Posts Tagged ‘Hospital-acquired infections’

Burnout Affects 30 Percent of Nurses

Wednesday, August 29th, 2012

With hospitals slashing costs to cope with growing financial pressures, nurses believe that the resulting insufficient staffing is detrimental to patients.  A team from the University of Pennsylvania has identified a key reason for this: Hospitals where relative fewer caregivers work typically provide inferior care.  If hospitals reduced their proportion of burned-out nurses to 10 percent from the prevailing 30 percent, they would prevent 4,160 cases a year of the two most-common hospital-acquired infections and save $41 million in Pennsylvania alone.  “It is costing hospitals more money not to spend money on nursing,” said Linda H. Aiken, one of the study’s authors and director of the Penn Nursing School’s Center for Health Outcomes and Policy Research.

The researchers determined that the nurses studied averaged 5.7 patients on a typical shift, said Rutgers University professor Jeannie Cimiotti.  “Maybe they are staffed a little bit above what they should, but if they (hospitals) can provide an organizational climate that’s conducive to nursing, I think they’d be fine,” Cimiotti said. “That doesn’t mean you can overburden them because workload is one of those factors that does contribute to burnout.”

“Most burnout is related to high workload,” said Patricia Eakin, an ER nurse who is president of the Pennsylvania Association of Staff Nurses and Allied Professionals.  Patients nowadays need a whole lot of care. There’s a lot of equipment, a whole lot of fancy things. A lot of things that take a lot of time and a lot of attention.”

Historically, the number of nurses per patient was low following World War I.  At what would ultimately become Baylor University Medical Center, the hospital in 1919 accommodated 225 patients who were cared for by a nursing staff of 12 graduates and 100 students.  As recently as the 1980s, nurses often cared for eight or nine patients (Insert Nurse Together link here.)  The night shift could see a single nurse caring for as many as a dozen patients, often without a Certified Nursing Assistant (CNA) to assist.

The shift in the United States from Florence Nightingale’s concept of multi-bed wards (which often contained 30 or more beds and were typically staffed by one or two nurses) to private and semi-private rooms started in the years following World War II and was mostly complete by the 1970s.  Private hospital rooms at this time were primarily reserved for patients whose families could afford to pay extra to keep their relative out of a ward and hire a private duty nurse to provide one-on-one care.  According to Jean C. Whelan, PhD, RN, “Private-duty nursing was the employment of nurses by individual patients for the delivery of care.  Patients hired their own nurse, who cared for them either in their homes or in the hospital.  Patients paid the nurse for her services with cash, based on a predetermined fee.  The nurse, generally employed for the duration of an illness, cared for only one patient at a time.  In essence, the private-duty nurse delivered highly individualized care to paying patients for as long as a patient needed and could pay for the nurse’s services.”

According to a U.S. National Library of Medicine of the National Institutes of Health Study, thousands of nurses — the vast majority of them women — migrate each year in search of better pay and working conditions, career mobility, professional development, a better quality of life, personal safety, or sometimes just novelty and adventure.  The percentage of foreign-educated physicians working in Australia, Canada, the United Kingdom, and the United States is currently reported to be between 21 and 33 percent, while foreign-educated nurses represent five to 10 percent of these countries’ nurse workforce.”

In 1994, nine percent of total registered nurses were foreign-born RNs; by 2008 that percentage had risen to 16.3 percent, or about 400,000 RNs.  Of those, approximately 10 percent had immigrated to the U.S. during the previous five years. About one-third of growth in RNs between 2001 and 2008 was fueled by foreign-born RNs.  The news is not all positive, though.  According to Newsweek, “While pay has risen in some regions to attract more nurses, in recent years it has flattened at the national level.  That’s why up to 500,000 registered nurses are choosing not to practice their profession — fully one-fifth of the current RN workforce of 2.5 million.”

Bringing those badly needed nurses from overseas is not always easy, said William R. Moore of El Centro Regional Medical Center in California, who has been waiting two years for 20 nurses from the Philippines he recruited to obtain visas.  In the meantime, Moore can’t find talent in the area.  “We’re in the poorest and least literate county in California, right in the middle of the desert,” says Moore. “We’re not a destination for (American) nurses.”

As the role of registered nurses has evolved over the years to encompass increased responsibility, so too, have the educational requirements.  A two-year associate degree (AND) or a four years bachelor’s degree — typically a Bachelor of Science in Nursing (BSN) — are the two primary degrees required in the 21st century.  Many nurses opt to pursue their Master of Science in Nursing (MSN) degree, which requires a minimal commitment of two years to complete the course work.  Others go even further in their educations, studying for a Doctor of Philosophy (PhD) or a Doctor of Nursing Practice (DNP).

Studying for a BSN degree — like all college educations – doesn’t come cheaply.  According to the Registered Nurse Education Requirements website, “Tuition and clinical fees together make up the total cost of nursing education while the tuition fee for a two-year nursing course in a community college is just $1,400, the clinical fees can are considerably higher at $4,000 plus per semester.  For a bachelors course the students end up paying almost $7,000 to $8,000 in clinical fees while the tuition is still lower at just $2,000 to $3,000 per semester.  Apart from this, students will also have to incur the cost of books, parking, basic living expenses and housing in case of out-of-town colleges. The cost of training at hospital affiliated nursing schools can be higher at $55,000 for resident student and over $100,000 for non-residents.”

ACA Is Fixing U.S. Healthcare Delivery: Donald Berwick

Wednesday, January 4th, 2012

Dr. Donald Berwick, who oversaw Medicare and Medicaid until recently said the programs are trapped in a health system that promotes wasteful spending and inefficient care. “Healthcare is broken,” Berwick, who headed the Centers for Medicare and Medicaid Services (CMS), said.  “We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste and unreliable.  Despite the best efforts of the workforce, we built it wrong. It isn’t built for modern times.”  Berwick said the Patient Protection and Affordable Care Act (ACA) is changing how physicians and hospitals are paid and deliver care through such innovative arrangements as accountable care organizations (ACOs), which improve coordination and lower costs.”

According to Berwick, it is not clear whether these efforts will produce results quickly enough to silence the critics who want to make more radical changes that would shift the majority of the burden onto beneficiaries.  “That is the central question, the nub…whether that will happen fast enough, I just don’t know.”

To read the full transcript of Berwick’s remarks, click this link:

Berwick defended his tenure as CMS administrator. Even though he failed to win Senate confirmation, that did not impact his ability to get things done, though he would have preferred a longer term.  “An agency of this size will do better with longer-term leadership commitment,” he said.  With the knowledge that his tenure was likely to be short, Berwick felt a greater sense of urgency to achieve things.  Berwick’s most challenging decisions involved state requests to cut Medicaid benefits and writing regulations to encourage doctors and hospitals to form ACOs, while not making the requirements overly burdensome.

Berwick took exception to state’s efforts to limit hospital coverage for Medicaid recipients, which is presently under review by federal regulators.  Hawaii has proposed a 10-day limit on some enrollees; Arizona has proposed a 25 day limit.  “It’s a nonsensical idea.  If a patient needs 20 days, the patient should get 20 days,” he said.

According to the Bangor Daily News, Berwick’s departure from CMS is “an unnecessary loss.” Berwick’s parting words should help Americans understand how their health system is in the process of being improved.  The article notes that “Waste is a broad term, including needless medical procedures, failure of adequate preventive measures, duplication and inefficiency, as well as outright fraud.  Hospital-acquired infections have caused the deaths of almost 100,000 Americans each year and the illness of millions more, according to the U.S. Centers for Disease Control and Prevention.  Dr. Berwick has reported that these complications have added as much as $45 billion a year to hospital costs borne by taxpayers, insurers and customers.  He said that some hospitals have virtually eliminated some infections that other hospitals still consider inevitable.  Under the Affordable Care Act, sometimes called Obamacare, financial incentives will go to hospitals that excel in fighting these infections starting in 2015.

Unnecessary hospital readmissions add another $12 billion a year, estimates the Medicare Payment Advisory Commission.  It says half or more of these readmissions could be prevented through better coordination and patient education, permitting them to recover at home rather than re-entering the hospital with complications.  ‘Integrated care’ will also reduce costs, said Dr. Berwick, by protecting patients from having to tell their stories over and over to different providers and letting a doctor know what medication they had already been given.  No figure is available for the savings from automated record keeping, but it is becoming substantial.  Preventive medicine is already reducing waste, for example by detecting diseases at early stages for prompt treatment.  The Affordable Care Act makes preventive benefits like cholesterol tests, mammograms and screening for colon and rectal cancer free for everyone with Medicare.”