Category Archives: Health Care Workers

Prospective study of violence against ED workers

Source: Terry Kowalenko, Donna Gates, Gordon Lee Gillespie, Paul Succop, Tammy K. Mentzel, American Journal of Emergency Medicine, Volume 31, Issue 1, January 2013

From the abstract:
Background: Health care support occupations have an assault-injury rate nearly 10 times the general sector. Emergency departments (EDs) are at greatest risk of such events.
Objective: The objective was to describe the incidence of violence in ED health care workers (HCWs) over 9 months. Specific aims were to (1) identify demographic, occupational, and perpetrator factors related to violent events (VEs) and (2) identify predictors of acute stress in victims and predictors of loss of productivity.
Methods: A longitudinal, repeated-methods design was used to collect monthly survey data from ED HCWs at 6 hospitals. Surveys assessed number and type of VEs, and feelings of safety and confidence. Victims also completed specific VE surveys. Descriptive statistics and a repeated-measure linear regression model were used.
Results: Two hundred thirteen ED HCWs completed 1795 monthly surveys and 827 VEs were reported. Average VE rate per person per 9 months was 4.15. Six hundred one events were physical threats (PTs) (3.01 per person). Two hundred twenty six events were assaults (1.13 per person). Five hundred one VE surveys were completed, describing 341 PTs and 160 assaults. Men perpetrated 63% of PTs and 52% of assaults. Significant differences in VEs were reported between registered nurses (RNs) and medical doctors (MDs) and patient care assistants. The RNs felt less safe than the MDs. The MDs felt more confident than the RNs in dealing with violent patients. The RNs were more likely to experience acute stress than the MDs (P < .001). Acute stress reduced productivity. Conclusion: Emergency department HCWs are frequent victims of violence perpetrated by visitors and patients. This results in injuries, acute stress, and lost productivity. Acute stress has negative consequences on workers' ability to perform their duties. Related: Detroit area hospitals fight to stem emergency room violence
Source: Karen Bouffard, Detroit News, July 1, 2013

The Surrender of Oakland: The 2012 National Agreement between the Coalition of Kaiser Permanente Unions and Kaiser Permanente

Source: John Borsos, WorkingUSA, Volume 16, Issue 2, June 2013
(subscription required)

From the abstract:
A new, controversial agreement negotiated by the Coalition of Kaiser Permanente Unions (CKPU), led by the Service Employees International Union (SEIU) with Kaiser Permanente, the nation’s largest health maintenance organization, may portend a dangerous shift in labor relations in the U.S. In this case, it is the unconditional surrender of a union to a corporation’s agenda. The Surrender of Oakland—embodied in the 2012 Kaiser–CKPU national agreement—represents the complete capitulation of labor to management: in production, in marketing and capitalization, and even by allowing the employer to control Kaiser workers’ lives outside the workplace through an invasive wellness program. Abdicating their role as patient advocates, the new agreement requires SEIU and other coalition unions to promote wellness programs that may not be in anyone’s best interest except for employers trying to shift healthcare costs onto employees.

Verbal Abuse From Nurse Colleagues and Work Environment of Early Career Registered Nurses

Source: Wendy Budin, Carol Brewer, Christine T. Kovner, Ying-Yu Chao, Journal of Nursing Scholarship, Early View, 2013

Verbal abuse against nurses in the workplace, including abuse by other nurses, is both common and well-documented. The negative effects of that abuse and the adverse impact on patient care are also well-documented. Now, a study of newly licensed registered nurses (NLRNs) finds that nurses who are verbally abused by nursing colleagues report lower job satisfaction, unfavorable perceptions of their work environment, and greater intent to leave their current job….Intimidating and disruptive aggressive behaviors in the nursing workplace such as bullying, harassment, and verbal abuse contribute to medical errors, poor patient outcomes, and nurse turnover….
See also:
press release

The Evolving Role of Emergency Departments in the United States

Source: Kristy Gonzalez Morganti, Sebastian Bauhoff, Janice C. Blanchard, Mahshid Abir, Neema Iyer, Alexandria Smith, Joseph V. Vesely, Edward N. Okeke, Arthur L. Kellermann, RAND, Research Reports, RR-280, 2013

From the abstract:
The research described in this report was performed to develop a more complete picture of how hospital emergency departments (EDs) contribute to the U.S. health care system, which is currently evolving in response to economic, clinical, and political pressures. Using a mix of quantitative and qualitative methods, it explores the evolving role that EDs and the personnel who staff them play in evaluating and managing complex and high-acuity patients, serving as the key decisionmaker for roughly half of all inpatient hospital admissions, and serving as “the safety net of the safety net” for patients who cannot get care elsewhere. The report also examines the role that EDs may soon play in either contributing to or helping to control the rising costs of health care.

Nurse–Patient Ratios as a Patient Safety Strategy: A Systematic Review

Source: Paul G. Shekelle, Annals of Internal Medicine, Vol. 158 No. 5 Part 2, March 2013

From the abstract:
A small percentage of patients die during hospitalization or shortly thereafter, and it is widely believed that more or better nursing care could prevent some of these deaths. The author systematically reviewed the evidence about nurse staffing ratios and in-hospital death through September 2012. From 550 titles, 87 articles were reviewed and 15 new studies that augmented the 2 existing reviews were selected. The strongest evidence supporting a causal relationship between higher nurse staffing levels and decreased inpatient mortality comes from a longitudinal study in a single hospital that carefully accounted for nurse staffing and patient comorbid conditions and a meta-analysis that found a “dose–response relationship” in observational studies of nurse staffing and death. No studies reported any serious harms associated with an increase in nurse staffing. Limiting any stronger conclusions is the lack of an evaluation of an intervention to increase nurse staffing ratios. The formal costs of increasing the nurse–patient ratio cannot be calculated because there has been no evaluation of an intentional change in nurse staffing to improve patient outcomes.

Key Summary Points
– Cross-sectional studies, mostly in intensive care unit or postsurgical settings, support a relationship between the number of nurses staffed per patient and inpatient mortality.
– The strongest evidence supporting a causal relationship between higher nurse staffing levels and decreased inpatient mortality comes from a longitudinal study in a single hospital that carefully accounted for nurse staffing levels and found decreases in mortality of 2% to 7%.
– Limiting any stronger conclusions is the lack of an evaluation of an intervention to increase nurse staffing ratios.

2013 Assisted Living State Regulatory Review​

Source: National Center for Assisted Living (NCAL), March 2013

From the summary:
Published in March 2013, this report offers a state-by-state summary of assisted living regulations covering 21 categories; provides contact information for state agencies that oversee assisted living activities; and includes each agency’s Web site address.

Eighteen states reported making regulatory, statutory, or policy changes impacting assisted living/residential care communities from January 2012 through January 2013. At least nine of these states made major changes, including Colorado, Georgia, Michigan, Missouri, New Jersey, New York, Ohio, Oregon, and Washington. In 2012, states continued developing new models for surveys, expanding disclosure and reporting requirements, addressing life safety and infection control issues, and allowing increased delegation of medication administration to non-nurse staff.

– New Jersey and Colorado joined the small but growing number of states with innovative survey approaches, developed in part to help better target resources. New Jersey’s Department of Health (DOH) collaborated with The Health Care Association of New Jersey Foundation to create a voluntary program called Advanced Standing. To receive this distinction, a facility must comply with all applicable regulations as well as submit quality data reaching benchmarks established by a peer review panel. Participating facilities do not receive a routine survey, but any time a facility falls below DOH standards, it can be removed for cause from the program. The state also performs follow-up surveys based on a random sample. In January 2013, Colorado began conducting risk-based re-licensure inspections for assisted living residences (ALRs), initially on a pilot basis. Under the new system, ALRs meeting criteria specified in the law will be eligible for an extended survey cycle. In 2012, Michigan also began using a new renewal inspection system.
– After creating an additional level of licensure for assisted living communities a year earlier, Georgia updated rules for personal care homes in January 2013, including new requirements for additional staff training, staffing above minimal standards, and a resident needs assessment upon move-in. Also effective in January 2013, New York adopted rules stating that no adult home with a capacity of 80 residents or greater may admit or retain more than 25 percent census of residents with serious mental illness.
– Several states made changes to policies and rules for care provided to residents receiving Medicaid services, some to accommodate managed care contracting. In 2012, the state of Washington changed its licensure term to “assisted living facility” from the outdated “boarding home.” Oregon began requiring facilities to adopt policies for the treatment or referral of acute sexual assault victims.

Texas on the Brink

Source: Texas Legislative Study Group, March 2013

…In Texas today, the American dream is distant. Texas has the highest percentage of uninsured adults in the nation. Texas is dead last in percentage of high school graduates. Our state generates more hazardous waste and carbon dioxide emissions than any other state in our nation. If we do not change course, for the first time in our history, the Texas generation of tomorrow will be less prosperous than the generation of today. Without the courage to invest in the minds of our children and steadfast support for great schools, we face a daunting prospect. Those who value tax cuts over children and budget cuts over college have put Texas at risk in her ability to compete and succeed….

Incidence of needlestick and other sharp object injuries in newly graduated nurses

Source: Ya Hui Yang, Shyh Jong Wu, Chao Ling Wang, Chun Yuh Yang, Saou Hsing Liou, Trong Neng Wu, AJIC: American Journal of Infection Control, Article in Press, published online 13 March 2013
(subscription required)

Nurses are particularly at high risk of needlestick and injuries by other sharp object (hereafter called needlestick injuries). Newly graduated nurses (hereafter called new nurses) now comprise >10% of a typical hospital’s nursing staff. Nursing students have a higher risk than registered nurses. As nursing students graduate and become new nurses, their needlestick injuries warrant close attention. However, there have been few studies looking into needlestick injuries in new nurses.