In April 2008, Baystate Medical Center (BMC), a 653-bed teaching hospital in Springfield, MA, began implementation of its Bar Code Point of Care (BCPOC) technology to positively impact medication administration in reducing errors.
In the early pilot programs, BMC reported a 50% bedside scanning rate for all medications and a medication error rate of 1.2 errors per 1,000 patient days.
Following the implementation of an organizationwide bar code scanning process in September 2008, BMC improved its medication scanning rates to 87%-90%. The medication error rate also decreased to 0.3 errors per 1,000 patient days, a 75% reduction.
Implementation and pilot programs
Planning and implementing a bar code scanning system at the bedside was a major undertaking for BMC, because the patient safety-focused process is designed to significantly reduce medication administration errors.
"What is so impactful about the whole process is that all departments—with the exception of some emergency departments—are fully bar coded," says Gary Kerr, MBA, PharmD, director of pharmacy services at BMC. "The central pharmacy has been re-engineered to support the outputs necessary to drive and sustain medication bar codes."
BMC started small, with a six-month pilot program that involved three nursing units. It was during this six-month pilot program that Kerr and Mark Heelon, PharmD, medical/surgical director at BMC, committed themselves to learning everything about the bar coding process.
It became clear early on that there were numerous obstacles when scanning a patient every time he or she received a medication, from packaging to process. Examples of identified scanning challenges included large-volume IVs, medications without bar codes, medications with reflective packaging (e.g., suppositories), and computerized physician order entry (CPOE) mismatching products or administration times of medications.
One specific example of a CPOE scanning issue occurred in the pediatric ICU, where continuous Albuterol updrafts needed to be scanned on an hourly basis, resulting in suboptimal scan rates for the unit. To help resolve the issue, interdisciplinary collaboration among nursing, informatics, and pharmacy focused on educating staff about how to correctly enter continuous Albuterol orders.
This process was accomplished by developing a medication care set to guide the provider in selecting the appropriate products that ultimately influenced scan rates. This intervention also reduced the number of times the respiratory therapist needed to scan the medication. "There was really no reason to have the respiratory therapist repetitively scanning on the hour for Albuterol," says Heelon. "Or for any nurse, for that matter."
The process was changed from needing to scan constantly to the staff member or nurse scanning the medication only when the Albuterol updraft was replaced.
"The foundation of the success of this project was the open line of communication between pharmacy and nursing," says WendySue Woods, RN, MSHA, CSHA, senior consultant at The Greeley Company, a division of HCPro, Inc., in Marblehead, MA, and senior advisor to BMC.
BMC felt comfortable implementing this process organizationwide after trialing it for six months and receiving feedback from the nurses on the unit.
Current bar coding success
On each unit, BMC nurses have ready access to bar code scanners. With the scanner in hand, the nurse is able to enter the patient's room with the patient's medication and scan the label on the medication.
This process augments the five rights of medication administration at the patient's bedside to ensure that the correct patient receives the correct medication.
"In the past, a medication error that might have reached the patient could have been backtracked to a pharmacy technician placing a wrong medication or strength in the automated dispensing cabinet," says Heelon. "With the new processes and scanners at the patient bedside, we have seen a dramatic decrease in medication errors reaching our patients."
As many healthcare organizations battle the nursing shortage that is only expected to worsen as baby boomers retire and the need for healthcare grows, new nurses entering the field in cities may be surprised with how they are greeted: An associate's degree in nursing is not good enough.
A veteran nurse, Joanie McMahon MS, RN, clinical education/organizational development at Mercy Medical Center in Cedar Rapids, IA, says this theory of hiring only those with a bachelor's degree has been around since she entered the nursing world in the early 1980s when there was a hiring freeze at many hospitals.
However, for many new nurses, this may come as a bit of a shock. One Philadelphia nurse was surprised when applying for jobs this spring after he was turned away because organizations were only looking for nurses with a nursing degree or bachelor of science in nursing. Even though this nurse was an RN, the organization was not satisfied with his degree because it was from a community college.
Those looking to become a nurse have three different options. They can go to school for four years and get a nursing degree or bachelor of science in nursing. Option two: They can get an associate's degree and only go to school for two to three years, while option three has the individual going to a diploma school for about three years. All three require would-be RNs to pass a licensing exam that tests basic skills; starting pay is about the same.
In Pennsylvania, there are many diploma schools, despite the fact that many hospitals only accept nurses with bachelor's degrees. For instance, the Hospital of the University of Pennsylvania has enforced this policy since 2004, while many other Pennsylvania hospital systems—Thomas Jefferson University Hospital, Children's Hospital of Philadelphia, and Albert Einstein Medical Center—are following suit and prefer students with bachelor's degrees.
Pennsylvania is not alone; New York and New Jersey have introduced legislation requiring nurses to get bachelor's degrees within 10 years of licensing.
Many of the organizations believe that requiring nurses to have a bachelor's degree or higher is beneficial in the end. Nurses are working with increasingly complex machines and patients, hospitals are moving toward evidence-based medicine, and this sort of thinking may not be emphasized in the more technically oriented associate's degree programs.
"I know of a BSN program that has taken away its hospital-based clinical rotations and are doing the rotations in a simulation lab," says McMahon. "In my book, this is not cutting it. There must be the appropriate balance of the clinical and the classroom didactic time in order to produce a strong critical-thinking nurse that can adapt and flex in today's healthcare world."
For many nurses, working toward getting an associate's degree is an inexpensive and faster way to getting into the profession. Although some facilities will only take those with bachelor's degrees or higher, many healthcare organizations still consider all nurses for job positions.
For instance, if a new RN is applying to organizations located in the city, he or she can try applying to more rural hospitals or positions outside of hospitals. One facility, Hahnemann University Hospitals in PA, looks for the right attitude and thinking skills in a potential new hire, and not particular degrees.
McMahon agrees, stating "it is a combination of the instructor, clinical, curriculum, class time, hands-on, and life experience all rolled into one that make for the perfect new nurse."
As Nurses Week is upon us (May 6-12), many organizations and companies are coming up with ways to honor nurses in any way they can. Whether it is free cookies in the break room, banners hanging from the ceilings or a placard with quotes from physicians on why they appreciate nurses, most facilities are honoring its nurses. But it doesn't stop there. Even some companies are honoring nurses.
For instance, take Cinnabon.
Collaborating with The DAISY (Diseases Attacking the Immune Systems) Foundation, these two companies found a way to show their appreciation for nurses and the extraordinary service nurses provide on a daily basis. During Nurses Week, when a nurse shows their healthcare badge at any local Cinnabon bakery, they will receive a free Cinnabon Classic Roll.
"Nurses always put others before themselves, so we're happy to thank them for their constant "WOW" service," said Gary Bales, Cinnabon president, in an official statement.
Even though Nurses Week has been going on for quite some time, dating back to 1974, some issues have been brought to the forefront.
Is Nurses Week still necessary? Other healthcare professions do not get a week, or even a day, while physicians have one day dedicated to them (March 30.) However, one thing remains clear, nurses should still be celebrated, whether it be during this week, or constantly throughout the year.
For example, Monica Weisbrich, RN, believes Nurses Week is still necessary as it "is celebrated at the time of Florence Nightingale's birthday to remind nurses about the influence one nurse can have on returning patients to health."
"Today's nurses continue that dedicated work and deserve to be recognized. It is also a time where nurses can re-commit to their own professional values," says Weisbrich.
Lisette Cintron, RN, MSN, CHCQM, CNL, Clinical Nurse Educator/NICHE Program Co-Coordinator of Juniper, FL believes that nurses should be celebrated and recognized on a daily basis.
"In our profession, we fail to recognize the work that we/nurses do. We need to take the time and stop and tell each other 'great job,' 'thank you,' etc. We need to show our appreciation for each other and our profession," says Cintron.
"On a daily basis, we are giving of ourselves in order to help another i.e. the ill, the recovering, the dying, in order to provide exemplary care and compassion that we believe all our patients deserve," says Cintron. "It is why we went into nursing, right? So, why should we not recognize that? Nursing has come a long way since Florence Nightingale, and although we still have a long way to go we have made great accomplishments."
Even though Weisbrich agrees Nurses Week is often commercialized, she suggests "putting money into causes meaningful to nurses and the nursing profession is the way to go."
One suggestion Weisbrich makes is donating to the Nurses Float (http://www.flowers4thefloat.org/) which is a non-profit organization that is trying to raise enough money to have a float dedicated to nurses in the 2013 Rose Parade. "We are asking all facilities make a donation to this historic project over the next three years during Nurses Week to honor and celebrate each nurse. This is the ultimate level of recognition-to be part of history," says Weisbrich.
"Whether it be a school, occupational, nursing home or hospital nurse, we all need to be recognized and learn to recognize each other and not during one week, but every day. So let us celebrate," says Cintron.
A recent report in the Harvard Business Review contradicts the idea that employees value recognition of their efforts higher than anything else. The top motivator of performance is actually progress.
The study involved gathering more than 12,000 e-mail diary entries from the participants, which revealed that making progress in one's work, no matter how little or big, is associated with positive emotions and high motivation. The survey noted when participants experienced progress in their jobs, 76% of people reported it as their best day.
The report suggested that managers clarify overall goals, ensure staff members receive the right support for their efforts, and work to ensure minor glitches are perceived as learning opportunities.
What could hospitals learn from this report?
"The message here, in my opinion, is how out of touch management is with the staff's priorities," says Tonya Barrerre, RN, assistant nurse manager, emergency department, at Robert J. Dole VAMC, in Wichita, KS. "Management answered with completely opposite positions regarding what they thought the staff felt was important."
But the reported also cautioned managers not to abandon recognition.
"I firmly believe that recognition is important; however, it needs to be recognition that the employee values," says Sharon Taylor, RN, MS, CIC, CPHRM, CHC, director of risk management and accreditation services at Burgess Health Center in Onawa, IA. "This means that managers must know their employees. What is considered important to one is not necessarily important to another."
Even though progress may be the leading motivator of performance, managers should not shy away from recognizing staff for a job well done. If staff members meet or exceed their goals, managers should praise them, as this gesture will continue to motivate workers.
"I also think that we can’t overlook the fact that organizations need to have a growth ladder of some type that does give a monetary reward for those who take responsibility for their professional growth," Taylor continues. "Non-monetary compensation is a must, but at some point we do need to recognize that monetary compensation is also essential to continually motivate staff who excel."
The Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, IL, believes in the "mother standard of care," or treating patients as if they are family members or "your own mother," says Kimberly Bertini, RN, Coordinator for the ANCC Magnet Recognition Program® at CTC.
For years, CTC used restraints on patients who became confused because of brain metastasis, chemotherapy brain, or a mixture of pain medications.
However, Bertini says staff members at CTC were uncomfortable using the restraints on patients, and many opted to stay overtime and sit with patients to refrain from using the restraints.
"We noticed the staffs' reaction to placing patients in restraints," says Bertini. "We decided it was time to make a change and actually begin treating patients like they are our mother."
In 2005, CTC gave up restraints altogether to mirror this belief and the culture of the organization. Since then, CTC continues to decrease patients' length of stay, falls, and has only had one outstanding case in which a patient needed restraints because of the danger posed to him- or herself.
Going restraint free
From the beginning, the administrative team at CTC was supportive of the decision to stop using restraints on patients, says Bertini.
"The administrative team saw this as a way to help empower the staff and let them take patient care into their own hands," she says.
CTC's first step to becoming restraint free involved increasing the number of staff. If a patient came in and fell under criteria for which a restraint might previously have been necessary, a patient care tech or sitter was assigned to the patient's room at all times.
"We decided not to hire sitters from an outside agency because of our culture," says Bertini. "It is hard bringing in an outside source and then having to teach [him or her] about our culture and beliefs."
By staying within CTC, the patient and family are already familiar with the staff member, and it helps the patient trust the caregiver.
In addition to having sitters available, CTC has bed alarms on every patient's bed. The bed alarm sounds an alert when there is a certain level of movement in the patient's bed or if a patient decides to climb out of bed at the foot because of raised side rails.
The bed alarm not only acts as an alert to the nurses if a patient is out and moving, it also helps patients inform their nurses that they have gotten up in the event they forget to hit the call button on their own.
"At CTC, our age range of patients is from 18 to 100," says Bertini. "We have patients in their 30s and 40s who are a fall risk and can forget to call a nurse when they attempt to use the bathroom, and this system helps everyone."
Additional measures
The use of sitters and bed alarms are only two of the strategies that CTC used to become restraint free, says Bertini. In addition to these tactics, staff also conducted mandatory hourly rounds. Prior to 2005, CTC staff conducted rounds, but there was no strict time period and they were not mandatory.
"The staff would round every hour to an hour and a half, and we could not guarantee even this," says Bertini.
Now, staff members make rounds at least every hour, and if the patient is at a higher risk level, the staff member will check in with the patient more often.
The staff also have a team check-in used in conjunction with the patient rounding that helps the nurse and primary care physician review the care plan of each patient for the day. At the beginning of the day, the PCP and the nurse sit down with the patient for five minutes and develop the care plan for the day.
For each patient, the team writes on a whiteboard ¬located in patients' rooms what the patient deems as important for the day, what the nurse needs to get done, and what the PCP has to accomplish. The plan also outlines any procedures the patient has that day.
"The plan allows everyone to be on the same page and provides a timeline for the day," says Bertini. "This way, if a patient wants a bath, the doctor can tell the patient it won't be until 4 p.m., and the patient isn't waiting around."
This also helps patients' family members stay in the loop regarding the kind of treatment their loved ones will be receiving.
"By CTC staff being so open and up front about the care the patient will receive, it is a relief for the family who may not know what to expect," says Bertini.
For years, nurses have been fighting an uphill battle to change the way the public views them as professionals. With television shows like Nurse Jackie, Grey's Anatomy, and Mercy each portraying nurses in a different light, it's no wonder the public's view of nurses is skewed.
Even men in the profession have a hard time breaking stereotypes, just think of Gaylord Focker in Meet the Parents.
For female nurses, the phrase "naughty nurse" has the public believing female nurses should be wearing white stockings, a short skirt, and heels while attending to their patients.
In an effort to change this stereotype, nurses are speaking out against Mariah Carey's recent music video for her song "Up Out My Face." Nurses want Carey to reconsider the video, in which Carey and fellow pop star and rapper Nicki Minaj are wearing white stockings and high heels.
"I'm sure Ms. Carey was inspired by the nursing research that shows how music can improve patient outcomes, and she just wanted to pay tribute to the profession, " said Sandy Summers, executive director of Baltimore-based advocacy group The Truth About Nursing, in a press release. "But these images associate nursing with female sexuality, undermining our claims to adequate resources."
Millions have already viewed the video, but Summers thinks this may mislead people who do not know much about the profession into thinking nursing is just "a tired sex joke, not a life-saving profession for college-educated men and women."
Male nurses are rare, accounting for only 5% of the 2 million registered nurses in the U.S., but national ad campaigns are trying to help break stereotypes about male nurses.
The ad campaign is asking men "Are you Man Enough to Be a Nurse?" The ads depict a variety of men and then provide a brief description of a hobby each man enjoys. The men shown in the campaign are dressed in nurse scrubs, sports attire, and business suits.
According to a study conducted by the Bernard Hodes Group in 2004, 50% of the men surveyed have encountered stereotypes in the workplace, and 56% said they encountered the stereotype at school.
Even though the use of these ad campaigns can help promote nursing and recruit more males into the profession, the Hodes study reveals that the men did not view the ads in a positive way.
However, an assistant professor at the UCF's College of Nursing believes that no matter where you work, if it is in a good team environment, the stereotypes will not matter.
"We did not care if you were male, female, white, black or Puerto Rican," Christopher Blackwell, assistant professor at the University of Central Florida, said. "What we care about was that you were a good, productive member of the team."
When the phrase "book club" comes up, one thinks of a group of people, meeting at a coffee shop or a member's home, discussing the most recent best-seller discussed on Oprah's daytime television show.
However, the definition of a book club will now have to include nurses reading medical-themed literature to better connect with their patients.
The first hospital to institute the idea of a nursing/physician based book club was in 1997, and over the past decade-plus, similar ideas and book clubs have become more popular across 25 states, including California, Massachusetts, and New York.
By reading medical themed literature—such as "The Death of Ivan Illyich" by Tolstoy or "The Diving Bell and the Butterfly" by French Elle Editor-in-Chief Jean-Dominique Bauby—nurses and physicians can develop a better understanding of what the patient is going through.
Clinical Nurse Educator Lisette Cintron, RN, MSN, CHCQM, CNL, recalls how physicians formed a book club on their own at a previous place of employment. Cintron says that in addition to reading medical literature, "they read up on new and interesting evidenced-based topics and discuss their thoughts, findings, etc.," she says.
In addition to the book club, Cintron says the nurses also formed a journal club.
"The Journal Club is made up of nurses who review evidence-based practice topics and have discussions. They have even sent out information on the shared-governance councils as recommendations or suggestions that the facility may want to look into for possible changes and improvements."
As far as her own opinion on the idea, Cintron believes it has a positive effect for all participating parties.
"I believe that having book/journal clubs adds to the current knowledge base of nurses as well as physicians and can add positive outcomes to facilities that have it implemented within their organizations," she says.
As many nurses are already big advocates for finding alternative ways to grow in the practice through added knowledge and sharing of information, this is an example of life long learning, which Cintron supports.
"This is one avenue that can be used as a forum when one is not ready to return to school to further their education, but wants to continue learning and growing within their profession."
Staff members are often trained to report a potential medical error, or near-miss event. However, more often than not, these events go unreported.
In 2003, The University of Texas (UT) System, which is made up of six health institutions, developed a system that allowed the anonymous reporting of close calls, near misses, and potential errors.
Despite the reports' anonymity, only 175 were gathered during the first two-and-a-half years of the program.
After seeing this result, Robert L. Massey, PhD, RN, NEA-BC, director of clinical nursing at UT's M. D. Anderson Cancer Center, and a former colleague wanted to know why the program was not working and how they could encourage staff to report medical errors.
In 2005, Massey and his former colleague proposed and implemented a pilot test of the Good Catch program at M. D. Anderson. By putting a positive spin on the reports (increased reporting of near misses helps the hospital learn how to prevent future errors) and developing a competition to encourage reporting, M. D. Anderson received 2,744 reports of potential errors during the initial six months of the pilot program.
A positive twist on reporting medical errors
The Good Catch program's pilot test began in December 2005 and ran through May 2006. Three components make up the program and help it stand out from the previous program used by the organization:
Terminology change
End-of-shift safety reports
Incentives, such as safety awards, which are supported by executive leadership
M. D. Anderson's original reporting system used the terms "near miss" or "close call" to report potential errors.
"The phrases 'near miss' and 'close call' came across to the staff as almost negative," says Massey.
After taking a close look at the terminology, M. D. Anderson chose to use the phrase "good catch" to identify when a potential error is reported.
"Using 'good catch' takes a more positive connotation, and staff members are not as discouraged to report potential errors," says Massey. "These types of events never get to the patient or else they would not be considered a good catch."
In addition to changing the terminology, M. D. Anderson decided to encourage staff members to report these potential errors at the end of their shifts through an end-of-shift safety report. The communication encourages staff coming off shift to talk with the staff coming on shift about any good catches that occurred throughout the shift. Doing so helps all staff members maintain awareness about potential errors.
For example, if a staff member on the morning shift reports a transcription order error, the next staff member coming on shift is made aware of the situation so he or she can be aware of a potential good catch of the same nature.
"If this happens multiple times on a shift or in a 24-hour period, we can address the situation immediately," says Massey.
World Series of error reporting
Friendly competition among staff is also used to encourage the submission of good catches at M. D. Anderson. The organization uses a baseball theme as a form of competition, says Massey. Inpatient units form teams—complete with mascots created by each team—and the team that reports the most good catches at the end of each "season" wins.
"We follow the same schedule as the regular baseball season," says Massey. "And around October, we hold a World Series for the two teams in each league that have the most good catches up to that point."
Throughout the year, teams receive safety awards for submitting the most good-catch reports. The teams are also part of divisions, each of which hosts its own divisional playoffs for the most good-catch reports.
Eventually, the teams with the most good-catch reports in each division are eligible for the World Series. Both teams then compete for the championship. Massey and his staff monitor any increase in reporting greater than 10% to make sure there is no padding of results.
At the conclusion of the World Series, the winning team receives a safety award party—usually a pizza/cake party. The team also gets a trophy.
Over the past five years, rapid response teams (RRT) have been brought to the forefront of American hospitals.
In 2004, the Institute for Healthcare Improvement (IHI) launched its 100,000 Lives Campaign of which RRTs were a focal point, and in 2008, The Joint Commission added a National Patient Safety Goal requiring hospitals to have a process to recognize and respond to patients who are deteriorating. Those requirements are now located in standards PC.02.01.19, HR.01.05.03, and PI.01.01.01.
Both of these initiatives sparked interest in RRTs among hospitals, especially at St. Anthony Central Hospital (SACH) in Denver, which developed its own RRT in conjunction with the IHI initiative.
However, in 2008, SACH officials began to notice a trend of patients who were meeting the criteria for RRT, but for a variety of reasons, the team was not called.
A subgroup of 17 missed opportunities (including deaths) were identified in the first half of 2008. With the help of simulation training and debriefing interviews, SACH was able to lower that number to nine for the second half of 2008 out of 2,400 trauma-related admissions for the year. That number was cut again for 23 total missed opportunities and no resulting patient deaths out of about 2,400 trauma-related admissions in 2009.
Education and simulation training
In 2008, Pamela Bourg, RN, MS, ANP, CNS, director of trauma services at the facility, first noticed a trend developing across the trauma patients at SACH. There were particular instances where patients met the criteria for an RRT, but upon further investigation, Bourg found that the nurses were not calling a team to follow through.
Aware of this fact, and understanding the need for change, Bourg teamed up with two colleagues, Julie Benz, RN, MS, clinical nurse specialist, and Melissa Richey, RN, BS, clinical nurse for the trauma services. They worked together to educate the staff at SACH to be more knowledgeable about when to call the RRT and more comfortable in doing so.
Working with the Wells Center in Colorado, a facility that provides state-of-the-art patient simulation tools, Bourg, Benz, and Richey rented a simulation-training dummy to help the staff members at SACH gain experience through simulation.
"Wells Center supplied us with the simulation mannequins, along with the nurse driver," says Bourg. "But we were able to use our own nurse educators and advance practice nurses to help facilitate the groups."
The nurse driver helped run the simulation, but SACH staff wrote the script for the missed opportunity scenarios. During the simulation training, a nurse performed an assessment of a patient. Then, based on what the nurse observed, he or she called an RRT.
"The purpose of the simulation training is to help the nurses recognize the signs and symptoms, identify the patients at greater risk, and then distinguish if they need to call an activation of the RRT," says Bourg.
The staff members at SACH first participated in the simulation training in July 2008. Between August and December 2008, Bourg and her colleagues analyzed missed opportunities that took place after the simulation training and saw a drop in the number. They also analyzed the number of staff members who called an RRT.
Results not typical from simulation training or education
Bourg's team found that the majority of missed opportunities occurred in the off-hours of the hospital: on the weekends, before 7 a.m., and after 5 p.m.
Bourg also discovered that when the nurses appropriately identified a patient in need of an RRT, there were acute changes in the patient's condition. But when the changes to the patient were not as acute and more subtle, the nurses did not notice them quite as readily.
Even though the number of missed opportunities decreased toward the end of 2008, as 2009 began, Bourg watched the numbers increase, despite staff members having gone through simulation training.
"We sat down and knew there were other issues we needed to identify because the numbers were increasing despite the fact we had provided staff members with training," says Bourg.
At first, Bourg thought it might have something to do with new graduates working at SACH. But after looking closer, Bourg discovered that other factors contributed to the missed opportunities.
"In addition to the huge changeover we saw at SACH, we also saw that staff members who had been with us for over two years were failing to activate an RRT," says Bourg.
In hopes of improving the number of missed opportunities, Bourg and her colleagues went back and began interviewing staff members who failed to activate an RRT. They developed a debriefing tool using a variety of nursing literature to help understand why nurses were failing to activate the RRT.
"We try to make sure that when a missed opportunity presents itself, we contact the nurse within 24 to 48 hours to ask them more about the situation," says Bourg.
When a nurse has a missed RRT opportunity, an advance practice nurse conducts a debriefing interview—not the manager. During the interview, the nurse is asked questions about:
What was going on at the time of the missed opportunity
What kind of patient report he or she received from the previous nurse
Whether there were competing priorities
Whether he or she was familiar with the patient's case
"We are not trying to assign any blame," says Bourg. "We are trying to create a culture of safety so people are willing to come forward and give us the information to help make our practice better." In addition, staff went through simulation training again in July 2009.
For more on this story and tips for successful RRTs, see the April issue of Briefings on Patient Safety, a product of Patient Safety Monitor.
HCPro, Inc., the parent company of HealthLeaders Media, recently conducted a survey among 179 nursing professionals in the healthcare industry regarding the effects of the 2009 economy.
The results illustrate how the tumultuous 2009 economy had varying effects on facilities of all sizes in acute care, critical access, long-term care, ambulatory, home health, and rehabilitation settings.
Although the data reported do not dissect the particulars at any one institution or among any one age group of nurses, they provide a comprehensive look at the issue among a variety of facilities. The data also offers a glimpse into how each facility dealt with the economic downturn and where they stand in 2010.
The results show most facilities were affected in some way by the economy, as 60% reported cutting back on travel expenses along with renegotiating supplies in 2009. Facilities also reported individual ways that specific units helped their facility cut back on spending—for example, 78% of the respondents said overtime was reduced.
Even though a vast majority of the respondents reported cutting back on spending, and finding alternative ways to save money, many facilities worked on staff morale by offering verbal recognition from managers and above (72%); and nominating an employee of the month (51%).
There is good news though. Seventy-four percent of respondents said their facility is currently hiring, while 65% said they plan to travel to one to two conferences in 2010.
Sheryl Tripp, MSN, RN-BC at OhioHealth in Columbus, OH, is not surprised by the results.
"We all know the age of the nurse is older and wiser and in several years those masses will be retired and perhaps another nursing shortage can be expected. But as for addressing the economy, I think everyone had to do something," she says.
Tonya Barrere, RN, assistant nurse manager in the Emergency Department at Robert J. Dole VAMC, says the results are not alarming.
"I agree with what facilities are doing to try to stay ahead of the game. Keep hiring nurses and reduce turnover. I think that reducing travel and supply costs are obvious measures to save a buck, but saving on education is not a smart move. If hospitals are pro-education, they can retain more staff and more staff loyalty," Barrere says.
Particularly at Tripp's facility, OhioHealth saw a decrease in travel expenses and staff did not receive raises. However, to help keep up staff's morale, employees received a bonus. "We have maintained a good finance, did not do layoffs, and we are hiring," says Tripp. "I think we will still need to do most of these things to stay ahead for a while."