Category Archives: Health Care Workers

Managing the Human Toll Caused by Seasonal Influenza: New York State’s Mandate to Vaccinate or Mask

Source: Arthur Caplan, Nirav R. Shah, JAMA: Journal of the American Medical Association, Viewpoint, Vol 310, No. 17, November 6, 2013
(subscription required)

…The state of New York it implementing a first-of-its-kind mandate for the use of masks in all unvaccinated health care personnel, both staff and volunteer. The new regulation, which goes into effect with the 2013-2014 flu season, requires unvaccinated health care personnel in regulated settings to wear a surgical mask in areas where patients or residents may be present. These settings include hospitals, nursing homes, diagnostic and treatment centers, home care agencies, and hospices. Under the new regulations, health care facilities are obligated to report the number of personnel who have been vaccinated and must supervise unvaccinated staff to ensure the appropriate use of masks. Personnel who fail to comply will be subject to the same institutional disciplinary procedures imposed on workers who do not follow other infection control procedures. In addition, the state may cite a facility for failure to comply with these regulations if requirements are not met…

16-Hour Shifts, But Not a Real Worker?

Source: Sarah Jaffe, In These Times, Working ITT blog, October 23, 2013

Resident physicians work long, grueling hours as they finish their medical training. Eighty hours a week or more is typical. During that time, under the supervision of an attending physician, they have major responsibilities—making medical decisions, treating patients and performing surgeries…. For that, the residents are typically paid $40,000 to $50,000 a year. Hospitals get a great deal: Residents are required to do between three and six years of training depending on their speciality, and while they’re doing that training, they’re a lot cheaper than a hospitalist, who might make $200,000. And the promise of that future fat salary keeps residents hustling through these broke, overworked years. It’s a recipe for exhaustion and exploitation that led Graff and his colleagues to think a union could help. He sees the union as an opportunity for residents to speak to each other, compare problems, and negotiate with the hospital over common issues rather than struggling alone….

…Healthcare workers, who are held to a standard of selfless care, face a particular form of pushback when they make demands for themselves. Administrators often say that asking for shorter hours or better pay shortchanges patients, who are the reason healthcare workers went into the field in the first place. Yet overworked, stressed doctors can’t be good for patient care either…

Health Care’s Unrivaled Job Gains and Where it Matters Most

Source: Joshua Wright, Economic Modeling Specialists Intl., October 7, 2013

…As EMSI and CareerBuilder’s recent analysis makes clear, no segment of the economy has withstood downturns and uncertainty better than hospitals, offices of physicians, home health care providers and the other industries that make up the health care sector…. From 2001 to 2002, when a recession slowed hiring in most sectors, health care (including government-run hospitals) added 530,000 jobs, a 4 percent increase. And since 2007, employment in health care has ballooned 10.7 percent (an addition of 1.85 million jobs) while all other industries in the U.S. have declined 2.8 percent (a loss of 3.85 million jobs)….

…The three states with the highest share of health care jobs – Rhode Island (16.5 percent), West Virginia (16.0) and Maine (15.6) – each have larger-than-average concentrations of residents 60 years or older, which increases the need for health care services.

While Northeast states tend to have older populations, and thus higher shares of health care workers, this trend can be found across the United States. After Rhode Island, West Virginia and Maine, health care jobs are most prominent in Pennsylvania (15.7 percent), New York (15.6) and Massachusetts (15.3)….

Hospitals With Higher Nurse Staffing Had Lower Odds Of Readmissions Penalties Than Hospitals With Lower Staffing

Source: Matthew D. McHugh, Julie Berez and Dylan S. Small, Health Affairs, Vol. 32 no. 10, October 2013
(subscription required)

From the abstract:
The Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals’ financial incentives with payers’ and patients’ quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses’ efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.

Developing Guidelines for Evaluating the Results of Criminal Background Checks

Source: Nikki Hopkins, Katherine Thomas, Journal of Nursing Regulation, Volume 4, Number 3, October 2013
(subscription required)

From the abstract:
Criminal history is becoming a significant challenge in determining appropriate sanctions for licensed nurses and applicants. Through the development of objective disciplinary guidelines for criminal conduct, the Texas Board of Nursing has been able to ensure consistency and fair consideration of criminal history information in licensing and disciplinary decisions. This article describes the development of the guidelines, the underlying policy considerations, and the efforts to maintain and improve them.

Policies and Practices in the Delivery of HIV Services in Correctional Agencies and Facilities – Results From a Multisite Survey

Source: Steven Belenko, Matthew Hiller, Christy Visher, Michael Copenhaver, Daniel O’Connell, William Burdon, Jennifer Pankow, Jennifer Clarke, Carrie Oser, Journal of Correctional Health Care, Vol. 19 no. 4, October 2013
(subscription required)

From the abstract:
HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of correctional agency partners from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) revealed that HIV policies and practices in prevention, detection, and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery gaps in corrections.

Health Care Workers Unprotected: Insufficient Inspections and Standards Leave Safety Risks Unaddressed

Source: Keith Wrightson, Taylor Lincoln, Public Citizen, July 17, 2013

From the press release:
Health care workers suffer more injuries and illnesses on the job each year than those in any other industry, but the Occupational Safety and Health Administration (OSHA) conducts relatively few inspections of health care facilities and is hamstrung in its ability to take action to resolve unsafe conditions by an absence of needed safety standards, a new report by Public Citizen shows…. Nurses, nursing aides, orderlies and attendants suffer more musculoskeletal injuries than workers in any other field. Costs associated with back injuries in the health care industry are estimated to be more than $7 billion annually….

New Study Challenges Conventional Wisdom on Pay-for-Performance Incentive Programs

Source: Robert Wood Johnson Foundation (RWJF), Press Release, September 19, 2013

One of the many approaches the Affordable Care Act takes to making health care more efficient is pay-for-performance incentives for clinicians. The underlying idea is that if doctors, nurses, physician assistants, and others are judged and rewarded based on the quality of the care they provide and actual patient outcomes, more of the necessary interventions will occur while fewer unnecessary tests and procedures will be performed, saving money and improving the quality of care.

Various studies have tested the concept, reaching mixed results. But two new studies by Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research recipient R. Adams Dudley, MD, MBA, and colleagues suggest that for incentives to be effective, they must be carefully targeted and designed.

Dudley’s two studies were published this month in the Journal of the American Medical Association. The first tests the effectiveness of incentives for small medical practices that have implemented electronic health records (EHRs). The second focuses on how incentives should be distributed to achieve maximum effect—to individual clinicians, to their practices, or to both….
Effect of Pay-for-Performance Incentives on Quality of Care in Small Practices with Electronic Health Records – A Randomized Trial
Source: Naomi S. Bardach, Jason J. Wang, Samantha F. De Leon, Sarah C. Shih, W. John Boscardin, L. Elizabeth Goldman, R. Adams Dudley, Journal of the American Medical Association, Vol. 310 No. 10, September 11, 2013

Effects of Individual Physician-Level and Practice-Level Financial Incentives on Hypertension Care – A Randomized Trial
Source: Laura A. Petersen, Kate Simpson, Kenneth Pietz, Tracy H. Urech, Sylvia J. Hysong, Jochen Profit, Douglas A. Conrad, R. Adams Dudley, LeChauncy D. Woodard, Journal of the American Medical Association, Vol. 310 No. 10, September 11, 2013