Robust data and analysis provide speed, reliability, and rapid information-sharing, Tampa General's new CNO says.
Effectively gathering and using data allows nurse leaders to achieve outcomes more quickly and more reliably, says Annmarie Chavarria, DNP, MSN, RN, NEA-BC, who brings her data-driven leadership style to Tampa General Hospital as its new senior vice president and chief nursing officer.
Chavarria developed a data-driven leadership style to solve problems faster for patients, she says.
"We can move forward so quickly and we don't have to wait long periods of time to realize that we need to pivot," says Chavarria, who brings more than 15 years of nursing leadership experience to Tampa General, a 1,007-bed nonprofit academic medical center.
She embraced data "once I realized that we didn't have to spend months on something, but we could spend a couple weeks. [When I noticed] that something wasn't making an impact, but we could pivot and do cycles of improvement on it and actually make changes much faster because our changes are affecting people's lives," she says. "It's affecting patients; it's affecting their outcome; it's affecting quality of care that we provide."
Gathering usable data
The process for gathering data depends on the problem that needs to be solved, and it may mean asking "why" more than once, she says.
"When we're looking at a problem, we ask a bunch of 'whys,'" she says. "We might ask 'why' six or seven times to get to the bottom line of what is causing the problem or what it is that we are trying to measure."
"A lot of times we'll look do a gap analysis [to see] all the pieces and what we're missing. Then we sort of build out things so we can get the pieces of information that we're missing," she says. "It's similar to an apparent cause analysis. Once we identify what that [cause] is, we call it a key process measure. We use those believing that those processes are going to affect our outcome because they're key in that outcome."
Sometimes they're wrong and must make adjustments to start all over again, Chavarria says.
"If we're doing the process well but the outcome doesn't change, we have to circle back and do a cycle of improvement and dig down again and ask those "whys" five more times or more until we get to another process that might be affecting that outcome," she says.
Managing cognitive bias with data
Relying more on data is advantageous in reducing cognitive bias in clinical care, Chavarria says.
"Historically in nursing, we did a lot of things by what we thought anecdotally, and then when we actually get to see data, sometimes it forces us to change our mindset because whatever we thought was happening may not be what the data shows," she says. "Sometimes it does show the same thing, which is usually validating and helpful because then we know we were focusing on the right thing."
The risk related to data and cognitive bias is in measuring only what is thought to be the problem, which, in itself, is cognitive bias, she says.
"Your thinking needs to broaden and a lot of times you need to have outside people who are not in your world every day," she says.
Outside people might include data experts, information technology professionals, or consultants who can bring a fresh, new perspective to a problem, she says.
"It helps us if we are truly measuring the right thing, but if we picked only what we thought the problem was," she says, "then we might be letting cognitive bias affect us in a negative way."
Data and decision-making
For data to be quality enough to be used in decision-making, it must be consistent, plentiful, and trended, Chavarria says.
"We have to have it for a long enough period that you can make a decisions based off of that," she says. "A couple of data points does not make a trend, so you wouldn't make big decisions off of just a couple of points."
Data input also has to be known to be coming from an accurate place.
"Electronic medical records are challenging so sometimes things are documented in a couple of different places and not everybody documents in the same way," she says. "Usually having people at the point of care participate in these identifications of data and results of data and asking them, 'does that match what we do every day?' and 'does that feel right?' will help."
Make the data investment
Technology makes data collection and analysis much easier and more effective, Chavarria says.
"I have been very fortunate to work in organizations that have data centers or have processes or software set up with data like Qlik Sense [a data analytics platform]," she says. "If you don't have that, it's actually much harder to work with data."
Her advice to fellow nurse executives? "The best money you can spend is on technology that gives you this data that helps you make decisions accurately and quickly, and then helps improve your processes," she says. "It really is an investment you have to make."
Becoming a data-driven leader requires bringing staff along, as well, and building communication and an education strategy around it, Chavarria says.
"You also have to do a lot of training with people to help them understand data," she says. "You have to share it accurately. You have to push data to people; you can't expect that they would pull it out anywhere. You have to educate to it. You have to communicate it. You have to make sure that people are on the same page with why you're measuring things."
"With data, you can publish it, you can share it professionally, and you can put it out there and everyone can benefit," she says. "So, doing things faster, doing things more reliably, and being able to share things quicker is why I have adopted it."
UPMC Williamsport used a bundled approach to prevent catheter-associated urinary tract infections.
A Pennsylvania hospital's quality improvement initiative led to a rapid turnaround in catheter-associated urinary tract infections (CAUTIs) and a sustained approach to preventing healthcare-associated infections.
Hospital-acquired CAUTIs are the second most common healthcare-associated infection, according to the U.S. Centers for Disease Control and Prevention (CDC), occurring most frequently in intensive care units (ICUs). They are preventable events that can lead to poor patient outcomes and higher healthcare costs.
UPMC Williamsport, part of the University of Pittsburgh Medical Center (UPMC) Susquehanna health system, reported 13 CAUTI events in 2018, far exceeding its benchmark of four or fewer such infections annually. Six of the infections occurred in the ICU of the 224-bed rural regional medical center in north central Pennsylvania.
UPMC Williamsport responded by establishing a CAUTI reduction task force, which developed a quality improvement initiative with both education and practice-related interventions.
The multifaceted approach quickly reduced CAUTI rates and paved the way for hospital-wide implementation with long-term impact.
During the four-month intervention period covered in the study, the ICU had no reported CAUTI events, compared with two CAUTI events during the pre-intervention period. In addition, the CAUTI incident rate decreased by 1.33 per 1,000 catheter days. Total catheter days increased by 10.5% from the pre-intervention period, which may be attributed to higher ICU admissions and a higher device utilization ratio during the intervention period, according to the study.
"One of the strengths of this initiative was the overall simplicity of the interventions," co-author Holly Shadle, DNP, CRNP, FNP-BC, a nurse practitioner in the neurosurgery department, Neuroscience Center at UPMC Susquehanna, said in a press release. "These interventions were direct and efficient, with few direct costs or necessary equipment, making the process easily adaptable for hospital-wide use."
The educational portion of the initiative began with all ICU nurses participating in module-based didactic training on each component of indwelling catheter care, followed by hands-on skill and competency sessions.
Another element of the bundle involved indwelling catheter-related documentation and orders, including a daily checklist and a nurse-driven removal protocol for discontinuing catheter use, according to the release.
The electronic checklist used drop-down features for all responses, except for the catheter insertion date, to prevent free-text responses and typos. A completed checklist was required each night for every room in the ICU—even those without patients or with patients who didn't have indwelling urinary catheters.
Program adapted hospital-wide
Documentation compliance increased significantly, from 50% before the interventions to 83.3% during the interventions, the study says.
Because of the project's success, the newly formed CAUTI quality assurance and performance improvement team began adapting the program for hospital-wide implementation.
Additionally, the informatics department began integrating a version of the daily checklist into the electronic health record.
Nurses challenge Chicago hospital's alleged safety and employment law violations.
Registered nurses at Community First Medical Center in Chicago were planning an in-person picket, along with a virtual press conference today to alert the public to what they say is a variety of state and federal violations that jeopardize patient safety.
"At least 60 of our nurses have become ill, and three have died since the start of the pandemic as we have been working without appropriate personal protective equipment and struggling to make do with broken equipment, and without adequate supplies," Kathy Haff, RN, said in a press release from National Nurses Organizing Committee/National Nurses United (NNOC/NNU).
"Hospital management's refusal to address the ongoing and potentially life-threatening problems that persist throughout the hospital is putting our patients and our staff at risk," Haff said. "As we continue to mourn the loss of our coworkers who died in service to our community, we are determined to fight for our patients."
The picket was scheduled for early today at Community First Medical Center, followed by a virtual press conference at 12:30 p.m. CDT, according to the release. The press conference can be viewed on the National Nurses United Facebook page through this link.
Nurses have documented what they believe to be numerous safety violations and employment law violations at the hospital and are calling for investigations by the Occupational Safety and Health Administration (OSHA), the Illinois Department of Public Health, the Illinois Department of Labor, and the Illinois attorney general’s office.
Some of the violations they allege include:
Broken door in a negative pressure room: Negative pressure rooms isolate patients with infectious disease such as COVID-19 by using a pressure differential to keep air in the patient room from escaping into common areas. If a door can’t be closed, contaminated air can travel to other areas and expose patients and staff to infectious agents.
Failure to maintain required temperature in cardiac catheterization lab. Due to a broken HVAC system, temperatures in the catheterization lab have been documented as high as 80 degrees and at least twice, high temperatures have led to equipment failure, they said. Illinois law mandates that hospitals must keep their HVAC systems in working order at all times.
Continued failure to fit test nurses for N95 respirators despite 2020 OSHA citation and fine. NNOC/NNU initiated the 2020 OSHA investigation after three hospital nurses died of COVID-19: Nancy Veto, RN, died in May; Anjanette Miller, RN, a nursing supervisor, died in April; and Dione Malana, RN, died in July. In December 2020, OSHA found that hospital administration had not taken appropriate steps to fit test the nursing staff for N95 respirators, and the hospital had failed to develop and implement a written respirator protection program. The hospital was fined $13,000. Hospital administration has, as of this date, still not fit tested nurses for the respirators they are providing, the nurses said.
Lack of personal protective equipment and faulty N95s: Hospital administration is supplying nurses with N95s stored in brown paper bags, not in their original manufacturer’s packaging, making it impossible to know if the respirators are expired, they allege. They also claim that straps on these N95s often break, nurses must reuse gowns intended for single-use, and nurses are asked to use gloves that do not fit.
The nurses also accuse the hospital of failure to pay employee health insurance premiums, causing loss of healthcare and failure to pay overtime.
This is not the first time Community First Medical Center has come under fire. In January 2020, eight emergency room physicians quit over safety concerns related to supply shortages, staffing issues, and equipment problems.
This contract makes improvements to staffing, including an agreement that EMMC management will make improvements to critical care departments that nurses at Maine's largest unionized hospital have requested for the past three years, according to a press release from the Maine State Nurses Association (MSNA).
"The pandemic has been incredibly difficult for all healthcare workers," Cokie Giles, RN, MSNA president, said in the press release. "When our management approached us about extending our current contract, we saw an opportunity to make important changes that we have wanted for a long time."
The hospital also voiced satisfaction with the contract.
"We are pleased to reach this agreement with the nurses' union, so we can continue to provide support and stability for our staff, who have skillfully pivoted daily to meet the changing needs of our healthcare environment in response to the global pandemic," Deb Sanford, MBA, MSN, RN, the hospital's vice president of Nursing and Patient Care Services, said in a statement. "Our common focus has always been on caring for our patients, our community, and each other. This agreement highlights the strength in collaboration that I’ve seen all year, as our nurses have come together to provide safe patient care during COVID-19."
The contract reflects the work of the nurses, said Ali Worster, Esq., the hospital's vice president, Human Resources and Patient Experience.
"The changes enhance resources to support our good work, reward them for the skilled care they provide, and allow us to recruit the best and brightest to our ranks into the future," she said. "We were able to reach creative decisions that brought both sides together and ultimately [will] improve the experience of staff and patients."
One of the strongest parts of the agreement is that it doesn’t have any takeaways, Giles said.
"We have a very strong union contract, built over many years," Giles said of the union that represents more than 900 nurses at EMMC. "The foundations of this agreement with EMMC made sure that our patients can get the care they need and that nurses have a real voice at the medical center."
Denver Health's online scavenger hunt and escape room helps train new nurses by 'hitting different modalities of learning and being able to capture all learners,' Denver Health nursing educator says.
Denver Health is putting finishing touches on a new teaching game—a virtual escape room that will roll out during National Nurses Week, May 6-12.
An escape room—whether a physical room or an online, virtual room—requires participants to crack codes, uncover hidden clues, and solve challenging puzzles, all designed to help them escape the room or an impending disaster in a limited amount of time.
The new game's virtual setting is the hospital's night shift on December 31, 1999, and the impending disaster is an information technology (IT) catastrophe caused by a Y2K bug threatening to shut down all hospital computer systems. The objective is to find the clues and solve the puzzles in time to escape the IT disaster.
Education components of the new virtual escape room game are based on nurse-sensitive outcomes, says Jama Goers, PhD. RN, Denver Health's director of Nursing Education and Research.
"We want more awareness about NDNQI® [National Database of Nursing Quality Indicators]—how it's defined and how we're doing at Denver Health, as well as really highlighting some of the successes that we've had over the past year," she says.
For example, part of the game shows several NDNQI benchmark charts, asks the question, "Which indicators has NICU outperformed benchmark for 8 out of 8 quarters?" and offers several possible answers.
Teams can physically gather together to play the game or they can play individually on demand, says Jennifer Bonn, RN, a Denver Health professional development specialist.
"Our intention is that they can do both," she says. "I envision a night shift crew on a slow shift playing together or a single nurse playing alone during some downtime. That’s why the leaderboard will include participation by unit and by team. If it's collaborative, it would be highly effective and more fun."
Gamification is a growing trend in healthcare education, as evidenced by the increasing number of peer-reviewed scholarly articles on the subject.
Making learning fun
Denver Health started using gamification in 2014 with an orientation game called Saving Denver, a two-hour, in-person scavenger hunt around the health system's campus, as part of a larger orientation program.
Saving Denver calls for teams of participants to follow a map and work together to save Denver from an infectious disease by finding and unlocking dozens of clues to lead them to the location on campus of their next challenge.
For example, when a team finds a locked box containing the next clue, their task is to log into the health system's computer system, access a particular policy, and find its number, Goers says. That policy number is the code to unlock the box.
"Every activity was associated with an organization policy, she says.
Besides familiarizing new nurses with Denver Health policies and culture, the game also helps them get acclimated to their new surroundings, Goers says.
When the pandemic required social distancing last year, Denver Health created an online version of the scavenger hunt, allowing the health system to continue its fun orientation even with the constraints of COVID.
"They still have the same clues and hints and need to do things [as the in-person game], but they're able to navigate now through a virtual campus," Goers says
'Gamification [is] an effective way to teach'
Learning with games is effective, according to research exploring nurse education and gamification.
A sample of 115 nurses was divided into three groups, each learning from a different teaching method, to evaluate their clinical knowledge before and after orientation.
The gamification group posted the highest mean scores post-orientation, compared to the academic and online module groups. The study concluded that, "gamification [is] an effective way to teach when compared with more traditional methods. Staff enjoy this type of learning and retained more knowledge when using gaming elements."
Measuring gamification's success for Denver Health's nurse education consists primarily of gathering feedback and self-reporting, Goers says.
Providing the best tools for learning
Some people can learn from traditional instructional methods, but others require more tactile approaches to learn and retain information, which is what gamification offers, Goers says.
"It's about hitting different modalities of learning and being able to capture all learners," she says. "That way, we're able to fully capture our learners' needs in providing the content that they're going to need to be successful."
Gaming is one solution for capturing and holding attention people's attention spans, which some experts estimate can be as little as just seven minutes.
"It's about finding that balance and being able to maintain attention and deliver content that's meaningful to our end users," she says.
Advantages of gamification
Besides offering a bit of fun to nurses as they learn, gaming provides team building and socialization, and learning a particular policy becomes more appealing and less of a checked box, Goers says.
"Instead of it being, 'Here we are going through another policy,' people are a little bit more engaged in trying to get through the game quicker because there is that competitive component or that reward at the end," she says. "That makes it fun and it's a little bit different."
Learners also appreciate the flexibility of navigating the system at their own convenience, she says.
"They don't feel pressure that they have to do it within a certain timeframe, so they're able to absorb a little bit more," Goers says. "And they just really appreciate a different approach to policy and procedure and onboarding."
Online education resources identify, assess, and counsel patients at risk for harm.
The Emergency Nurses Association (ENA) is giving emergency nurses tools and information they can use to help patients at risk for firearm injuries or death.
The Firearms Injury Prevention Education program, funded in part by the American Academy of Pediatrics, features a webinar, online course, and a podcast series focused on identifying patients who might be in danger and the steps emergency nurses can take to assess, educate, and provide follow-up care to those individuals.
"We did a study published about a year ago that looked explicitly at how emergency nurses assessed for firearm safety and access to lethal means during the ED visit, and what we found was that the vast majority of emergency nurses were not asking [about firearm access], and there are a variety of reasons for that," Lisa Wolfe, PhD, RN, CEN, FAEN, FAAN, director of ENA's Institute for Emergency Nursing Research, said in a podcast launching the program. "But a prime one is that there's a lack of comfort in having that conversation."
The American Medical Association has issued educational material for physicians discussing firearm safety with patients, but there were no guidelines for emergency nurses, Wolfe said. So the ENA included a webinar in the new program for ED nurses to ask across different patient groups about firearm safety to assess for lethal means.
"The conversation is different with parents of a child who comes into the emergency department; it's different with adolescents; it's different with people who come in with behavioral health complaints, like depression and suicidality," she said.
Other high-risk groups are geriatric patients and patients who present to the emergency department for domestic violence or intimate partner violence, she said.
"The presence or absence of access to lethal means in those populations makes a really big difference in the risk assessment for those patients and, therefore, how you would intervene or pull resources in for that," she said.
"This is not suggesting that you have these lengthy conversations with … people who are there for ankle sprains or sort of other things that that probably have nothing to do with firearms," Betz said in the podcast. "At the same time … we have the privilege of really of intersecting with patients who are in very vulnerable states and are going through some kind of mental health crisis like a divorce or worsening substance abuse, or maybe they're involved in domestic violence."
The webinar and learning modules help nurses identify age-specific risk factors; triage and assessment guidelines; discharge education; and tips on approaching firearm accessibility within the context of injury prevention and safety, ENA said.
'This is not about gun control'
The program's goal is first and foremost patient safety, Betz said.
"Anyone who works in the ER understands how important it is that we connect with people where they're at and that we are there to help and to heal, to give hope, but not to dictate to people how they live their lives," Betz said, "and so I hope that people listening to this and the other parts of this program recognize this is not about gun control, it is not about confiscation, it is not about judging people for why they own guns or why they don't, but it is about providing counseling around safer storage or safer access when someone's at risk."
Much like her work at the University of Colorado, the program's core is preventing firearm injuries.
"In the firearm injury prevention initiative that I lead, that's really coming from a space of collaboration and communication," she said, "and listening and working closely with the firearms community—retailers and owners and instructors—to really honor our shared goal of health and security, and respecting diversity of views, and helping people find the solutions that work for their family."
Disaster-response nurses are seeking RN volunteers to administer COVID-19 vaccines through May.
Nurse volunteers from the Registered Nurse Response Network (RNRN) who have been vaccinating thousands of residents of the historically underserved South Los Angeles community have extended the COVID-19 clinic through the end of May and are calling for more volunteer RNs.
Since March 1, RNRN has deployed six teams of volunteers who have helped administer more than 66,000 COVID-19 vaccines at the Kedren Community Health Center in South Los Angeles so far, according to a press release. A seventh team of RNRN nurses began volunteering this week.
RNRN is calling on registered nurse volunteers to assist at the clinic, operated in partnership with International Medical Corps, in the coming weeks. Interested RNs can sign up to volunteer for the vaccine team here.
Such targeted clinics are helping to even out the vaccine disparity found in minority communities that are significantly behind in getting COVID-19 vaccines because of unavailability and other barriers such as transportation issues, no access to computers or social media, language, and education.
As of April 13, 2021, the Centers for Disease Control reported that race/ethnicity was known for slightly more than half (55%) of people who had received at least one dose of the COVID vaccine. Of this group, nearly two thirds were White (65%), 11% were Hispanic, 8.5% were Black, 5% were Asian, 1% were American Indian or Alaska Native, and less than 1% were Native Hawaiian or Other Pacific Islander.
"Providing free and equitable access to the vaccine is such an important step in defeating the pandemic," Jean Ross, RN, president of NNU, said in the release. "We are so proud of our RNRN volunteers who are helping to vaccinate thousands of people in underserved communities."
"Everyone is so thankful to be vaccinated," Mo Berry, a retired University of California-Irvine nurse, who volunteered at the clinic in March, said in the release. "I am proud to be a part of NNU's work to address the historic inequities that have adversely affected underserved communities for so long."
Autonomy, relationships, and development are among the keys to building a culture of engagement, American Organization for Nurse Leadership education director says.
Building a culture of engagement in a hospital or health system begins with recruiting and hiring nurses committed to the mission and then creating an environment where they can flourish personally and professionally, says a director with the American Organization for Nursing Leadership (AONL).
"Team member engagement is directly related to one's commitment and connection to their organization," says Crystal Lawson, DNP, RN, CENP, education director for AONL.
The growing number of studies on nurse engagement identify a number of outcomes, such as safety, decreased mortality rates, decreased falls, quality, and patient experience.
Engagement also affects a hospital or health system's bottom line. Fifteen of every 100 nurses are considered disengaged, with each disengaged nurse's lack of productivity costing an organization $22,200 in lost revenue annually, according to a 2016 study published in the American Nurses Association's Online Journal of Issues in Nursing. Consequently, a hospital with 100 nurses could potentially lose $333,000 annually, while a large system with 15,000 nurses could lost $50 million.
Building a culture of engagement is among the learning objectives of the Virtual Nurse Management Institute, a three-day virtual, interactive course being offered by AONL April 28-30.
"[The course is] designed for current nurse managers looking to add the critical management tools necessary to be successful in their current role and take their career to the next level," Lawson says.
Lawson shared with HealthLeaders why engagement is crucial to both the organization and the individual nurse and how nurse leaders can build and cultivate a culture of engagement in their own organizations.
This transcript has been edited for clarity and brevity.
HealthLeaders: What are the most important benefits of a culture of engagement to a hospital or health system?
Crystal Lawson: Highly engaged teams have better retention rates, higher patient satisfaction, and improved organizational performance. Ultimately, this affects patient outcomes, organization reputation, and healthier communities.
Organizations should also look at how they recruit new talent and the employee onboarding process. A culture of engagement can be cultivated by hiring the appropriate talent that are committed to the mission, vision, and values. Research shows Gen Z places value on culture fit over traditional benefits such as salary, insurance, and PTO, so it is important to clearly communicate your organization's mission and values, especially as they relate to diversity, equity, and inclusion. Clearly communicating this and empowering team members can significantly influence a culture of engagement.
HL: What are the benefits of engagement for each nurse in that hospital or health system?
Lawson: Engaged nurses experience higher levels of happiness and in turn better health. Organizations with a culture of engagement demonstrate that people are valued. Employees feel rewarded and recognized. Nurses involved in professional governance have the opportunity to have their voices heard and impact outcomes. This allows the nurses to work smarter and produce better outcomes, which fosters innovation. Engaged nurses are dedicated to the mission and feel more energized and committed to their work.
As many areas across the country continue to experience a shortage of healthcare workers, these market forces allow new clinicians to be selective in choosing where and for what kind of organization they want to work. As younger generations value flexibility and work-life balance, organizations may consider offering clinicians the ability to tailor their schedules to provide time for innovation, as one example. Creating a career lattice that enables new clinicians the ability to move within the healthcare organization may also be attractive.
HL: What are the top drivers of engagement?
Lawson:
Autonomy. This translates to being trusted to make decisions. Another way I like to put it, delegate the outcome and not the approach.
Relationships. Positive relationships within teams and mutual respect are core to engagement. One question on a Gallup employee engagement survey asks, "Do you have a best friend at work?" There is concrete evidence that those who answer "yes" are twice as likely to be engaged.
Development: Employees want to receive helpful feedback and support to help them achieve their personal and professional goals.
Leadership: Are leaders role-modeling the way? Are they communicating a common language and committed to supporting a healthy practice environment? Are they visible and accessible? As the saying goes, "People don't quit a job, they quit their boss." The manager role is critical to engagement.
Meaning: Are you able to find meaning in your work today? Connecting your work back to the purpose is a powerful way to create engagement. It is the leader's responsibility to bring purpose and meaning to the work, as well as setting clear goals and expectations for the team. Leaders must also inspire their team to the "why" behind their work. I personally believe demonstrating the “why” is one of the most powerful ways to drive employee engagement. Having purpose and meaning at work creates happier individuals and overall organizational success. Shared values make it easy to work toward a shared vision. It builds camaraderie and everyone is invested in success.
Capitalizing on strengths: Last, but not least, I would add that an employee's ability to use their knowledge and skills is directly related to an employee's engagement. Being able to use your strengths makes the work more enjoyable and allows career growth. The quote that comes to mind: “Only do what only you can do.”
HL: Covid-19 has turned healthcare upside down and nurses are going to feel the effects of trauma and burnout for a while. How does a nurse leader build a culture of engagement in those circumstances?
Lawson: Engagement is reciprocal. One of the most powerful exercises is to connect to your purpose and find meaning in every day's work. There are best practices for resiliency. Individuals are responsible for identifying the practices that work best for them. Leaders should invest in their own resilience, role model how they find resiliency, and disseminate this to those they lead.
The foundational principles for engagement still apply during the COVID-19 pandemic. It is essential to set clear goals and expectations. Be intentional about choosing happiness, building positive relationships, and being present and fully engaged. These principles of engagement are true for nurse leaders and frontline nurses.
'It's not necessarily that they don't want it, but they just can't get it,' says a leader of the Hispanic nurse association.
Minority communities are significantly behind in getting COVID-19 vaccines because of unavailability, say advocates on the front lines of vaccination efforts.
Fear and lack of trust are other reasons for disproportionate vaccine rates, they say.
"It's really more about convenience, not that individuals do not want to take it," says Linda Carper, an ambassador for the National Institute of Health's All of Us Research Program, an initiative to build one of the most diverse health databases in history. "The individuals that I know that are African Americans—young, old, middle age—we want to take the vaccine."
Her church, Greater First Baptist Church, located in the Houston, Texas, suburb of Independence Heights, an historic Black municipality, was looking to serve as a vaccination site, but received approval for one day only, and then only for residents of a particular ZIP code, she says.
"What about the rest of the week or the following week?" she says.
"It's about availability … in the communities that have transportation issues or where people are not able to get to the information through social media, because not everybody does social media," Carper says. "You have to make it available to the community."
This year’s theme for National Minority Health Month is #VaccineReady to underscore the need for these vulnerable communities to get immunized as more vaccines become available.
"These are groups of people that have such high rates of morbidity and mortality related to COVID-19, and they're the ones that we really need to get the information out about immunizations and get them immunized," says Norma Cuellar, past president of the National Association of Hispanic Nurses (NAHN).
As of April 8, 2021, the Centers for Disease Control reported that race/ethnicity was known for slightly more than half (55%) of people who had received at least one dose of the COVID vaccine. Of this group, nearly two thirds were White (65%), 11% were Hispanic, 8% were Black, 5% were Asian, 1% were American Indian or Alaska Native, and less than 1% were Native Hawaiian or Other Pacific Islander,
'It's not necessarily that they don't want it'
Fear—of the vaccine and of drawing attention to themselves—and inadequate messaging are among "several" reasons Latinos are not getting vaccinated, Cuellar says.
"There's a lack of feeling safe, that if they go to any of these facilities … there's going to be issues related to immigration status," she says. "We can educate and tell people a million times that we won't ask for immigration status but there's still a big fear factor that they will be identified and that ICE (U.S. Immigration and Customs Enforcement) will come and pick them up and they'll have ramifications from that."
Vaccine public service announcements by radio, internet or television have been inadequate in general, Cuellar says, which means most Latino communities get their information—which may not be accurate—from friends and family.
"With the amount of [COVID] deaths in their communities, one thing is the fear of COVID in general, and many don't understand that they can't get COVID from getting an immunization, so specific information to groups is very important," she says. "How we get that message out in a safe, comforting way that taking vaccine is better for us is not necessarily getting out to the public."
Overcoming obstacles to accurate vaccine education is fundamental to getting Latinos and other minority communities immunized, Cuellar says.
"When you have barriers like language, education, socio-economic status, and healthcare access, it's just difficult to get the shot," she says. "It's not necessarily that they don't want it, but they just can't get it."
In a national health crisis that continues to claim more than 1,000 lives each week, according to latest figures from the CDC, getting the vaccine into as many arms as possible, as quickly as possible, is vital, health advocates say.
"[As to] why it seems so disproportionate," Carper says, "that is a question that those who distribute the vaccine and made the decision about where and who would get the vaccine will have to answer."
Nearly 90% of surveyed nurses say their supply chain management system causes them stress.
Nurses face significant supply chain management problems that impact patient safety, efficiency, and hospital margins, says a market report released today that includes results from a nursing survey.
The report, Nurses: The Secret Factor for Better Supply Chains, an annual market report issued by healthcare inventory provider Syft, highlights hospital supply chain challenges at the point-of-use and key areas that require improvement. The nursing survey was conducted by Sage Growth Partners, a healthcare consultancy, to understand nurses' perspective of hospital supply chains, according to a press release.
Of 100 nurses surveyed—50 nurse leaders and 50 frontline nurses—in February, 86% said they leave procedures to hunt for supplies at least occasionally, according to the report.
Some 25% said they don’t always check product expiration or recall information, which increases risk of patient safety issues; 48% attributed this to lack of time.
Frontline nurses were more likely than nurse leaders to report frequent supply shortages, with nearly 10% more of them saying they occur often or occasionally, according to survey results.
The report also revealed a disconnect between nurse leaders and frontline nurses regarding how often nurses check product expiration and recall information prior to opening an item. While 84% of nurse leaders said their teams always check this information, only 66% of frontline nurses said they always check.
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80% of nurses said they want more supply chain automation tools
95% said inaccurate physician preference cards decrease their efficiency
65% said their current supply documentation system is too time consuming
Supply chain problems take a significant toll on nurse stress and burnout
86% said their supply chain documentation system causes them stress
33% said hospital leadership is not working hard to reduce OR nurse stress
18% said they have considered leaving their current role due to supply chain problems
Supply chain problems result in excess waste and lower margins
76% of nurses said supply shortages are common, and 23% said that the greatest impact of this is reduced revenue
33% lack access to waste-reduction tools such as barcode scanning
12% said their OR wastes supplies in more than 25% of cases
"Hospitals are taking steps to improve their supply chains after seeing vulnerabilities exposed by COVID-19, but these findings show that they won't be successful until they start factoring in the nurse experience," Todd Plesko, CEO of Syft, said in a press release.
"Nurses are experiencing pervasive and troubling challenges related to efficiency, patient safety, waste, and mental health due to supply chains not recognizing their needs," he said. "Creating a more nurse-centric supply chain is critical to every hospital’s success.”
