Still, healthcare workers generally feel safe going to work each day, new survey says.
Violent patients are a top safety concern for nurses, reveals a recent survey commissioned to better understand healthcare worker concerns.
Of the nurse respondents, 81% are concerned about patients becoming violent, which is understandable given that 59% of them reported a dangerous event at their workplace, according to the Healthcare Worker Safety Survey conducted by Motorola Solutions, which specializes in video security and access control.
The study, fielded between December 2022 and January 2023, analyzed answers from 500 respondents working in the healthcare field, including doctors, nurses, technicians, and administrators across the United States.
Hospital and healthcare system employees generally feel safe going to work each day, with 68% of healthcare workers stating they feel extremely or very safe while at work and 89% saying that they trust their workplaces to keep them safe in the event of an emergency.
Some of the biggest safety concerns healthcare workers have include patient(s) becoming violent (72%), the impacts of burnout/mental health (61%), and active assailants (42%).
Only 40% of respondents believe their workplace is extremely or very well prepared to manage an active assailant scenario.
More than half (54%) of healthcare workers noted that they would be at least somewhat likely to quit if a violent incident unfolded in their workplace.
Healthcare workers perceive staffing shortages to be one of the biggest safety concerns because they believe that loss of personnel will negatively affect the mental health of remaining workers and lead to job burnout (77%) and it will affect patient safety and care (72%).
Mental health
Widespread mental health challenges and job burnout also concerned survey respondents. More than half of them (56%) indicated that their or their colleagues’ mental health is generally worse now than during the height of the COVID-19 pandemic.
Nurses responded that mental health is “extremely” worse now (24%) while, comparatively, physicians said that mental health is at the same level now that it was during the height of the pandemic (31%).
Healthcare employees are also increasingly concerned about their patients’ mental health and the effect this may have on worker safety, the survey indicated. Almost three-quarters (71%) of healthcare workers said that patients’ mental health impacts their or their colleagues’ safety and well-being while at work.
Safety notifications
Healthcare employees would feel safer if more interconnected communication platforms were used for emergency notification, training was prioritized, and safety guidance was centralized, the survey noted.
Specifically, respondents shared that they would feel more prepared if their workplace: utilized panic button technology or another 911-alerting system (55%); conducted safety procedure training (51%); used customized text and/or phone alerts (48%); made safety plans digital and easy to access for all staff (46%); and offered a safety app with resources, plans, and emergency contacts (44%).
Those who work in hospitals or health systems must feel confident in their level of personal safety, despite a rise in violence, the survey concluded.
By taking into account healthcare employee safety concerns, consistently conducting safety training, and adopting new communication technology, health systems “can ensure that their staff is able to render the best possible patient care without unnecessary, unnerving distractions,” the survey said.
A shared leadership/professional governance mindset is key to a successful practice redesign, CNE says.
Editor's note: This article appears in the June 2023 edition of HealthLeaders magazine.
Care models had not wavered much since hospitals became medicalized in the early 20th century, and particularly since the Centers for Medicare & Medicaid Services (CMS) were created in 1965, says Jason Gilbert, PhD MBA RN NEA-BC, executive vice president and chief nurse executive, Indiana University Health.
But now, nursing shortages, increased patient acuity, and workforce pipeline challenges are requiring nurse executives to configure different care models.
Gilbert spoke with HealthLeaders about how he and his organization are approaching practice redesign and best practices to implement a redesign.
This transcript has been lightly edited for clarity and brevity.
HealthLeaders: What is your definition of practice redesign?
Jason Gilbert: I love this question, because we've had a big debate about that. There’s a lot of confusion in the literature and healthcare in general, about the difference between what a staffing model is and what a care model is. Both of these are very important, but they have a distinct focus.
Staffing plans are all the activities that are required to ensure that there's an adequate number and mix of healthcare team members to provide care. Nationally, this has been a big focus on ratios and with benchmarking—supply and demand.
But the definition we’re using for care model delivery models is the way tasks, assignments, responsibility, and decision-making authority are structured to accomplish quality patient care outcomes. These define which healthcare worker is responsible for which tasks, and then who has the authority to make decisions.
With all of that said, I don't think you can separate one from the other. There’s been a great focus nationally about staffing plans and nurse-to-patient ratio, but in my opinion, not enough emphasis on nursing care model redesigns.
We need to get away from thinking about redesign as if we’re going to be finished with this in the near future. It’s really care model evolution. These need to continue to evolve.
Both staffing models and care delivery models have that impact on quality, safety, mortality, affordability, and health equity, but you need to assess the contextual issues—geography of your units, availability of technology, your level of preparation, experience of your available caregivers, your pipeline, financial resources, licensing, accreditation, state practice acts, and then of course, patient and family.
Jason Gilbert, PhD MBA RN NEA-BC
HL: When is it necessary to re-engineer, or evolve, the way patients receive care?
Gilbert: The burning platform that's caused this necessity has been the huge supply and demand mismatch between the number of caregivers available and patient demands and acuity. We’ve been through many nursing shortages in the past but nothing really quite like this one. This has been exacerbated over the last several years with accelerating retirement rates, more work options outside of acute-care settings or in healthcare for nurses, and changing expectations in the workplace.
We have a pipeline issue with lack of faculty in nursing schools and a great number of qualified applicants are turned away every year just because there aren't enough to teach the next generation. We’re also experiencing a knowledge complexity gap in the profession. Millennials and Gen Z are now the largest portion of the workforce, which flipped in 2020 when baby boomers—and I hate those labels of generations—once were the largest sector in the healthcare workforce. They’re taking a lot of experience with them as they retire, so we have to rethink the way we provide care and onboard and partner with schools.
So, we need to continue to evolve improved quality and safety and patient care in the way it's delivered and to make care more affordable and equitable. Our past models are just not sustainable, not only for our patients, but for our direct caregivers, as well, and we saw a lot of this exacerbated during the pandemic. Our patients are telling us that they don't always like to receive care in the way that it's designed, and our caregivers are telling us they don't always like providing care in the way that it's been designed in the past.
We have lots of data on this and it's time to change our mindsets and embrace the changes that are ahead of us. As a profession, nurses have the duty to ensure that patients receive quality healthcare, so we're going to have to take a more active role in care model redesign.
HL: What does practice redesign look like at Indiana University Health?
Gilbert: As we are entering in this work, we want to be thoughtful about how this is going to be different. A lot of times we trial things, but then we don't always get good data for what works or what doesn't, or we try to wait for the perfect model before we would implement anything because, quite frankly, the stakes are high and there is that innate fear that you're going to make a mistake that's going to cause you not to give quality care.
So, we created a vision statement for care model redesign, and then associated guiding principles: we wanted to engage our frontline team members, we've encouraged autonomy, rapid testing, and frequent evaluation. We’re trying to get a little more agile and nimble with what works and what does not and spread that so we share the lessons learned across our system.
We have a lot of different pilots going on in the system and we have a research study that's going on with five innovation units across the state, so we're not waiting for perfection on this, but once we communicate the vision and the criteria, we developed some change management tools for our frontline leaders to help with how to go about this.
Part of the mindset shift for this has been to lead more through guiding principles that are not a one-size-fits-all. There were some who were probably waiting for me as the chief nurse executive to say, “This is the care model at IU Health; now everyone go out and implement this and everything will be fine.” I don't think that you can lead this way. I could have done that, but I think it would have failed miserably.
HL: What are key tips you would suggest in implementing practice redesign or evolution?
Gilbert: Balancing that structure and autonomy and not waiting for the perfect model that's going to work for everyone. Care is so complex across different patient populations, and different acuity levels that we have to lead more through guiding principles and really involve the front line and the voice of the patients and families in redesign.
It's been key to equip the frontline managers with the change management tools because there is a fear of, “What if this doesn't work?” or “What are we going to have to ask the staff to do?” It’s a shift to say that we want the staff to come up with the ideas and help with the redesign.
Leverage your professional governance structures and the Magnet principles—team empowerment, continual improvement mindset, focus on quality, safety, affordability, and equity. The biggest step is to let go of the past and challenge the status quo. Ask the “why,” and then help communicate the “why” with team members.
HL: Change in healthcare is traditionally slow, so how do you encourage others to let go of the past?
Gilbert: I have found that these initial pilots really work with the willing. There are many who want this change. They live with this every day, and they're frustrated and they want to provide care in different ways. Our frontline team members see the deficiencies, so who better to be involved in the changes?
Letting go of that traditional paternalistic command-and-control models of leadership and getting into that shared leadership/professional governance mindset is the key to the future with this. The best ideas come from our front line on how we're going to change care or do things more efficiently.
HL: What have you learned from your efforts to implement practice redesign?
Gilbert: That you can't look only within the four walls of your organization to change this, so we've taken a very active role in partnerships outside of the hospital with some of our partner universities. IU Health has given grant money to both Ivy Tech Community College and to the IU School of Nursing for expanding enrollment to help with some of the issues they have. We're also looking for community partners with high schools and vocational schools to look at pipelines for healthcare workers.
You also have to take a very active role in advocacy for public policy. You have to do a full assessment of the communities you serve, community partnerships, and if we're going to change practice, we have to work with our state and federal legislators in order to do that as well.
When 100% of the nursing faculty at one upstate New York reported incivility as a major departmental issue, they reversed course.
Incivility among nurse educators—bullying, disrespect, harassment—is growing and affects new nurses’ view of nursing as a profession, according to a new study published in NursingCenter.
Workplace incivility among faculty and students in nursing education has been known to have “detrimental effects on health and well-being, disrupt teaching and learning, and negatively impact the adequate preparation of new graduate nurses,” the study notes.
With 85% of nurses report incivility in healthcare, creating a culture of civility beginning in nursing school and extending into the workplace, is crucial to healthy environments and safe patient care, according to the study, which outlines a particular nursing program’s efforts to address incivility.
At a large nursing program in upstate New York, 100% of the nursing faculty reported that incivility was a major issue in the department. They enjoyed teaching nursing students but did not care to work together as a faculty group. Their complaints included a lack of teamwork, favoritism; undermining, demeaning comments; stealing others' joy at work; blaming each other for incivility; bullying behavior; and failure to recognize accomplishments.
As a result, faculty did not work as a team in creating new innovative projects, developing and revising curricula, or simply helping each other when needed, according to the study, authored by Maureen Kroning, EdD, RN and Sara Annunziato, MSN, RN.
However, the faculty admitted their desire for a civil environment where they could experience joy in the workplace, so in May 2019, five nursing faculty launched an effort to address incivility and identify and implement effective strategies to create a civil environment so faculty could experience joy at work, according to the study.
The five faculty members and the nursing program director developed an Incivility Care Plan by incorporating the American Nurses Association (ANA) Nursing Process and the American Psychological Association's five essential components to healthy workplace practices: employee involvement; work-life balance; employee growth and development; employee recognition; and health and safety.
“Each step in the nursing process can help address the issue of incivility,” the study says. “Care planning using the nursing process allows one to assess incivility, diagnose the human condition as a result of the incivility, plan and develop strategies or interventions, evaluate if the interventions were successful, and revise the plan of care as needed.”
The study was implemented in early 2020 and by March COVID-19 cases surged in New York. The unexpected rapid transition to remote teaching created intense challenges, but it also led to an equally unexpected, “unprecedented” level of collaboration and communication among faculty, the study says.
For example, some faculty excelled in teaching remotely and helped other faculty learn and implement the needed technology to teach remotely. And during remote teaching, faculty met weekly to share experiences and how they were doing during the pandemic, which brought joy as they collaborated to achieve the semester's teaching and learning objectives.
From 2019 to 2021, as full-time faculty retired or resigned, potential candidates were carefully chosen for their ability and commitment to work effectively in a team environment, possession of a positive attitude toward work, and zero tolerance for incivility.
Implementation
For the next two years, accomplishments, such as weddings, births, graduations, promotions, and more were announced and celebrated at faculty meetings and shared with administration and adjunct faculty.
“Encouraging open communication and acknowledging, recognizing, and supporting faculty concerns were the first vital steps in addressing incivility in the department,” the study says. “To improve communication, faculty worked hard to include all adjunct faculty in team meetings and to disseminate all meeting minutes to full-time, part-time, and adjunct nursing faculty [as well as] support and lab staff.”
Evaluation
A five-question anonymous and confidential survey indicated that 73.7% of participants responded that they were experiencing joy at work.
Asked to select from a list of strategies that might contribute to bringing joy to work, participants responded:
A positive attitude: 92.1%
Collaboration with peers: 89.5%
Being a team player: 84.2%
Working toward a common goal: 78.9%
Celebrating each other's accomplishments: 68.4%
Accountability for creating an environment of civility: 57.9%
Creating a zero-tolerance attitude for incivility: 52.6%
Hiring new faculty who are positive and team players: 50%
Speaking out against incivility: 36.8%
“To effectively work as a team, the nurse faculty need to focus on effective collaboration instead of competition to improve nursing programs and student success,” the study notes. “True teamwork requires the mindset that the success of any team member is a success for all and that a failure to achieve a goal is a failure of the team as a whole.”
New study to determine whether stress-reduction techniques can remedy nursing students' struggle to graduate.
While stress is no stranger to nurses, it frequently begins long before they start their first job.
Indeed, research indicates that nursing students experience higher stress levels compared to other majors and that these levels are on the rise. The result is a “bottleneck” or struggle to graduate, which has further effect on a dire workforce shortage.
Cathy Tierney, EdD, assistant professor of nursing at the University of Nebraska Medical Center College of Nursing’s Northern Division and her colleagues are looking into this challenge with a two-year study, “Bottleneck Reduction: Use of Simulation and Stress Reduction Apps in BSN Courses to Increase Academic Success.”
The “bottleneck” is not new, Tierney said, and faculty often recognize it.
“If students struggle in the first and second semester, usually by the third and fourth semester, you can tell the difference,” she said.
For nursing students working through their final year of attaining a Bachelor of Science in Nursing (BSN), stress comes from three primary areas, according to a 2022 nursing study:
Academic stressors: Exams, anxiety of failure
Clinical stressors: Extreme fear of failure, negative reaction to death or patient pain
Personal/social stressors: Economic problems, family issues
Additionally, demands of studying, completing didactic and clinical assignments, and doing actual clinicals leave little free time for nursing students, the study says.
Clinical placements may require nursing students to spend considerable time away from campus and the feeling of being responsible for the well-being of patients can be overwhelming—both of which remove nursing students from the normal social developmental activities of their same-age peers, the study says.
Nursing students participating in the “bottleneck” study, which began January 1, are coached on meditation and stress-reduction techniques. They also are working with faculty to develop individualized study plans.
“We’re being proactive to address student stressors and develop a plan for success by making sure students are familiar with the academic resources available,” says Tierney, who has expertise in wellness and self-care.
Tierney completed her Doctor of Education at Bryan College of Health Sciences in 2021 with a dissertation topic on how traditional nursing programs incorporate self-care practices into the student nurse experience. She has extensive experience using complementary modalities to promote self-care and holistic wellness, and has practiced as a certified hypnotherapist and healing touch practitioner.
Additionally, the study includes incorporating simulation into classroom content, which is offered to all students regardless of whether they participate in the study.
Recently developed vrClinicals for Nursing training platform ramps up the 'day-to-day unpredictability of nursing.'
New immersive virtual reality (VR) technology is transporting Herzing University nursing students to a busy hospital floor where they must handle multiple patients and frequent interruptions—just like the real world.
vrClinicals for Nursing, an immersive, VR nursing education experience, recently was developed by Wolters Kluwer, Health and Laerdal Medical. Students using vrClinicals for Nursing with a Meta™ Quest 2 headset will be engaged in an authentic, virtual clinical environment where they must navigate real challenges nurses encounter on the job: prioritizing multiple patients with varied, complex cases; colleague interruptions; and patient requests.
With the current nursing shortage and limited clinical opportunities, newly licensed nurses are increasingly managing higher patient caseloads and must refine their independent clinical judgment earlier in their careers, according to Wolters Kluwer. Metaverse-related technologies, which are being used in many nursing schools, can provide the experiences to better prepare today’s nursing students for this environment.
The new technology mirrors the “the day-to-day unpredictability of nursing,” says Leila Casteel, DNP, APRN, NP-C, a practicing family nurse practitioner and associate vice president, Curriculum & Innovation at Herzing University, a Milwaukee, Wisconsin-based private university.
Casteel spoke with HealthLeaders about how the new technology is benefiting and preparing the university’s nursing students.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: How much of the current learning is in-person clinical work and how much is virtual simulation?
Leila Casteel: About 45% to 50% of our clinical hours across all of our clinical courses are simulation and of that simulation, there's a component of campus-based high fidelity, which is a smaller component. So I would say overall, about 35% of our clinical hours are completed using a virtual clinical experience.
HL: As a practicing nurse yourself, and also as an educator, how effectively does virtual simulation prepare nurses for the real world of nursing?
Casteel: It may sound a little blasphemous to say, but in many ways it prepares students more so than some of the live placements, and that's for a number of reasons. We've recognized that something has degraded a little bit in new grad nurses, and you think, “How did we get here? How, over the last 20 years have we become less effective at the bedside when we graduate?”
Part of that is the unpredictability of where your students land, and so much is dependent upon not only the strength of the clinical instructor, but the environment itself—the patients, the staff, and the willingness and interest of the nurses. You also have nurses out there who don't know the clinical judgment model because that's not what they learned.
So, we have to ensure that our students are getting that full experience and that we have measurable outcomes. One of the best things about virtual experience is that it can be very intentional and have very specific outcomes that are assigned and aligned with whatever's happening in that course. And you can ensure that all your students are getting that experience from end to end, which feels a lot better than the uncertainty of just sending them out.
HL: Virtual learning seems to provide a less stressful environment where students can make mistakes without endangering a patient. How does this aid in their learning?
Casteel: It’s absolutely a part of their learning. That freedom to fail and the formative assessment that we can complete in this type of environment is so critical to their own self-confidence when they go out and are working with live patients, so it's almost necessary. They need to explore, because at the heart of clinical judgment is decision-making and how we determine next steps. For students to be able to think that way, they have to start thinking about not only the decisions they're making, but why they're making them, what the risks are, and making alternative decisions.
That's exactly what virtual simulation provides is the opportunity to explore and make a decision. Maybe it's not the right one, but now you've got this opportunity, this excellent opportunity, to explore that decision in a more meaningful way, so that you can try again.
HL: What does the new vrClinicals for Nursing technology bring to your students that previous platforms don’t?
Casteel: Primarily, the concept of having multiple patients, diverse patient experiences, and that idea of learning to multitask. So often, virtual products are focused on a single patient at a single time and there's a lot of limits to that. We can do a lot to enhance even those experiences and we do because we love all virtual clinical experiences.
But this is unique because it is much more like what you would expect in an actual facility or on the job: multiple patients, diverse conditions, and things to consider. They’re fully built out, so there's their story, their history, the chart, and everything else, so students get to dive in and learn a lot about the patients before coming into clinical, which is extremely important and something they can’t do currently.
The level of urgency is a little different. With most virtual experiences, the student has a little bit more control over that urgency and that feeling of stress, because they can hit a pause button and they’re focused on one single patient. This experience really does require them to be in a mode of thinking, “What is the next best thing to do if I've got 10 conflicting priorities?” They have to think that through and articulate that to their instructor. It’s so much more complex, but in a positive way.
What’s really interesting about this experience is the way it weaves in and out of clinical urgency and then into contemplation and reflection, and then back into clinical urgency and back out into reflection, contemplation, and discussion. That’s good for a lot of reasons, but mostly for the deeper learning that can occur in that guided experience.
HL: How do the students feel about using virtual simulation technology?
Casteel: For a decade or so, we've had this interesting group consisting of very experienced techies and also some who didn’t want anything to do with it. But what we're seeing now, especially post-pandemic, is even those who were a little late to the game are now accustomed to using technology for everything.
We use our phones for everything, so there’s much less resistance. They’re almost drawn to it because that is now the norm. If the experience itself is meaningful, students report that not only did they learn something, but they were given that brain space to think about what they were learning so it sticks a little bit more. And they're going to be able to go tomorrow and explain that to somebody because it was an experience and not simply following a nurse and trying to mimic behavior. So, when it's done well, students really like it.
Legislation to bolster rural hospitals includes provision to give CRNAs autonomy.
The recent bipartisan Save America’s Rural Hospitals Act includes a provision to permanently remove physician supervision of Certified Registered Nurse Anesthetists (CRNAs), under Medicare Part A conditions of participation.
That provision, along with another to include non-medically directed CRNA services as a mandatory benefit under the Medicaid program, is being cheered by the American Association of Nurse Anesthesiology (AANA).
CRNAs have been practicing without this regulation for nearly three years under healthcare flexibilities issued during the public health emergency.
"Today more than ever, rural communities must address accessibility issues, including a lack of healthcare providers, the needs of an aging population suffering from more chronic conditions, access to healthcare, and larger percentages of uninsured and underinsured citizens," said Angela Mund, DNP, CRNA, president of AANA.
"As a CRNA who grew up in a small town in far northwestern Minnesota, I know firsthand the challenges of recruiting healthcare providers and how important the solo CRNA was to ensuring that we could provide surgical services to our community,” she said.
More than 170 rural hospitals across the country have closed their doors since 2005, and 453 rural hospitals are vulnerable for closure, according to the National Rural Health Association.
"This legislation would permanently end Medicare cuts that have devastated small-town hospitals,” said U.S. Rep. Sam Graves (R-Mo.), who reintroduced the bill along with U.S. Rep. Jared Huffman (D-Calif.),to rescue rural hospitals on the brink of bankruptcy and get them back on solid ground.
"CRNAs are the primary providers of anesthesia care in rural settings and have been instrumental in delivering care during the pandemic to patients where they live and when they need it," said Mund, in encouraging AANA members to contact their local U.S. Representative to support the bill.
"Often, CRNAs serve as the sole anesthesia provider in rural hospitals, affording these facilities the capability to provide many necessary procedures," she said
The importance of CRNA services in rural areas was highlighted in a study that showed that compared with anesthesiologists, CRNAs are more likely to work in areas with lower median incomes and larger populations of citizens who are unemployed, uninsured, and/or Medicaid beneficiaries.
Protective elements of a foam dressing may benefit other patients, as well, a new study says.
By adopting a revised clinical process and using a polyurethane foam dressing, a New York City hospital reduced the incidence of medical device-related pressure injuries (MDRPIs) following a tracheostomy to zero for four years, according to a study published in AACN Advanced Critical Care.
About 2.5 million patients experience hospital-acquired pressure injuries (HAPIs) each year, costing about $11 billion, according to the study. Nearly 24% of those incidents occur in ICU patients, as compared to up to 18% among general admission patients.
MDRPIs associated with a tracheostomy account for up to 10.9% of hospital-related incidents, the study notes.
NewYork-Presbyterian Westchester’s quality-improvement initiative used evidence-based resources from the Preventing Pressure Injuries Toolkit funded by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.
A key part of the new process was a revised PDT tracheostomy procedural kit and documentation, with the foam dressing placed under the tracheostomy flange during insertion. Both were secured with sutures and a flexible holder.The foam dressing remained in place for seven days, with primary care nurses assessing the site at least every 12 hours, the study says.
The dressing was then changed to a standard nonwoven gauze drain sponge after seven to 10 days as clinically instructed.
The results showed that suturing a foam dressing as part of PDT tracheostomy insertion can reduce the incidence of associated MDRPIs.
"When COVID-19 increased demand for healthcare equipment, we were able to refine our processes, transition to a revised PDT tracheostomy kit and maintain the integrity of the initiative," says Hazel Holder, DNP, MSN, RN, ACCNS-AG, CCRN, a critical care clinical nurse specialist and study co-author.
"We took a multidisciplinary approach that engaged all related specialties, with surgical site assessment and any clinician concerns discussed during daily rounds," says Holder, who conducted the study with Brittany "Ray" Gannon, PhD, MSN, AGPCNP-BC, a nurse scientist.
Prior to the initiative, in 2018, the incidence of HAPIs at the hospital was 1.39% for all ICU patients, with tracheostomy MDRPIs accounting for 0.19% of the incidents—15 HAPIs, including two MDRPIs in 1,077 patients. Of the two PDT tracheostomies performed, both patients experienced MDRPIs.
In 2019, the overall HAPI incidence decreased to 1.30%, with nine tracheostomies and no MDRPIs. The tracheostomy MDRPI incidence remained at zero for the next three years.
During the four years of this project, a total of 22 PDT tracheostomies were performed in the ICU, with the foam dressing placed at the point of insertion in all procedures.
That placement of the foam dressing can reduce the incidence of tracheostomy MDRPIs, and may benefit other patients as well, the study concludes.
“Although some process modifications may be necessary, the protective elements of the polyurethane foam dressing may benefit other patient populations as well,” the study says, “including pediatric, neonatal, and surgical.”
'Rising stars' focus research on underrepresented and low-income groups.
Five Johns Hopkins School of Nursing (JHSON) faculty members whose research focuses on underrepresented and lower-income groups will be able to grow their research after being named as the inaugural holders of the Baltimore-based university’s newly established Term Professorship for Rising Faculty (Rising Professorship).
The Rising Professorship is a three-year period of funding to support faculty members in research, collaboration, policy involvement, and leadership within nursing and beyond.
“This significant investment in faculty underscores our commitment to offering rising stars a place where they can both succeed in their careers and build the science, research, and networks needed to further nursing and improve health,” said Sarah Szanton, PhD, RN, FAAN, dean of the school of nursing.
Alexander examines such complex issues as intimate partner violence (IPV) that leads to sexual health outcome inequities in marginalized communities, HIV resilience, and societal gender expectations.
Alexander is inaugural chair of the Nursing Initiative of the Mid-Atlantic Center for AIDS Research (CFAR) Consortium, lead faculty for the Violence Working Group at the Johns Hopkins Center for Injury Research and Policy, and chair of the HIV/STI Committee of the Society for Adolescent Health and Medicine.
Kamila Alexander, PhD, MSN/MPH, RN
Alexander has been honored with the 2020 Johns Hopkins School of Nursing Dean’s Award for Outstanding Nurse Researcher, the 2020 Betty Irene Moore Fellowship for Nurse Leaders and Innovators, and the 2018 Johns Hopkins University Catalyst Award, Office of the Provost.
Long-term goals for her research are to “develop and implement new conceptual frameworks across national and international settings that prevent IPV and promote sexual well-being among women and their emotional partners,” according to Alexander.
Brockie seeks to achieve health equity through community-based prevention and intervention of suicide, trauma, and adverse childhood experiences among vulnerable populations.
Teresa Brockie, PhD, MSN, RN, FAAN
Brockie, a member of the White Clay (A'aninin) Nation from Fort Belknap, Montana, is a leader of the Young Medicine Movement, which introduces Native youth to health science careers and provides mentorship by Indigenous researchers and clinicians to Fort Belknap scholars.
Her intervention called Little Holy One is rooted in understanding that high rates of historical and current trauma in Native communities compromise caregivers' mental health and parenting, which in turn affect early childhood behavior problems and adverse events that increase children's risk for suicide and substance use in adolescent and young adulthood.
In 2020, she received the Brilliant New Investigator Award, Council for the Advancement of Nursing Science-American Academy of Nursing and received the RADM Faye G. Abdellah Award for Nursing Research, The United States Public Health Service (USPHS) in 2016.
Commodore-Mensah is looking to reduce cardiovascular disease risk among Africans in the United States and in sub-Saharan Africa through community-engaged research and implementation.
She is a cardiovascular nurse epidemiologist and co-founder and president of the Ghanaian-Diaspora Nursing Alliance, a nonprofit organization that advances nursing education in Ghana. Her research expertise includes immigrant health, global health, cardiovascular disease epidemiology, and social determinants of health.
Commodore-Mensah is CEO of the African Research Academies for Women, a nonprofit seeking to address gender disparities in science, technology, engineering, and mathematics in Africa. She also is principal investigator of the LINKED-BP and LINKED-HEARTS programs, two trials aimed to improve hypertension control and management of chronic conditions in community health centers.
Commodore-Mensah, who was named to the 2020 World Heart Federation Salim Yusuf Emerging Leaders Programme, is a fellow in the American Academy of Nursing as well as the American Heart Association, Council on Cardiovascular Nursing.
Samuel addresses socioeconomic disparities by advancing health equity for individuals and families with low incomes. Her current research examines the pathways that link low income and financial strain to physiologic aging.
This includes investigating the health impact of policies and programs related to economic well-being for low-income households. Samuel’s research also looks at aspects of neighborhood and household environments that may influence health disparities.
Laura Samuel, PhD, MSN, RN, FAAN
Samuel also evaluates the health impact of programs and policies intended to improve economic well-being for low-income households and her research has shown that greater participation in the Supplemental Nutrition Assistance Program (SNAP) and higher benefit amounts are associated with improved health outcomes for low-income adults.
Her research interests stem from her clinical experience as a family nurse practitioner where she regularly witnessed the myriad of ways that a lack of financial resources can be detrimental to health.
Taylor identifies and addresses pain disparities with older women from underrepresented racial ethnic groups and helps individuals with disabilities increase social participation and independence.
Taylor, whose research is strongly connected to her 10 years of clinical practice in long-term care and women’s health settings, is principal investigator of a study that addresses unmet needs of caregivers aging with and into disabilities.
Janiece Taylor, PhD, MSN, RN, FAAN
She is co-associate director of JHSON’s RESILIENCE Center, designed to improve the health and function of people with disabilities and their caregivers by adapting and scaling two award winning evidence-based programs for children and older adults with disabilities—Chicago Parent Program and CAPABLE—and is principal faculty of the school of nursing’s Center for Equity in Aging.
Taylor was selected as the first nurse in the Robert Wood Johnson Harold Amos Fellowship Program and throughout her career, has received funding from the John A. Hartford Foundation, National Institute of Nursing Research, Mayday Foundation, and more.
Teamwork, along with communication and awareness, can build an effective infection prevention program.
Infection prevention and control is fundamental to providing safe and high-quality patient care. A poor infection control program can result in increased rates of infections, significant illness, and death, and raise the likelihood of multidrug-resistant bacteria.
Awareness is the key to a successful infection prevention (IP) program, says Carol Vance, MSN, RN, PHN, CIC, the multi-site prevention director for Advocate Children’s Hospital in Chicago, a 381-bed facility that is one of the largest network providers of pediatric services in Illinois.
Vance spoke to HealthLeaders about how communication, awareness, and teamwork can contribute to an effective IP program.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: What are the most common hospital-acquired infections?
Carol Vance: Central line associated bloodstream infections (CLABSIs), along with catheter associated urinary tract infections (CAUTIs) and surgical site infections (SSIs).
HL: What are standard infection control precautions every hospital needs?
Vance: Obviously, hand hygiene is one of the most important things, but I think it's also important to look at things that are not what you hear all the time. There's another component from an executive level that's important, and it’s how those measures are applied and making sure that processes are created with minimal barriers.
An important component is the communication both ways to ensure that if there is some sort of barrier to hand hygiene—a barrier to actually doing the evidence-based bundles—then that is heard by leadership and is actively worked on with the front line to gather to minimize those barriers or challenges.
HL: Can you give an example of how that might apply?
Vance: From a hand hygiene perspective, it might be a situation where the hand hygiene dispensers are in the right place, so when it comes to auditing, it doesn’t take more time for that frontline person to do the right thing.
Also, evaluating the process to do a dressing change or to do anything that is part of the evidence-based bundles. And asking if there is a way to create a better flow that minimizes the extra work to do the right thing.
HL: What else can hospitals do to reduce infections?
Vance: Along with communication, awareness always needs to be top priority and that is challenging when there are so many competing priorities. It involves trying to find what works with the culture of the hospital to create awareness that is every day with every patient and every frontline person and that will look different at each institution.
The core of IP is the same. We know what works; hand hygiene, using the evidence-based practices, making sure your protocols are standardized and they’re easy to replicate. But there's another component to that, especially post-COVID. There's a lot of burnout and additional stress outside and inside the hospital, so communication at all levels is important. Healthcare has had a lot of turnover, and those core components of communication and increasing awareness are vital to get the post-pandemic crew up and running.
Carol Vance, MSN, RN, PHN, CIC
HL: How has the pandemic enhanced safety protocols?
Vance: It was hard on healthcare, but it also allowed healthcare to grow very quickly in certain areas. We learned how important it is to work with our supply chain team members and for systems to work together to get the appropriate personal protective equipment. In the beginning of the pandemic, that was very eye-opening.
There’s also been an enhanced understanding of what isolation precautions are, and the “why” behind them. Due to the fact that hospitals were inundated with COVID patients, they had to understand the “why” behind the PPE and how it can protect them, so it definitely allowed a lot of opportunity for education. It also brought different departments together within the acute care setting to work together on creating processes that helped.
HL: Nurses traditionally have had a large role in infection control. Who else should be responsible for infection prevention?
Vance: We always like to say infection prevention is everyone's role—physicians, respiratory therapists, supply chains. Infection prevention is part of the entire continuum of health.
It is particularly important to make sure each location has the knowledge of infection preventionists; someone who can help translate what the latest guidance is coming out. During the heat of the pandemic, we were gaining all of our knowledge as we went, so it was very important to have an infection preventionist who could decipher and work with the different types of specialty areas—oncology, bone marrow transplant, behavioral health—to navigate and apply it to those areas. Infection prevention is everybody's job, but you need to have that strong IP leader to help answer those questions that the front line may have.
HL: How is your facility doing with IP?
Vance: We are a very large organization, and we have a very strong IP system team. Most hospitals throughout the US took a hit during COVID with an increase in infections, but from an Advocate Aurora standpoint, we talk about infections all the time. It is always on the forefront of discussions: What can we do to improve? How do we share our best practices between hospitals? How do we educate our IPs to ensure that they are truly the experts?
I'm very proud of our system team; the majority of them are all certified and the site IPs share with each other and work collaboratively with the frontline teams. It’s great to see the buy-in, the increased awareness, and putting patient safety first. We have a great process, but we’re always looking to improve and that's important.
HL: What role does technology have in IP?
Vance: Integrating technology to get the front line working with the patient more is always important. They have hand hygiene technology that can give data back on how well each person is doing on hand hygiene.
Also, we do a lot of audits and the one thing that is important is they utilize audit technology to help decrease the amount of steps to get the data. So, if they're doing central line auditing or if they're doing catheter auditing, they can use different types of platforms to have their auditors enter the data and get real-time feedback, and having that real-time feedback is important to make those adjustments.
Despite record-level turnover and low unemployment rates, employers can improve their hiring system.
Navigating the current hiring environment is a challenge and healthcare recruiters are feeling the heat.
Faced with record-level turnover, historically low unemployment, and job openings above 10 million, organizations have never faced a more challenging labor market, says a new report from
Employ, Inc., a provider of recruiting and talent acquisition solutions.
Add inflation uncertainty, massive rounds of layoffs, and interest rate increases to the mix, and it’s easy to see why healthcare organizations and other companies are finding it difficult to respond in this challenging talent landscape.
The report, based on Employ’s proprietary recruiting data and findings from a survey of more than 1,200 HR decision-makers conducted last November, revealed that more than 65% of HR decision-makers think recruiting is more stressful now than it was a year ago, primarily because there are not enough qualified candidates (59%), there are more open roles to fill (51%), competition from other employers (44%), and more employees are leaving the organization (43%).
Workforce shortages have become an urgent issue at health systems and hospitals across the country. Healthcare organizations are facing severe nursing and physician shortages, along with deficits in other areas, as well.
Indeed, workforce challenges were ranked No. 1 on the list of hospital CEO top concerns in 2022, according to an annual survey conducted by the American College of Healthcare Executives.
The largest recruiting challenges in attracting and hiring quality talent, according to the report, are:
Not enough talent to fill positions: 56%
Competition from other employers: 54%
Inability to compete with salary requirements: 33%
Poor communication from candidates in the hiring process: 29%
The hiring process takes too long: 28%
Not able to work from home: 27%
Hiring professionals’ top recruiting priorities are improving the quality of candidates (61%), improving speed of the hiring process (44%), and getting more candidates for each open role (41%).
Other priorities include improving the onboarding process (38%) and having a more diverse talent pipeline (31%).
Job candidates, on the other hand, have their own motivations in seeking new employment. Their primary motivations are getting more money (34%) and the ability to work remotely (21%), according to the report.
Improving recruiting outcomes
The report offers three strategies to help organizations improve their hiring system:
1. Deliver positive experiences: Invest in the needs of hiring managers, recruiters, and candidates, and deliver positive experiences for these audiences. Shorten feedback loops and improve communication and collaboration. Ensure the hiring process delivers positive experiences that enhance the company’s employer brand.
2. Identify where to optimize processes: Keep a clear eye on applicant flow and the talent pipeline to uncover insights into where the recruiting process can improve.
3. Leverage purpose-built recruitment technology: Adopt recruitment software and talent acquisition technology that is tailor-made for the complexity, size, and hiring needs of the organization.
“Companies of every size and recruiting complexity must stay the course and remain resilient as they plan for 2023 and beyond,” the report notes.
