An 85-year-old hospital patient faces first-degree assault and other charges after allegedly shooting and wounding a nurse inside Danbury (CT) Hospital. Stanley Lupienski, who was being treated at the hospital, shot a nursing supervisor three times in the cardiac care department, on the eighth floor, at 2:37 p.m. on March 2, police said. The nurse was rushed to the emergency room, where he was in stable condition, hospital officials said.
Washington, DC's largest private hospital has fired 11 nurses and five support staff members who failed to make it to work during the back-to-back snowstorms that paralyzed the region in February. Dozens of staff members at Washington Hospital Center face internal investigations, union representatives say, and it is unclear how many employees will lose their jobs. The nurses union, Nurses United of the National Capital Region, has filed a class-action grievance with the hospital, the Washington Post reports.
It is a bit of an industry joke: Hospital employees are statistically among the most unhealthy Americans, particularly when it comes to cardiovascular health.
To combat this fact, Spartanburg (SC) Regional Healthcare System—designated as an ANCC Magnet Recognition Program® (MRP) organization in 2005—sought to improve the health of its 5,000 employees as it aimed to reduce the comparatively high rate of deaths from heart disease in the region—556 versus 536 per 100,000 nationwide.
And with planning and effort, it did. Spartanburg successfully inspired employees to exercise, helped employees lose 1,759 lb. collectively, and identified 250 employees with elevated systolic blood pressure, while simultaneously improving the overall health of its community and laying a blueprint for other hospitals to follow. This included the education of three OB/GYN groups, one family medicine group, the Spartanburg Regional Medical Center (SRMC) employee health department, and all of the medical residents who rotated through the chest pain department, as well as two employee wellness challenges and screenings.
SRMC is also part of the HeartCaring® Program, a Spirit of Women national campaign focusing on outreach and education of heart health issues.
"What we realized was that we needed to give this information out and take care of our own employees," says Mary Mathes, executive director of women and children's services at SRMC.
Mathes says there was an opportunity to set up an employee health program that could reach a large number of employees, and to do so in a gender-specific way—remarkably, more than 80% of Spartanburg's employees are women. Not only could the hospital target a massive percentage of its workforce, but it could also tap into behaviors female healthcare providers tend to exhibit.
"This information will not only go out to our female employees; they would take this information back to their homes," says Mathes.
This was a deliberate thought—organizers knew that women generally make the healthcare decisions for their families, "and so, if we could educate them, we knew this information would go into the home and into the community," says Mathes.
Why do nurses and other healthcare providers so often exhibit signs of poor health?
"I think healthcare providers in general put themselves last," says Mathes. "They work long shifts and then they have to multitask lives outside the job. We recognize that as the healthcare field."
Thus, Spartanburg's goal was to help its employees realize that their own health is just as important as the health of their patients.
Distributing information
As a member of the Spirit of Women Network, Spartanburg was provided a wealth of evidence-based information and materials that could be distributed to staff.
"All we had to do was find a vehicle to provide this information to our staff," says Mathes.
Every employee has an annual health evaluation at the hospital. Organizers realized that one place where every employee would eventually find themselves—and where they would be in the right frame of mind to think about their own health—was the waiting area for these evaluations.
"There was an opportunity there to provide educational materials, and then to have them meet face-to-face with a nurse practitioner," says Mathes.
J.T. Smith, RN, MSN, BC, CVN-1, chest pain center coordinator at Spartanburg, is in charge of education for clinical healthcare providers. Smith educated the nurse practitioners and physicians on the program.
"We found there was a knowledge deficit," says Smith. "When asked what they thought the No. 1 killer in women was, the majority said breast cancer, when it's heart disease."
With the nurse practitioner actively providing information and printed materials as takeaways in the waiting area, these annual evaluations became a good opportunity for staff outreach.
The importance of 'when'
To maximize the program's impact, SRMC implemented its outreach program early in the year.
"We did it at a strategic time of year," says Smith. "In January, everyone is motivated, ready to change their lifestyle. That's when we said, 'Let's look at your heart health.' And this leads into heart month [February], when we offer different venues for heart education."
SRMC is particularly interested in employee health—beyond evaluation, cholesterol screenings, and the like, the hospital also has a half-mile indoor walking track where staff members can squeeze in a workout during their lunch break. Because of the success of the indoor track, the facility has been able to rally support to get a larger outdoor track built as well.
Once under way, the program caused a welcomed issue—education materials were flying out the door.
"The biggest problem was keeping up with materials," says Mathes.
Supply had trouble keeping up with demand, prompting frequent calls from employee health center and physician practices for additional materials.
"Honestly, sometimes getting into physician offices was a problem initially as we got them to realize this was a program that could benefit their patients, but once we got into the offices, [Smith] was able to describe what we were doing, and they embraced it," says Mathes.
Spartanburg took an MRP concept and turned it inward. "With [the MRP], when you think about your nurse practice model, our theory is caring for our own and reaching out," says Smith. "Caring for our own is paramount, that we not forget that we have a large population of women are right here in our institution."
Success stories
SRMC offers blood pressure screenings every February. In one year, it took more than 500 blood pressures and found that 50% of the employees who were screened had elevated systolic blood pressure. The hospital was able to provide guidance for those employees, whether through advice, treatment, additional tests, or further evaluation.
"It sounds very simple, but I'll venture a guess that if you talk to healthcare providers . . . we take blood pressures every day but very seldom take our own or each others'," says Smith. "We felt there was possibly a need there, and unfortunately we were right."
And once those basic healthcare needs were met, the facility knew its employees would pass on the information they learned. "Part of our education with our employees was knowing they would take it back to the bedside," says Mathes. "This information could be passed on to their patients when they're ready to go home. Just educating our staff would help our patients."
The next step is to demonstrate continual improvement and growth. This means keeping things interesting.
"The other thing is to keep up with the employees," says Smith. "We have to keep offering them opportunities to learn more about their risks and how to live a healthy life. We have to be creative and keep our employees interested in clever ways."
A small room just off the admissions area at Tufts Medical Center in Boston contains what many in the facility describe as the nerve center of the hospital. It looks like the bridge of the Starship Enterprise. Multiple plasma screen monitors blink with yellow, green, and blue squares.
Employees sit seated in front of the monitors, analyze the colors and icons as they enter new data into the computers below, and relay information to callers.
To the outside observer, the screens look like a bunch of flashing lights, but these screens are actually a snapshot of the entire facility. They are a part of Tufts' RapidView system, powered by McKesson's Horizon Enterprise Visibility™ solution.
RapidView isn't a tool that benefits just one department. The system helps improve every aspect of the facility, from housekeeping to employees to physicians.
"RapidView allows us to access timely, correct information so we can better align patient needs with our resources," says Terry Hudson-Jinks RN, MSN, vice president of patient care services at Tufts Medical Center.
Reading the board
This is where June Stark, RN, BSN, MEd, director of case management and quality support services at Tufts Medical Center starts her day—in the admission discharge transfer (ADT) center. With just a three- to five-minute scan of the screens, Stark can tell whether Tufts has enough discharges to meet the scheduled admissions.
"There is an art to it," Stark says. "After a while you can just look at the screens and know if it's going to be a busy day."
Each screen in the ADT center represents a floor of the hospital and each square represents a room. The color of a room is based on what type of patient is occupying the bed—a green room means the patient is an inpatient, blue means the patient is receiving observation services, etc.
This morning Stark notices the squares on one floor are almost all solid green, which means discharge orders have not been written for those patients. She sends a page to the nurses and case managers on that floor telling them to make sure the latest data are in the system and to promote additional discharges.
When Stark checks the boards later in the day she hopes to see a few green and white striped squares where green squares appeared in the morning. Green and white striped squares mean a physician wrote a discharge order and a discharge is pending.
A striped square also displays how many minutes have passed since the physician wrote the order. This makes it easy to track how quickly patients are discharged after the physician writes the order.
Improving patient flow
RapidView system is partly a response to the Massachusetts mandate that EDs can no longer divert patients, says Melissa Culkins Bair, RN, MS, nursing director of the ADT Center at Tufts Medical Center.
"One of the reasons we came up with the bed board [RapidView] was so that we could improve patient flow because we couldn't have the ED closing the door," Culkins Bair says.
RapidView improves patient flow by providing up-to-the-minute information for healthcare professionals, admitting staff members, and housekeeping staff members. Before RapidView, there was no mechanism to track such information.
"We worked in silos before centralizing patient access with RapidView. We didn't always have up-to-date information on unit-based throughput, leaving us uninformed on the clinical priorities," Culkins Bair says.
Electronic timers within the RapidView system keep track of everything.
For example, when staff members discharge a patient, this is communicated automatically by messages fed from clinical information systems to all employees by turning the green and white square brown, which means the room is dirty.
The housekeeping staff members and all other hospital employees on that floor see the brown square on one of the many LCD screens mounted in the common areas. Housekeeping goes to the brown room and signs in that he or she has begun cleaning. This turns the square brown and white and also starts the clock. Once finished, the crew member signs off that the room is clean and moves on to the next brown square.
This time-keeping feature makes staff members more accountable because it allows administrators to see how the patient moves along the continuum in real time. If it took three hours longer than expected to clean the room, managers can investigate the reason for the delay and take steps to improve the process.
RapidView also makes the ADT Center staff members' job a lot easier. With a scan of the screens, they can determine whether the hospital has any open beds, when beds will be open, whether a patient has an infectious disease, along with other patient information.
"The key to RapidView is that it is correct and it is timely," says Hudson-Jinks. "Because the variables keep changing minute to minute, your information cannot be 20 minutes old."
According to Hudson-Jinks, this access to timely information allowed Tufts to lower length of stay, treat more patients in 2009, and turn away fewer patients in acute need from surrounding communities.
Improving patient quality
"The thing that makes this system different is that it's not just a bed tracking system. It has clinical features," Culkins Bair says.
RapidView allows the medical staff to get an idea of the patient's case at a glance. For example, if the patient is on fall precaution, deidentified text appears on the screen that communicates this information to healthcare professionals. Healthcare professionals see this information on their floor's screen.
Icons also help healthcare professionals track where a patient is in the facility. If a patient is in radiology for testing, an icon appears on his or her room, and a timer starts. This way, staff members can tell family, visitors, and other healthcare professionals where the patient is and when he or she is expected to return.
There are also icons that appear to tell healthcare professionals that lab work has come back. A trained observer can even tell whether the results were normal or abnormal based on the icon's color.
In addition, RapidView has changed the way Tufts structures its ADT process. An RN works alongside an ADT Center staff member to ensure that patients are placed properly on the front end according to their condition.
Saving time
The RapidView system is also saving the Tufts staff a lot of time. The ADT Center staff no longer needs to make as many calls to each floor asking how many discharges are expected for the day or how many beds are available.
"Before, we relied on too many people to call and tell us information, whereas now, the information comes to us," says Hudson-Jinks.
As a result, the hospital's processes are streamlined and that in turn allows staff members to handle high volumes with relative ease.
This article was adapted from one that originally appeared in the January 2010 issue ofCase Management Monthly, an HCPro publication.
"Why are nurses so mean to each other?" asks Theresa Brown, RN, in this blog posting published online by the New York Times. Brown thinks it’s time the profession discussed the issue more openly, saying "A majority of nurses do not bully on the job, and that majority needs to set a new tone. We have to come out of the corner, stop allowing our co-workers to tear at one another's flesh and instead speak up."
A West Texas jury quickly acquitted a nurse who had been charged with a felony after alerting the state medical board that a doctor at her hospital was practicing unsafe medicine. After a four-day trial, a state court jury found that the nurse, Anne Mitchell, was not guilty of the third-degree felony charge of "misuse of official information." Conviction could have carried a prison sentence of up to 10 years and a fine of up to $10,000.