A union is threatening a one-day strike involving 16,000 registered nurses at 39 hospitals in California and Nevada, saying hospitals aren't providing enough protections against swine flu for its members. The union said one of its members died in August after contracting swine flu and that dozens of others have been sickened by the disease. It wants to use the contract negotiations to establish safety procedures around the United States.
Nashville hospitals have started to receive shipments of the injectable version of the H1N1 vaccine, which can be taken by people who aren't eligible for the nasal spray. Baptist Hospital received 600 of the 3,000 shot doses it ordered, and Vanderbilt University Medical Center also got about 2,500 doses. Like the H1N1 FluMist nasal spray, the shot will be given to healthcare workers first. Any remaining doses probably will go to hospitalized patients.
Staff development specialists are well aware that the way new employees are oriented to an organization has a significant effect on their job satisfaction and, ultimately, on retention. It is essential that we take this belief and translate it into evidence-based practice. One very innovative educator did just that when she revised her nursing orientation program to help increase nursing retention rates in her organization.
Sylvia E. Prickitt-White, RN, BSN, MEd, is the nursing education/wound care clinical coordinator at the Heart of Lancaster Regional Medical Center, a 140-bed hospital in Lititz, PA. As the educator in the hospital, Prickitt-White found that orientation was taking more and more of her time. The demand for orientation was linked to the need to hire and orient new nurses on a very frequent basis. In 2005, she began to notice what she calls a "drastic turnover" of both new and experienced nurses.
"They would stay for about three to six months and then resign," says Prickitt-White. "Our retention rate of newly-hired nurses was about 25% to 30%."
At that time, general orientation took one week and unit-based orientation lasted for three months. She wanted to know why nurses were leaving so began contacting nurses who had left the organization. She says new nurses reported feeling "removed and disjointed once they left the safety of new employee orientation" and also reported a lack of connection after orientation was completed.
New orientation initiatives
As part of her efforts to find a solution to the problem, Prickitt-White conducted an extensive literature review on the topic of retention and orientation. According to the literature, nurse retention is boosted by some type of formal program that extends beyond orientation, such as a residency or mentoring program, that allow for regular contact with designated peers throughout the first year of employment.
Armed with evidence from her literature review, she approached administration and received permission to implement a new program. She designed an extended orientation program that lasts throughout the first year of a nurse's employment. She says the purpose is to "bring new employees together to give them information they may have heard during orientation, but may not have absorbed due to the extensive amount of information thrust upon new employees."
This program also gives them a chance to reconnect with each other and share comments, concerns, and triumphs. The year-long program is called Connections and consists of four components: Connecting the dots, focusing the picture, keeping the focus, and completing the puzzle.
Connecting the dots
"Connecting the dots" is a half-day program designed to help "pull the pieces together," says Prickitt-White. Held one month after the initial general orientation of a group of nurses, it brings the group back together.
The half-day program gives nurses a forum to reconnect with their group and allows them to ask questions and express concerns—both to each other and to Prickitt-White—in a supportive, non-threatening environment. It also fosters cohesiveness and a support network.
In addition to taking part in open discussions, the group has a chance to meet with people important to their practice, but who were not part of their general orientation due to time constraints, such as the diabetic educator. The chief nursing officer (CNO) also attends, giving the nurses an opportunity to discuss issues with her as well.
Focusing the picture
The next part of the program, "focusing the picture," is held three to four months after the group's hire date. The hospital may have more than one orientation group depending on how many orientations have been held during this time period. "Focusing" is held between the first and second shift and the second and third shift and is a two-hour program. Nurses are financially compensated if attending the class on off-duty hours, and, thus far, attendance has been good.
"Focusing" concentrates on hospital processes that may not have been addressed or were only briefly addressed in previous classes. Some topics include rapid response teams, hand-off communication, and a discussion of how they are doing with the documentation system and bar code medication administration. Depending on the response, Prickitt-White might offer some remediation work with nurses regarding medication administration and documentation.
And of course, a key part is the ongoing emphasis on communication and support.
Keeping the focus
"Keeping the focus" is split into two sessions, one at six months after hire and one at the nine month mark. Classes are offered to accommodate the needs of nurses who work various shifts. The content is flexible so that additional topics and issues can be addressed as needed. Topics addressed may include updates on National Patient Safety Goals, annual competencies, risk management, Medicare reimbursement, or Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results. Prickitt-White notes that discussing HCAHPS results, which reflect patients' experiences of their hospitalization, helps to focus nurses on thinking about customer service as well as clinical interventions.
The program also makes sure to allot time for open-ended discussion.
Completing the puzzle
The final component of the program, "completing the puzzle," is a class held about one year after hire. The session is scheduled for a time when most of the group is scheduled to work and is presented as a breakfast or lunch buffet.
The group members themselves guide this open-ended discussion, which serves to bring closure to the first year of employment. They also evaluate the orientation program to provide feedback on their experiences.
Results
Prickitt-White is "thrilled" with the link between her new program and retention rates.
"The retention rate one year after program implementation jumped to 65%," she says. "Today, three years later, retention has reached 80%."
Although many factors influence retention, it is clear that there is an association between the new program and improved retention. Other program strengths include enhanced communication, increased feelings of support among and for orientees, and more time for orientees to become assimilated into the organization. Challenges include the ongoing need to work with new administrators and managers to maintain buy in for the new program, scheduling nurses to attend the third and fourth program sessions (by this point they are carrying full patient loads and need to be covered on their units), and finding ways to effectively utilize orientation feedback.
Editor's note: Prickitt-White presented her findings at the Pennsylvania Workforce Investment Board conference in March 2009. She is currently working on developing a manuscript for publication to share her success with other staff development specialists. Prickitt-White's innovation has not only helped her organization and its newly-hired nurses, but has added to the evidence-based body of staff development knowledge as well.This article was adapted from one that originally appeared in the October 2009 issue ofThe Staff Educator, an HCPro publication.
Minnesota nurses are protesting Gov. Tim Pawlenty's move to eliminate subsidized healthcare for more than 30,000 low-income adults. Members of the Minnesota Nurses Association and their supporters will march to the Republican governor's Capitol office on October 12 to demand that he reverse the spending cut. The Minnesota Nurses Association is a union with 20,000 registered nurses as members.
For the first time in history, there are four distinct generations in the American workplace. Although no one learning style or preference is common to all members of a specific generation, there are some general characteristics that serve as guidelines for teaching strategies.
Be careful, however, not to stereotype learners. These characteristics and strategies are general suggestions to be adapted to the needs of individual learners.
Research findings indicate that each generation has particular attitudes, expectations, values, work ethics, communication styles, and motivators (Hammill 2005). Let's look at each generation, its characteristics, and teaching strategies that might be most helpful for its members.
The Veterans
Also known as Traditionalists, Veterans were born between 1922 and 1945 and personally dealt with two of the most significant events of the 20th Century: the Great Depression and World War II (Avillion 2008, Filipczak et al. 1999, and Hammill.)
The Veteran's view of family is that of a "traditional" nuclear family, consisting of two parents and their children within one household. They look upon education as a privilege (Avillion, Hammill) and view authority figures with respect. They are not likely to question them or express concerns directly, so you may not find they have concerns until you read their evaluations, so ask for feedback throughout the program. They prefer formal, businesslike learning environments (Avillion).
Teaching strategies for Veterans include:
Make sure learners are able to use equipment needed for the learning activity, especially for distance activities (such as computers, simulation tools, etc.) but don't assume they don't know how to use new technology.
Provide organized handouts that summarize the key points of the learning activity.
Explain how new skills relate to job performance
Encourage discussion.
Don't put Veterans "on-the-spot" by asking them to demonstrate unfamiliar techniques in front of others. Allow practice time in private.
Baby Boomers
Baby Boomers, the product of the post WWII baby boom, were born between 1946 and 1964. Baby Boomers saw the beginnings of changes in the family structure, from the traditional viewpoint of the Veterans to increased number of divorces and single-parent families (Avillion; Filipczak et al.; Hammill).
Boomers were usually doted on by their parents and grew up believing that they were entitled to the best the world has to offer. They believe that they are entitled to education, including higher education, and that they have a responsibility to change the world for the better (Avillion; Filipczak et al.)
Boomers have a passionate work ethic and desire for financial success. They value both teamwork and personal gratification in the workplace. Boomers are dedicated learners and initiated the self-help craze (Avillion; Hammill).
Boomers may come across as know-it-alls and do not respond well to authority figures. They respond best to educators who treat them as equals and share examples of their own experiences with learners. They value team work and personal gratification in the workplace and during learning activities (Avillion).
Baby Boomers are best motivated to learn if new knowledge and skills are designed to help them excel on the job and gain recognition (Avillion; Filipczak et al.; Hammill).
Consider these tips when planning education for Baby Boomers:
Incorporate team building activities, discussion, and icebreakers as part of learning activities.
Avoid extensive role-playing activities. Boomers do not usually like them.
Allow time for private practice of new skills since Boomers, like Veterans, don't like to display lack of knowledge in public.
Make information easily accessible. Remember that Boomers are the first generation to access the Internet and are fascinated with its use.
Generation X
Members of Generation X were born between 1965 and 1980. Referred to as the latch-key generation, Xers are accustomed to having both parents work outside the home and letting themselves in after school with their own keys (Avillion; Hammill).
Xers view education as a means to success. They are cautious about money, having seen their parents downsized, perhaps more than once. Accustomed to change in family and work status, this generation is comfortable with change. They like a balance between work and leisure, value flexibility, dislike close supervision, and prefer self-directed learning. Xers are born distance learners (Avillion; Filipczak et al.; Hammill).
Because they witnessed the downsizing of their parents, and perhaps grandparents, members of Generation X are not loyal to an organization. They do not automatically respect authority figures; you need to earn their respect. Instead, they are loyal to themselves and their own individual career paths (Avillion; Filipczak et al.; Hammill).
There are some distinct differences between how Boomers and Xers view work and education. Boomers invented the 60 hour work week while Xers insist on a balance between work and leisure. Boomers value the team concept at work and in learning, while Xers are perfectly content to pursue distance learning at a time and place convenient for them (Avillion; Filipczak et al.; Hammill).
Here are some tips for designing teaching/learning strategies for Xers:
Make learning activities fun. Xers value fun as part of work and learning.
Incorporate role-playing when possible. Xers enjoy role-playing scenarios and are not really worried about making mistakes in front of others as they learn.
Allow time for discussion. If the learning activity is conducted at a distance set up time for group meetings or online chats. Make use of e-mail as a means to answer questions and share information.
Earn Xers' respect by demonstrating expertise, and sharing your experiences with them. Be enthusiastic.
Xers like visual stimulation. They don't generally read as much as Baby Boomers and prefer visual illustrations over printed materials.
Generation Y
Members of Generation Y were born between 1981 and 2002 and are also referred to as members of the Echo-Boom Generation or Generation Net Avillion; Filipczak et al.; Hammill).
Generation Y's have grown up with technology and are completely comfortable with its frequent advances and changes. They equate education with the ability to find good jobs (Avillion).
They view downsizing as normal and have even less loyalty to organizations than Xers. They focus on what they do, not where they work (Avillion; Filipczak et al.; Hammill).
Here are some education tips for Y's:
Incorporate opportunities to interact with colleagues and educators.
Incorporate fun as well as structure in education. Provide information about objectives, goals, and schedules.
Establish a mentor program.
Provide written resources and ways to access journals, books, and other materials. Unlike, Xers, Y's enjoy and value the time that they spend reading.
Provide convenient distance learning opportunities, but make sure that you offer opportunities to collaborate and have discussions with each other and with educators.
Because you will be dealing with members of all four generations, plan varied activities that incorporate a variety of teaching/learning strategies. Be flexible and enthusiastic. All learners value educators who are sincerely interested in facilitating continuing education and the professional growth and development of their learners.
References
Avillion, A. E. (2008). A Practical Guide to Staff Development: Evidence-Based Tools and Techniques for Effective Education. Marblehead, MA: HCPro, Inc.
Hammill, G. (2005). "Mixing and managing four generations of employees." FDU Magazine Online. Retrieved September 1, 2009 from www.fdu.edu/newspubs/magazine/05ws/generations.htm.
Filipczak, B., Raines, C., & Zemke, R. (1999). "Generation gaps in the classroom." Training 36(11): 48-54.
This article was adapted from one that originally appeared in the October 2009 issue of The Staff Educator, an HCPro publication.
The head wound patient in the emergency department's bay three just threw up and a patient discharged over the weekend needs a follow up call regarding how he is recovering from his complicated procedure. Which patient is the priority? This dilemma is all too common for nurses and healthcare organizations that are striving to manage quality and patient satisfaction.
Study after study has shown that patients who have more interaction with nurses express higher satisfaction rates and increasing nursing time at the bedside has been shown to improve overall quality scores. The challenge, of course, is to reduce the administrative burden nurses carry so they can spend more time at the bedside. Studies conducted several years ago at Cedars-Sinai Medical Center in Los Angles indicated that, on average, nurses spend as little as 25% to 30% of their time at the bedside, though many hospitals are successfully working to increase that percentage.
Given the positive effect nurses have on patient satisfaction and quality, reducing the administrative burdens of frontline nurses should be one of the top priorities for nursing managers.
Nurses' responsibilities
In the wake of the country's nurse shortage, many nurses are wearing more than one hat during the workday, often taking their attention away from caring for patients at the bedside. One activity stealing this time is the responsibility to place calls to patients who have been discharged and need follow-up clarification on discharge instructions and prescribed medication. Nurses struggle to find time for this task while attending to their current patients.
These calls clearly have their place. The U.S. Agency for Healthcare Research and Quality recently cited that 20% of patients have a "complication or adverse event" after leaving a hospital. Many avoidable errors are due to patients misunderstanding post-discharge instructions such as cleaning a surgical site or taking prescriptions in correct doses. Follow-up phone calls educate patients and can help prevent further complications. However, these calls can be time consuming for busy nurses.
Considering there is an average of 120 million ED discharges annually in the United States, let's assume healthcare organizations conduct follow-up calls with 40% of that population with an average call taking five minutes. This translates into at least 150 million minutes, or 104,166 days, on the phone reviewing post-discharge instructions—and that's for ED patients alone.
Additional resources
One solution for some facilities has been to assign post discharge calls from nurses to centralized call centers staffed by trained call advisors or experienced nurses. Some facilities choose to create their own in-house call centers, while others rely on outsourced healthcare call centers. In either case, well executed programs can have a significant effect on nurses' job satisfaction—as nurses benefit from a reduced workload—and patients' satisfaction scores, as patients who receive post-discharge calls have been shown to have a more favorable impression of their care overall.
"We wanted to reduce or eliminate the need for our nursing staff team to engage in post-discharge calls if it meant they would be distracted from their current patient care duties," says Britt Berrett, president and chief executive officer. "Using an outsourced call center staffed with personnel who are trained to answer clinical questions was the best choice for us."
Results
The imperative to follow-up with patients after discharge is high because we know discharged patients can become readmissions if they fail to recognize the early onset of complications or if they fail to follow discharge instructions. However, there are two new factors spurring urgency in this arena. Medicare is positioning to eliminate payments for avoidable readmissions within 30 days of discharge, and it is tying reimbursement to HCAHPS patient satisfaction scores, making this an administrative priority for hospitals.
Many organizations are finding the right post-discharge program can help meet these challenges. A 200-plus bed Midwest hospital implemented a proactive call program for discharged ED patients and found a significant relationship between post-discharge calls and satisfaction scores. The chart below depicts the feedback generated based on a survey of 125 ED patients discharged between April 1 and June 30, 2009.
The scores represented here for overall rating shows the percent of patients who reported good, very good, or excellent care overall. The 'would recommend' data shows the percent of patients who said they would "yes, definitely" recommend the hospital to friends and family. Patients who received post-discharge calls were more likely to report good or better ratings of their overall care than their counterparts, and were more than 25% more likely to recommend the hospital.
One Florida hospital that aggressively used an outsourced call center strategy to manage inquiries from discharged patients uncovered an additional financial incentive. It estimated that it saved more than $11 million in one year by providing appropriate telephone triage that prevented readmissions.
From both the financial perspective and the quest to drive clinical quality, providing proper patient follow-up demands special focus and a selective strategy in order to reduce this common burden on nursing staff. If handled well, nurses and patients both benefit.
Mark Williard is senior vice president of Beryl, a healthcare-exclusive call center, where he oversees product management to support more than 450 hospitals, health systems, and private practices' call center programs. For more information, visitwww.beryl.net/.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.