Students, state legislators, journalists, and nurse advocates held a press conference at the Connecticut Legislative Office Building to protest the cut of a state-subsidized nurse-training program. Gov. M. Jodi Rell recently decided to suspend the heavily subsidized program to save $1.7 million to help close a $600 million deficit in the state budget. Advocates said suspending the program is short-sighted, not only because a nursing shortage looms in the future, but because jobs are so scarce. The press conference was organized by District 1199, New England Health Care Employees Union.
Peer Assistance Services, a Colorado nonprofit organization that provides guidance, support, and rehabilitation services for healthcare professionals, has seen an increase in nursing clients this year—a majority of whom needed help for alcohol and drug abuse.
But, the growing number of nurses seeking treatment for substance abuse doesn't necessarily reflect a growing problem, according to Rebecca Heck, BSN, RN, MPH, program director of the Nursing Peer Health Assistance program at Peer Assistance Services in Denver.
"We are seeing more nurses come forward, but the problem of substance abuse among healthcare professionals mirrors that of the general public," she says. "I don't know if there is an actual increase in the problem or if nurses are becoming more comfortable coming to us for help."
Heck attributes recent media attention surrounding drug thefts by Colorado healthcare professionals as influencing more nurses to seek treatment. The most recent being the case of a former Rose Medical Center surgical technician, Kristen Diane Parker, who admitted to stealing fentanyl-filled syringes and occasionally swapping them with her used syringes filled with saline. The Denver Post reports that 20 patients appear to have contracted hepatitis-C from Parker as a result.
"I think the stigma is still there and is powerful," Heck says. "But this is making the front page and people are getting scared and realizing they need help."
Treatment plans through the Nursing Peer Health Assistance program are individualized depending on nurses' needs and range from one to five years. Rehabilitation requirements can include therapy treatment, psychiatry, pain management, urinary analysis testing for drugs and alcohol, 12-step groups, sponsorship with a 12-step participant, and peer support groups. Any deviation from the rehabilitation may result in a referral to Colorado's Board of Nursing, in which a nurse may deal with consequences, such as a suspended license to practice or a public discipline in the form of stipulation.
"We want to lead nurses to treatment and monitor them to hold them accountable for that treatment," says Heck.
Literature shows that anywhere between 8%-12 % of nurses have substance abuse disorders that affect their ability to practice, says Heck. Studies have found prescription medication use to be higher among nurses than in the general population, while marijuana and cocaine use has been found lower among nurses than in the general population.
Aside from the easy access of prescription drugs on the job, a number of factors make nurses and other healthcare workers at high risk for substance abuse.
"The culture amongst all healthcare professionals is that we know how the drugs work, so therefore we think we can control them," says Heck. "But they control us like they do everyone else."
Nurses' often stress-filled and lengthy work shifts and nature to "take care of others—not ourselves" are other risk factors, says Heck.
Clients receiving Nursing Peer Health Assistance services complete intensive portions of treatment before returning to work. However, some practice while receiving less serious forms of support with approval from Peer Assistance Services, a therapist, a psychiatrist, or other treatment provider.
Nurses' identities are kept confidential, but they are required to disclose of their participation in the program to their nurse managers.
"Our number one goal is public safety," says Heck. "If a nurse relapses, whether through behavioral symptoms or positive drug tests, we remove them from work within 24 hours and we inform the nurse manager. But then we also make sure the nurse gets treatment."
Heck believes increased education about the causes of and prevention of substance abuse in nursing school and in the profession is needed to minimize the problem and push more nurses to get help.
"Nurses, risk management, and nurse educators do all of this work to make hospitals safer for patients, but we are all missing this huge element; to make nurses safer to provide patient care," says Heck.
When people in healthcare hear the word simulation, they generally think of a computerized mannequin that talks, breathes, and has other human physiological characteristics. Though the development of this human patient simulator, or HPS, has been able to serve as a breakthrough in the teaching/learning environment, there is more than meets the eye with the whole field of simulation.
Human patient simulation
HPS technology has been in use for about the last 10 years in some fashion. Implementation of HPS technology originally gained the most attention in nursing and medical schools, where its use continues to proliferate as new users encounter this technology for the first time.
More recently, such technology has made its way to the clinical practice arena and is used for orientation of new graduate nurses, ongoing staff development, staff competency assessments, required courses such as ACLS and PALS, and team training exercises for interprofessional education.
HPS technology is considered high fidelity, meaning that it is more lifelike than the older mannequins that did not respond via voice or change in physiological parameters when an intervention occurs. For example, high fidelity HPS technology can make a palpable pulse go away when there is ventricular fibrillation or asystole on the cardiac monitor, raise and lower the blood pressure in response to a drug being given, etc.
Standardized patients
There are other simulation teaching/learning modalities that can be used in concert with HPS technology or by themselves. Standardized patients, or trained medical actors, have been used in medical schools for the past 40 years to help medical students interact with real human beings. The use of SPs, as they are referred to, is gradually started to grow in nursing schools. SPs can act not only as a patient but as a family member or a disruptive colleague. This is particularly important, say, when staff development educators are trying to teach clinicians about teamwork and how to assertively speak up if they see something wrong.
For example, a "confederate," (also referred to as a disrupter), SP can act as an overbearing physician who adamantly insists that a nurse give a drug, even though it is not appropriate in that particular clinical situation and giving that drug could cause extreme harm or death to the patient. During the simulation activity, the nurse can learn how to effectively confront this confederate with good communication skills, which are an essential part of teamwork and patient safety.
Serious games and computer interactive devices
Other simulation modalities include serious games, which are essentially video games that are designed to teach concepts in an immersive computerized environment. The same game development technology that is used to build entertainment-focused virtual game worlds where "players" interact online using avatars (onscreen representatives of themselves), can be used to build learning games. Since the average age of video game players is now almost 40 years old, many in the workforce are very comfortable with this technology and would naturally be adept at learning this way.
Medical and surgical simulators, including devices that teach bronchoscopies, endoscopies, surgical procedures, coronary angiography, and many other skills, are proliferating in use. Computer interactive devices that teach IV insertion and IV therapy skills can be used for many different levels of providers, including paramedics, nurses, physicians, physician assistants, etc. Investment in these simulator devices, particularly for high-risk skills, can truly pay off in the long run.
Teaching teamwork
With patient safety being paramount, many institutions are using simulation modalities to teach and enhance interprofessional team training. One model that is commonly used is the Agency for Healthcare Research and Quality and the Department of Defense's TeamSTEPPS system, which stands for Team Strategies and Tools to Enhance Performance and Patient Safety. Since healthcare teams are often contingency teams where the individuals do not necessarily work together on a regular basis (unlike a football team), there is even more need to make sure that all staff are trained in good teamwork and communication skills as they are not likely to know each other's capabilities and weaknesses.
Using simulation techniques can provide a safe and effective environment for all levels of staff to learn and interact with others on the healthcare team. More information on TeamSTEPPS can be found at http://teamstepps.ahrq.gov.
Competitive advantage of simulation
One of the major challenges that permeates simulation methodologies is cost. HPS can run tens of thousands of dollars for the initial investment alone. SPs are generally paid hourly not only for their simulation time, but for their rehearsal and training time for each character that they portray.
Serious games can be expensive for an initial startup, but once built, that technological platform can be used to produce different immersive learning scenarios very efficiently and effectively. Medical and surgical simulators, though costly, can be used extensively and with many learners over a long period of time. Even with the cost issue, these methodologies are extremely important to implement if institutions wish to remain competitive.
For example, students who are graduating from nursing and medical school have now been generally exposed to some type of simulation teaching/learning during their educational program. They naturally expect the institutions at which they will work will also have the same technology and employ the same teaching/learning strategies. Having a solid simulation program at an institution where the equipment and infrastructure are in place, along with well-trained and enthusiastic staff development personnel, can only be a plus for recruitment and retention of staff. In addition, simulation has been shown to increase learner retention and engagement. As noted previously, it provides a safe alternative to learning and practicing difficult skills since no real patients are involved.
One way to control costs is to partner with the healthcare professional schools in the local region. Regional simulation centers are growing around the country, and sharing of resources can help control costs for all involved. In addition, it can have the added benefit of bringing together diverse learners who might not otherwise interact. Multi-environment simulations can also be done in these centers, such as an EMS transport to the emergency department, then a transfer to the ICU, and then a transfer to the operating room.
The technology for simulation modalities is continually improving as companies respond to user requests for more and more capability. Institutions need to jump on the bandwagon or will eventually get left behind as this progression occurs.
For more information on the many uses of simulation, go to the Society for Simulation in Healthcare Web site at www.ssih.org.
Mary Holtschneider, RN, BSN, BC, MPA, NREMT-P, is the director of nursing practice and education for the North Carolina Nurses Association in Raleigh.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
Nurses from three unions have founded a new national union to influence national healthcare policies and try to extend California's patient ratio law into other states. Organizers said the 150,000-member National Nurses United, the largest professional union for registered nurses in the country, will also push for a stronger voice in the healthcare overhaul process going on in Congress and the expansion of representation for nonunion nurses. The merger, approved at a convention in Phoenix, combines the California union with the Massachusetts Nurses Union and members from the United American Nurses, who work primarily in the Midwest. The unions will continue to operate separately, but will be aligned under the larger umbrella of National Nurses United, the San Francisco Chronicle reports.
A University of Miami-Jackson Memorial Hospital team is working to improve patient care and cut costs by making sure oft-overused antibiotics are prescribed only when needed. The program serves as a small example of how such evidence-based medicine can provide good care without increasing healthcare costs, which have been going up far faster than the rate of inflation, the Miami Herald reports. The program is building awareness among hospital employees by handing out pocket cards and pushing info on an internal website.
Firms that supply temporary nurses to the nation's hospitals are taking perilous shortcuts in their screening and supervision, sometimes putting seriously ill patients in the hands of incompetent or impaired caregivers, the Los Angeles Times reports. Emboldened by a chronic nursing shortage and scant regulation, the firms vie for their share of the $4-billion industry. An investigation by the nonprofit newsroom ProPublica and the Times found dozens of instances in which staffing agencies skimped on background checks or ignored warnings from hospitals about sub-par nurses on their payrolls.