find out that their services weren't really needed. Now, in an effort to cut down on such wasted calls, the Houston City Council has voted to hire tele-nurses to work with dispatchers. A minimum of two nurses will work around the clock, helping dispatchers give first-aid advice and suggestions on how to find a doctor for callers not experiencing true medical emergencies.

Over the next five years, the city will pay the non-profit Harris County Healthcare Alliance $6.8 million to find the nurses, who will be hired through subcontractor CareNet of San Antonio. The two entities will carry liability insurance offering protection of up to $3 million per claim to cover the exposure in assisting the 911 line.

Houston officials expect the program to save money as well as reducing the strain on local emergency departments. Right now, one 2006 study estimated that the city spends $50 million annually responding to non-emergency 911 calls.

To find out more about the program:
- read this Texas Healthflash item

SPOTLIGHT: Japan faces tough nursing shortage, too

Fri, 23 May 2008 06:59:52 -0400

In case you were wondering, the U.S. isn't the only country struggling with a nursing shortage. Faced with a growing elderly population, Japan is being forced to recruit hundreds of nurses and other caregivers from Indonesia, and expects to do the same in the Philippines and Thailand as well. Article

CA fines 13 hospitals for placing patients at risk

Thu, 22 May 2008 06:59:56 -0400

The California Department of Public Health has disciplined 13 hospitals for placing patients at risk of serious injury or death, fining each $25,000. The agency, which has issued 39 citations since October, won the right to fine facilities for serious violations of patient safety in 2007. Violations included a case in which a car crash victim died at Los Angeles-based public hospital Harbor-UCLA after nurses failed to monitor the patient's failing neurological condition. In another case, Olive View-UCLA was cited when a resident attempted a surgical procedure, handed the patient to another doctor, and failed to communicate that a patient's small intestine may have been perforated in the process.

To learn more about the citations:
- read this Los Angeles Times article

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LA bill offers legal protections for MD care during emergencies

Tue, 20 May 2008 06:59:55 -0400

The Louisiana state legislature is close to passing a package of bills that would protect medical professionals from lawsuits arising from care delivered during declared emergencies. Two of the bills are inspired and backed by Dr. Anna Pou, the New Orleans doctor who was accused of euthanizing patients after Hurricane Katrina. (Pou still faces civil suits related to the deaths in question.) The bills would provide protection against lawsuits for paid medical professionals who aren't covered under the existing Good Samaritan Act, which offers immunity from civil lawsuits for providers who voluntarily offer care to an emergency victim in need. This immunity would protect medical personnel from suits relating to simple negligence, but would still leave room for suits related to gross negligence. The protection would apply only to individual workers, not only to owners of medical facilities.

To learn more about the bills in question:
- read this item from The Times-Picayune

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