Advocates of mandated staffing ratios say they improve patient outcomes. A recent study finds otherwise.
Nurse-to-patient ratios are a hot button issue. Look no further than Massachusetts for an example. After a battle that included a legal challenge that put it before the state's Supreme Judicial Court, Baystate voters will see a ballot question on nurse-to-patient ratios in November.
Proponents of the initiative say it would improve patient safety while opponents say it would be too costly for the healthcare system to support.
And now, to add fuel to the fire, new research by physician-researchers at Beth Israel Deaconess Medical Center finds Massachusetts' previous regulations regarding nurse-to-patient staffing ratios in intensive care units were not associated with improvements in patient outcomes.
"We hypothesized that Massachusetts ICU nurse staffing regulations would result in decreased complications and mortality for critically ill patients when compared with patients admitted to ICUs across the country unaffected by Massachusetts regulations," lead author Anica C. Law, MD, core faculty at the Center for Healthcare Delivery Science and staff physician in the Division of Pulmonary, Critical Care, and Sleep Medicine at BIDMC, says in a news release. "But we did not identify improvements in patient outcomes associated with the state’s nursing requirements."
The Mandate
In 2014, Massachusetts passed a law requiring 1-to-1 or 2-to-1 patient-to-nurse staffing ratios in intensive care units, as guided by a tool that accounts for patient acuity and anticipated care intensity.
Researchers examined records from 246 medical centers nationwide and compared patient outcomes in Massachusetts’ six academic ICUs with outcomes in 114 out-of-state academic ICUs before, during, and after the state mandate was implemented.
They reviewed tens of thousands of ICU admissions, focusing on the change in mortality rates for patients in Massachusetts’ academic ICUs before and after the mandate was implemented. This information was compared with patients hospitalized in out-of-state hospitals.
Other analyses looked at changes occurring at community, non-academic ICUs and among a group of the sickest patients who received support from a ventilator. The research team also analyzed complication rates, including central line-associated bloodstream infections, catheter-associated urinary tract infections, hospital-acquired pressure ulcers, and patient falls with injury.
Staffing Ratio Results
Before and after the mandate's implementation, researchers found modest increases in ICU nurse staffing ratios—a change from 1.38 patients per nurse to 1.28 patients per nurse.
These increases were not significantly higher than staffing trends in states without state-mandated ICU staffing regulations. According to the researchers, this suggests nurse staffing increases in Massachusetts could not be attributed to the state legislation.
Additionally, the risk of mortality and risk of complications in Massachusetts’ ICUs remained stable after the law’s implementation, with no significant difference in trends compared to out-of-state hospitals.
"Our results suggest that the Massachusetts nursing regulations were not associated with changes in staffing or patient outcomes," Law says. "The modest changes in nurse staffing we saw in Massachusetts – approximately one extra nurse per 20-bed ICU per 12-hour shift – remained unassociated with changes in hospital mortality."
Yet, some research has reported different findings regarding nurse-to-patient ratios.
The AACN's online tool can effectively assess the health of work environments across a wide range of healthcare professions and settings.
What makes a work environment healthy? According to the American Association of Critical-Care Nurses, it's a place where healthcare professionals can make their optimal contribution. For almost a decade, critical-care nurses have been able to evaluate the health of their work environment with the association's online assessment tool based on its Healthy Work Environment standards.
Now a new study finds the tool has applications beyond critical-care, and is effective for assessing the health of the work environment for interprofessional patient care teams throughout a hospital's patient care settings.
“Although AACN’s assessment tool has been used primarily among acute and critical care nurses, our findings support consideration of wider use in multiple healthcare settings,” says Jean Anne Connor, PhD, RN, CPNP, director of nursing research, cardiovascular and critical care patient services at Boston Children’s Hospital, and the study's principal investigator. “Clinical leaders understand that to safeguard the quality of patient care, attention must be focused on the performance of healthcare teams.”
The Interprofessional Team
The assessment tool is an 18-question survey designed to help organizations or departments identify areas for improvement. It assists in measuring the health of a work environment against AACN's six Healthy Work Environment standards:
Skilled communication
True collaboration
Effective decision making
Appropriate staffing
Meaningful recognition
Authentic leadership
The study, published in the American Journal of Critical Care, reports the results of a two-phase administration of the tool to 2,621 patient-care employees at Boston Children’s Hospital.
Researchers administered the survey using a test-retest, two-stage approach. First, the AACN Healthy Work Environment Assessment Tool was administered to all healthcare team members, including:
physicians
nurses
social workers
therapists
clinical assistants
administrators
The first survey wave received 1,030 responses from 2,621 potential employee participants. Three weeks later, a second survey was sent to a random sample of 200 potential respondents stratified by role (physician, nurse, and others). The response rate for the second wave was 83.5%.
The results of the responses showed that the AACN Healthy Work Environments Assessment Tools is reliable and valid, supporting its use as an organizational measure.
Expanded Use
The Boston Children's Hospital has used the Agency for Healthcare Research and Quality’sHospital Survey on Patient Safety Culture since 2010 to assess how employees perceive their work environment regarding patient safety. It has also administered the AACN online assessment tool to interprofessional staff in critical care and cardiovascular programs annually since 2010 and recently expanded it to an enterprise-wide assessment.
The study's results have been used in the development of measurement benchmarks and led to use of the Healthy Work Environments Assessment Tool in a nurse-led consortium of 30 cardiovascular programs in freestanding children’s hospitals.
Nurse leaders should review and revisit social media policies to prevent HIPAA violations.
A Houston nurse was fired after allegedly violating HIPAA laws by posting about a patient with measles in an anti-vaccination Facebook group, reports the Dallas News.
While it may seem obvious that nurses should be savvy about patient privacy and social media use, this incident—as well as others—illustrate that more education is needed.
"Nurses need to be aware of the professional reputation they're creating for themselves and how they're using online tools," says Robert Fraser, MN, RN, a primary care nurse, author, and digital health strategist from Toronto, Ontario, Canada. "Social media does provide new opportunities and new ways of approaching how we communicate, but nurses need to reflect on their professional identity and their professional expectations within the workplace."
Reviewing hospital policies with their staff is one step nurse leaders can take to help prevent these types of incidents.
"What I encourage organizations to do is a) make sure they have a policy and b) that it's something they revisit over time," Fraser advises.
Some expectations, such as privacy rules including HIPAA, may already exist within other policies.
Fraser says there is a hierarchy of professional practice obligations and social media connects with all of them.
The highest level of the hierarchy pertains to laws, such as HIPAA, or other federal privacy legislation.
Before a nurse decides to post something on a social media channel, he or she should think about how that tool ties into professional practice.
Rather than restricting employees' access to social media while they are in the facility (as some organizations do) nurse leaders can model positive use of these tools.
For example, Fraser knows of a hospital that has used Facebook as an additional way of communicating information posted on the intranet or by email. They have also shared photos of nurses (taken with permission and without sharing identifying patient information) to highlight the work staff is doing.
"They were encouraging nurses to follow so that when they were looking at news updates and seeing what might be going on in their social world, they may also be able to engage around the positive professional behaviors that the organization wanted to endorse," he says.
Following an improvement initiative, emergency nurses reported increased knowledge of how to handle an active shooter incident.
An active shooter incident is something no nurse wishes to experience. Unfortunately, these situations can, and do, happen at healthcare organizations across the country.
Bon Secours Richmond Community Hospital, in fact, was on lockdown Wednesday following a threat of a shooting on its campus, the Richmond Times-Dispatchreported.
To prepare emergency department staff to effectively handle these types of incidents, active shooter training and simulations are a must, according to a new practice improvement initiative and study in the Journal of Emergency Nursing.
The goal that drove the initiative was to develop and successfully implement a safety strategy that increased the ability of a large pediatric emergency department staff to effectively respond to an active shooter in their hospital.
Survey results showed that of the 202 emergency nurses and ancillary staff members who participated in active shooter training:
92% felt better prepared to respond if a shooting occurred at their facility.
70% of participants reported an increase in knowledge and readiness.
Participants reported their first response to an active shooter incident would be:
Flee the scene (66%)
Protect patients (15%)
Hide (7%)
Fight (6%)
Call 911 (4%)
"We are in the infancy stage of this conversation," says study co-author and Emergency Nurses Association member Mary Baker, BSN, RN, of active shooter training in hospitals. "As emergency nurses, we practice our ACLS and PALS a lot. We've gotten very proficient at it because it's always top of mind. But when it comes to preparing for a catastrophe such as an active shooter in our own emergency department, most nurses have no idea how we'd react because we aren't preparing for it."
Nurse-patient ratios can increase by 50% when neurocritical care RNs travel off the unit to accompany patients to tests.
After a period of multiple changes and high nurse turnover in the 32-bed neurocritical care unit at Riverside Methodist Hospitalin Columbus, Ohio, two of the organization's RNs began pondering the question, 'Are neurocritical care nurses performing 14 hours of work on a 12-hour shift?'
As a result, Michelle Hill, MS, RN, AGCNS-BC, CNRN, CCRN, SCRN, and Jessica DeWitt, BSN, RN, conducted a workflow study to assess relationships between these various nursing responsibilities:
neurological assessment
documentation
traveling with patients for diagnostic tests
The study, published in the Journal of Neuroscience Nursing, also measured the effects of patient acuity and nurse experience.
The study found that for nurses on neurocritical care units, accompanying patients for imaging scans and other procedures significantly impacted nurse-patient staffing ratios.
Traveling Impacts Ratios
Over 30 days, observations showed that neurocritical care nurses spent more than 226 hours traveling with patients. The main tests and procedures involved were CT and MRI scans and vascular interventional radiology procedures.
The study found:
About 4.5 hours of a 12-hour shift were spent off the unit traveling for these tests
One nurse was off the unit for 38% of the shift.
"When a nurse travels there is a patient left behind for another nurse to care for," Hill says in a news release. "This alters the staffing and requires 'flexing up' – meaning that the nurse-patient ratio increases 33% to 50% during those times."
Nurses' experience levels were not significantly related to the amount of time needed to perform and document the results of neurological assessments.
However, less-experienced nurses spent more time documenting higher-acuity patients' statuses compared to experienced RNs.
New Positions Created
"Patients in a neurologic critical care unit require more staffing to account for the frequent neurologic assessments, charting, and traveling," the researchers write in the study.
Based on the workflow analysis, the authors recommended a new "circulator" nurse position to travel and assist with patients. Adding this position would, free primary nurses on the unit to stay with their patient.
Because the study identified an average of 2.5 high-acuity patients per day requiring a dedicated one-to-one nurse assignment for procedures and recovery time, Dewitt and Hill also recommended three new "one-to-one" staff positions to enable high-acuity patients or those with multiple diagnostic tests scheduled to be assigned to a dedicated nurse.
"Implementing additional staffing will counteract this unique characteristic of neurologic critical care patients and provide a possible tool to enhance retention," they write.
Increasing the percentage of women who complete at least 40 weeks of pregnancy
Decreasing the percentage of women who choose elective inductions or elective C-sections
Increasing nurses' and other pregnancy-care providers' effectiveness in reducing the number of elective inductions and C-sections
But a new studyhas made a surprising find—inducing labor in healthy women at 39 weeks into their pregnancy reduces the need for a C-section and is at least as safe for mothers and infants as waiting for spontaneous labor.
Induced Labor—A Safe Option
The study, published online in the New England Journal of Medicine, looked at 6,106 first-time mothers enrolled in the ARRIVE clinical trial. Carried out at 41 hospitals participating in the National Institutes of Health-supported Maternal Fetal Medicine Units Network, ARRIVE examined outcomes from two groups of healthy, first-time mothers. One group elected to induce labor at 39 weeks. The other group took part in expectant management—waiting for spontaneous labor but utilizing intervention if a medical need occurs.
The study found:
On average, women electing to induce at 39 weeks delivered nearly one week earlier than women who waited for spontaneous labor.
C-section delivery was less likely after elective induction (18.6%) than after expectant management (22.2%).
Women who chose to induce at 39 weeks had lower rates of preeclampsia (9%) than those who waited for spontaneous labor (14%).
A composite score measuring several health indicators in newborns including death, seizures, hemorrhage, and trauma did not differ significantly between the two groups.
Infants born after elected induction at 39 weeks needed less respiratory support after delivery.
"This doesn't mean that everyone should be induced at 39 weeks," says the study's co-author Robert Silver, MD, chair of obstetrics & gynecology at University of Utah Health and a maternal-fetal medicine physician at Intermountain Healthcare in Salt Lake City. "Electing to induce labor is a reasonable option that may give the best chance for vaginal delivery and improve outcomes."
Decreasing Unnecessary C-Sections
Based on the study's findings, the researchers estimate that inducing labor at 39 weeks could eliminate the need for one C-section for every 28 deliveries.
Since 2016, about 32% of infants have been delivered by C-section in the U.S., and medically unnecessary C-sections among healthy first-time mothers account for 80% of those deliveries.
"We're always trying to find the safest way to deliver babies and take care of our patients," says M. Sean Esplin, MD, an associate professor of obstetrics and gynecology at University of Utah Health and chief of maternal-fetal medicine at Intermountain Healthcare. "If the primary goal is to keep rates of C-sections down, then elective induction is an option."
Researchers are evaluating whether induction at 39 weeks is cost effective.
A 2017 article on the website MONEY, reports the cost of a C-section delivery can range from $14,528 to $7,439 depending upon the state. Vaginal births range from $10, 413 to $5,017.
Want to improve mental health screening, access to care, and emergency department length of stay? These organizations have done it.
Recent suicide deaths of celebrities have pushed the topic of mental illness into the public eye. Kate Spade and Anthony Bourdain are purported to have dealt with behavioral health issues for years, and they are not alone.
For many Americans, living with behavioral health issues such as depression, anxiety, and substance abuse is the norm.
According to the National Institute of Mental Health, in 2014 an estimated 43.6 million—or 18.1% of U.S. adults aged 18 or older—experienced any form of mental illness. That same year, about 4% of U.S. adults, nearly 10 million, had serious mental illness.
To address behavioral health issues, hospitals and health systems across the country are working , in a variety of ways, to improve and expand access to behavioral health services.
Here are three HealthLeaders articles on programs focusing on behavioral health needs.
"We had nurse suicides in our own workforce, and when we started talking to people, we found that many knew someone who had a nurse suicide in their organization. So, it wasn’t just us," she says.
After more than one nurse suicide occurred at UCSD Health, the organization piloted an expansion of the Healer Education, Assessment and Referral program to nurses.
The program provides suicide risk screening through an anonymous, encrypted, online format. If a nurse is high risk for suicide, a counselor contacts him or her through the encrypted system and invites the nurse to come for counseling. In the first six months of the program, 172 took the screening and 43% were found to be at high risk.
The newly opened Grace Grego Maxwell Mental Health Unit located at Dell Children's Medical Center of Central Texas is designed to provide comprehensive care and enhanced access to pediatric behavioral health patients.
"It's a best-practice model of a care system for integrated mental health services. We provide a holistic approach to treating children with mental disorders," says Sonia Krishna, MD, a child and adolescent psychiatrist at Dell Children's.
In addition to the inpatient care unit, the medical center offers behavioral healthcare in an outpatient clinic, intensive outpatient program, and a partial hospitalization program.
After cuts to the state of Illinois' mental health budget and the closing of six of Chicago's 12 city-run mental health clinics, Swedish Covenant Hospital in Chicago saw more patients with behavioral health issues seeking treatment in the ED.
On any given day there could be up to seven behavioral health patients in the ED, and many of the uninsured patients were waiting three to four days for transfer to an inpatient unit.
After Ajimol Lukose, DNP, RN-BC, nursing director at the hospital, developed a safe care delivery model to improve care quality and reduce behavioral health patients' length of stay in the ED, the organization saw a 40% reduction in ED LOS among uninsured behavioral health patients.
Wondering what this new generation is thinking in terms of career pathways and work settings? A new survey sheds some light on the subject.
During the past few years, there has been much lamenting about "those millennials," and how they just don't have the same work tendencies as the generations of nurses before them. Often, these assumptions are anecdotal and based off nurse leaders' personal experiences with the age-based cohort.
The new report, Survey of Millennial Nurses: A Dynamic Influence on the Profession, released by the healthcare staffing company AMN Healthcare, seems to confirm some of these observations. The report compares millennial nurses' (ages 19-36) responses on the AMN Healthcare 2017 Survey of Registered Nurses to responses from Generation X nurses (ages 37-53) and baby boomer nurses (ages 54-71). The questionnaires were sent out in March and April 2017, and 3,347 RNs completed the survey.
So just how do millennial nurses compare to nurses in other generations? Read on to find out.
On the Move
It's frequently mentioned that millennial nurses don't stay in their positions like baby boomer nurses do.
The survey findings seem to support that concept.
When asked about how the improving economy might influence their career plans:
About 17% of millennial RNs said they would seek a new place of employment as a nurse.
15% of Generation X RNs said they would seek a new place of employment as a nurse.
10% of baby boomer RNs said they would seek a new place of employment as a nurse.
Similarly, data from the RN Work Project, the national study that looked at career changes and work attitudes of new nurses, found:
17.9% of newly licensed RNs left within one year of starting their first jobs
60% left within eight years of starting their first jobs.
Regarding travel nursing, the AMN survey found millennial RNs are more open to traveling than their counterparts in other generations.
10% of millennial RNs said they would work as a travel nurse.
6% of Generation X RNs said they would work as a travel nurse.
About 5% of Baby Boomer RNs said they would as a travel nurse.
Advanced Practice Goals
According the AMN survey, millennial RNs are eager to join the ranks of APRNs.
49% of millennial RNs said they want to become APRNs.
35% Generation X RNs said they want to become APRNs.
12% of baby boomer RNs said they want to become APRNs.
Over the past decade, both the number of and need for nurse practitioners have grown.
28% of millennial RNs said they would pursue an NP degree in the next three years.
Another 14% said they would pursue education to become clinical nurse specialists.
7% said they would become certified registered nurse anesthetists.
Future Leaders
Millennial RNs show a desire to pursue nursing leadership roles.
36% of millennial RNs said they would seek a leadership role.
27% of Generation X RNs said they would seek a leadership role.
10% of baby boomer RNs said they would seek a leadership role.
To learn more about how one organization made changes to its nursing management structure to increased professional development opportunities and greater interest in nursing management positions, read Revamp Your Nurse Managers' Job Scope.
"Hospital-acquired pressure ulcers, falls in the hospital, falls that cause injury, DVTs, and pulmonary emboli are also caused by immobility," says Maggie Hansen, RN, BSN, MHSc, senior vice president, chief nurse executive at Memorial Healthcare System in Hollywood, Florida. "They have other factors that contribute to them, but [nursing] is taking ownership for preventing some of those things that should never happen to patients."
Still, finding the time to ambulate patients during a busy shift is something nurses often struggle to do.
"We heard feedback [from nurses] like, 'I really wish I had more time to ambulate my patients,'" says Leslie Pollart, RN, MSN, MBA, director of nursing at Memorial Regional Hospital in Hollywood, Florida. "While they knew it was important, competing priorities often impeded their ability to ensure timely patient mobility, and sometimes patients need more than one person to assist them in getting out of bed."
To address this issue and ensure patients were getting the ambulation they needed to achieve optimal outcomes, the hospital revamped its mobility program, including creation of a designated mobility team.
Outcomes
According to both Hansen and Pollart, the program has had numerous results.
Pollart says lower extremity DVTs in patients have decreased by over 30% since implementation of the program. They have also seen improved disposition to the right level of care.
"What we have found by having the more aggressive mobility program is we’re not having physical therapists bogged down with doing consults that aren’t medically necessary," Pollart says. "Now they can focus their time on the cases they really need to see. What we’re seeing is a better disposition for the patients when they leave."
Families are also more confident taking patients home from the hospital, and conflict at discharge has decreased, she says.
"When you talk about discharge planning with a family member and the only paradigm they see is [a] loved one is always in bed, they start to get anxious because they think, 'How am I going to be able to care for him or her at home?' " So, we wanted to make sure that we changed that perspective so that when that family came in, they saw patients who were out of bed for meals [or walking]," she says.
Hospital employee injuries have also decreased.
"At the start of the program, our employee-related patient handling injuries were quite high," Pollart says. "They averaged anywhere from on the low end to maybe 9 or 10 a month, and on the high end to maybe 25 to 30 a month."
After going live with a mobility team and investing in patient handling equipment, the hospital reduced employee injuries by over 60%.
"When you look at that just from an employee standpoint, one employee injury is too much," Hansen says, "but when you look at [the] financial standpoint—if you were only looking at the dollars—every workers' compensation claim … averages $20,000 dollars. The investment in that equipment is easily justified by the fewer number of injuries."
Finally, staff engagement and satisfaction has also increased.
Nonclinician mobility team members who help with the program are inspired to follow a career path in healthcare, Pollart says.
"I have a couple that are going to continue to go to school to be therapists. Another one really likes exercise physiology," she says. "So, it’s really helped them shape their future career path."
And hospital staff understands that the organization is committed to creating a safe work environment.
"The fact is that our hospital did recognize [the staff's] priorities and gave them a team and invested in the equipment," Pollart says. "Their perspective about senior leadership understanding the complexities of the work they do has significantly increased because of it. They feel like the organization is committed to their safety."
"Our mission [for the mobility program] is this: prevention of hospital-acquired functional decline and other adverse outcomes to facilitate the earliest and the most independent setting," Pollart says. "Our philosophy was if you walk into the hospital, we want you to walk out."
Here's are the five ways they're achieving that.
1. Make Mobility an Interdisciplinary Project
It was not just the nurses who wanted to improve patient ambulation, other disciplines were on board as well to create a new mobility program.
"With the physical therapists, similarly, we heard they frequently get pulled from doing their clinical consultation because nursing needs an extra pair of hands to get somebody out of bed," Pollart says. "Likewise, one of my surgeons said, 'You know, Leslie, I write activity orders, but they’re often not carried out consistently, so it’s a mere suggestion, not an order.' That was [a] frustration."
The director of rehabilitation and the IT department became engaged in the project. The IT department helped to integrate newly created assessment tools into the electronic medical record.
Thus, began the creation of a six-person dedicated mobility team.
"Some mobility programs cross-trained patient care assistants," Pollart says. "When I was evaluating that, I worried that someone who already had an established skill set would always feel like they had competing priorities."
Many of the mobility team members were transporters at the hospital.
"We actually hired them for their attitude, their desire to learn a new skill, and their communication," Pollart says.
The therapy department developed competencies to train the new team in safe patient handling.
"They had to go through a rigorous training with the therapy department," she says. "It wasn’t just didactic, it was simulation. Then they went on to seeing patients paired with a therapist. The therapist then signed them off when they felt that [the team was] completely able to be independent."
2. Designate Responsibility
One benefit of the mobility team is that it allows nurses and therapists to work at the top of their licenses.
"It allows the nurses to, for example, medicate a patient for pain in a timely manner rather than to get a patient out of bed. The person that doesn’t need a license to practice can [help ambulate patients] safely," Hansen says.
To achieve this, it was important to clearly delineate each group's responsibility with patient assists.
The mobility team is responsible for maximum assists, and nursing is responsible for independent or minimal assists. Therapists can be involved in a range of assists depending on the acuteness of the mobility issues and whether the patient needed a consultation for appropriate disposition, Pollart says.
"I think that’s what really went to the success of this program," she says. "This wasn’t just adding a team and expecting them to solve all the problems with mobility, but defining those responsibilities according to each job role."
3. Create an Assessment Tool
To clearly define the patient's mobility needs, an assessment tool was created and integrated into the EMR. This allows nurses to delegate mobility responsibilities to the correct practitioner, such as nursing, physical therapy, or the mobility team.
"Based on how [a] patient scores on the tool, that patient’s mobility is assessed to be independent, minimal, moderate, or maximum assist," Pollart says. "We wanted to target the mobility team and [the patients] that often required more man power to ambulate."
The tool is used to assess patients on admission and then at least once per day during the duration of their hospital stay.
Four questions are asked in the assessment:
Can the patient lift his or her legs often? If so, is it done independently or with assistance?
Can the patient move from a lying to a sitting position independently or with assistance?
Can he or she move from sitting to standing independently or with assistance?
Can the patient take a step forward?
The tool prompts the practitioner to go to the next question depending on the response.
"Then the mobility team has a work list of all of those patients that score into the mobility team," Pollart says. "We also populate the patient’s activity order."
Additionally, the mobility team has daily huddles with physical therapists and nurse managers to discuss the patient assignments and their mobility needs.
4. Ensure You Have the Right Equipment
In addition to the mobility team and the assessment tool, the organization also invested about $2 million in safe patient-handling equipment such as lifts, as well as education on how to use the equipment.
The assessment tool used to determine a patient's mobility status also tells nurses what the correct handling equipment is for that patient.
"Some of the patients just wouldn’t ambulate for fear of hurting the staff," Pollart says. "Now the nurses can say, 'You don’t have to worry because we have handling equipment that will help us help you get to a standing position.' "
5. Make Ambulation 'Fun'
"Part of the program is to encourage patients, [and] to make ambulation kind of fun and something to look forward to," Pollart says.
Upon admission, all family members are encouraged—unless it’s contrary to treatment—to bring in comfortable shoes for the patient. There are distance markers at certain points in the hospital so that the interdisciplinary team and the patients can track how far they've walked. Mobility journals are provided so patients can fill them out as they accomplish their mobility plans of care.
Patients are also encouraged to walk outside their rooms at least twice a day and to get out of bed for meals, which is known as "Heels for Meals," because the patients have their heels on the floor while eating.
With midterm elections just a few months away, there is still time to encourage eligible voters to get to their polling places in November. One organization encouraging nurses to do this is the American Association of Colleges of Nursing, which on August 7, launched Nursing Voices, Nursing Votes, a nonpartisan initiative designed to encourage, educate, and engage nursing deans, faculty, and students as they amplify their voices during election season.
"Elections are a cornerstone of our national framework and offer important opportunities for engagement and policy change," Deborah Trautman, PhD, RN, FAAN, AACN president and chief executive officer, says in a news release. "We are excited to introduce the Nursing Voices, Nursing Votes initiative so nursing schools within AACN's membership have the framework and tools available to be active members within our electoral process."
Voting is Vital
Nursing Voices, Nursing Votes is a multifaceted initiative that features social media use to inform AACN members of primary dates and registration deadlines. There is also a countdownto the 2018 midterm elections.
Additionally, the program offers AACN members the chance to join the conversation #NursingVoicesNursingVotes, enter and track voter registration statistics among member schools on the AACN website, and access additional state-by-state voting resources.
"Participating in the electoral process is essential," says Ann Cary, PhD, MPH, RN, FNAP, FAAN, chair of the AACN board of directors. "State and federal elections are foundational to policy change. Academic nursing leaders must embrace the role they play in advocating for the profession by educating students on the need to vote and impact healthcare policy."
Challenges Students Face
For nursing students, there are challenges when it comes to participating in the election process. For example, students may go to school at a different location than their voting address and may be unfamiliar with voter registration procedures. By collaborating with deans, faculty, and students, Nursing Voices, Nursing Votes reinforces voter education and provides resources to AACN members as they participate in local, state, and federal elections.
AACN encourages deans and faculty to designate time during orientations or policy classes for students to register to vote and join the Nursing Voices, Nursing Votes conversation either via Twitter or online.
With an estimated 4 million nurses in the U.S., the program's aim is to give power to nurses' voices by getting them out to vote.