Board members provide proficiencies from a range of perspectives and skills.
The American Nurses Association (ANA) today announced the launch of its new Innovation Advisory Board (IAB)—a group of leaders with deep expertise in healthcare innovation.
The 15-member board is comprised of representatives from nursing, education, design, nonprofit, business, venture, and philanthropy, who can offer a range of perspectives, experiences, and skills, ANA said in press release.
The IAB's purpose is to provide strategic guidance and thought leadership to ANA's Vice President of Nursing Innovation Oriana Beaudet, DNP, RN, PHN in developing and executing innovation.
"We are fortunate to have their vision and breadth of experience as we work to advance broader health nationally through innovation led by nurses," Beaudet said. "We wholeheartedly welcome their leadership and insights as we move this work forward."
Innovation is at the foundation of nursing, the new board members said.
Quality improvement is crucial, not only to benefit the patient but also to enhance processes for the staff, she says. "[Quality improvement] has the best outcome for the team and ultimately for the patient, so it's mission critical for an organization," she says.
Scanlon shared four ways she's created success in quality improvement.
1. Prioritize quality improvement
To truly improve quality, it must come before everything else, she says.
"When financials are spoken about first, then you're really not valuing quality," Scanlon says. "For us, quality is the No. 1 thing that's discussed first and then financials. Financials are always important—don't get me wrong—but really, the No. 1 imperative is for quality improvement across the organization."
Quality improvement will translate into dollars saved, as it did for Northwell Health when some $46 million in direct costs were saved in a single year, she says.
"Our chief financial officer Frank Rizzo [senior vice president and CFO of Northwell Health’s Central Region] really understood this and bought into this and what's so phenomenal is that our CFOs and our finance individuals truly understand," she says. "The dollars will come. Quality has to come first."
2. Create a structure
"The first thing is you have to have an interprofessional collaboration approach to quality improvement," she says. "You need to bring in exceptional quality improvement leaders—those that are looked at in the organization in terms of respect, in terms of getting the methodology, so that you're not going in a million places."
A nursing quality improvement coordinating group should be comprised of both leadership and frontline staff who understand performance improvement modeling, she says. They should: understand how processes and systems will be examined; look at information and data; and talk to stakeholders, which are staff, she says.
She applied these principles as a deputy chief nurse executive when she was seeking to reduce catheter-associated UTIs [CAUTI]. They tested minimally invasive devices that prevented incontinence for incontinent patients, along with trials around ambulation, bladder training, bladder scanning, and intermittent catheterizations, she says.
"Our catheter-associated UTI rate dropped over 60%," she says. "It was something we were extremely proud of and have been able to sustain and continue to improve across the health system."
Some hospitals in the Northwell Health system haven't had a CAUTI all year, she adds.
3. Begin with small steps
"Start with a microsystem," she says. "Start with small. A test of change. If that test of change works, grow that test of change, but then have a methodology to expand it."
Many times, clinicians may see, validate, and replicate a change, but they don't spread the change appropriately, and that must be part of the process, Scanlon says.
Years ago, she used a dashboard for performance improvement that included quality, professional development, certification, baccalaureate rates, master's rates, operational matrices, turnover vacancy, overtime dollars spent, and patient experience. Because of its success, that dashboard tool eventually was developed and spread within the health system to more than 120 nursing units and 21 hospitals, she says.
"I see a structure process outcome as a constant circle," she says. "You have this structure; you're looking at performance improvement; you're installing processes; then you're looking at the data and the outcome. And then the structure starts again. So how do I spread that to the next 30 units that I have in a hospital? You have to have buy-in. You have to have discipline in doing this. And you have to have exquisite project management skills."
4. Engage everyone in quality improvement
Engagement is one of the most crucial elements for performance improvement, and it starts with management and leadership, Scanlon says.
"You have to have leaders that promote shared governance, that promote staff bringing forth ideas, staff doing self-scheduling, and staff being involved. You have to let staff know that you care," she says. "Mutual respect is everything."
When Scanlon refers to staff involvement, she means more than clinicians.
"The housekeeper who keeps a room clean and prevents infection is, in my opinion, as important as the nurses and the doctors that care for the patient," she says. "Every staff member is part of the solution in terms of improving your organization, whether it be quality or engagement or financial performance or patient experience."
Developing an engaged staff can produce profound quality improvement results, as Scanlon experienced when she sought to reduce pressure ulcers in patients. One way she does this is by enlisting RNs and patient care assistants (PCA) as frontline champions.
Of Northwell Health system's 2,600 nurses and PCAs, more than 1,500 of them are some type of champion—facility champion, pressure ulcer, skincare, patient experience, CAUTI, CLABSI [central line-associated bloodstream infections], and quality, she says.
For the pressure ulcer work, more than 100 staff members wanted to be champions in the effort.
"When I came, the [pressure ulcer] numbers were very high," she says. "We had an exquisite wound care and ostomy nurse, Mary Brennan, and we created an entire process around pressure ulcer and skincare champions."
"We had over a 90% reduction in pressure ulcers," she says, crediting the nursing care.
As a result, the "very extremely acute" Northwell hospital with liver and cardiac transplant departments, ended up with just 10 cases of pressure ulcers for an entire year, she says.
"This was really something that I was so most proud of because that's part of the structure—how to get the frontline staff involved and engaged. But we not only got them engaged, we enriched them. We gave them the tools, the education, and the ongoing support," she says.
The best quality improvement outcomes occur when everyone is working toward the same goal, she says.
"Everything is team. You can't do anything by yourself," she says. "The true heroes of this are nurse managers and our frontline staff—the registered nurses and PCAs. They are the ones who are making this happen every day."
Partnership relieves schools of logistical burdens of staffing, testing, data management, and reporting.
A new RAND Corporation report shows that local health systems can help COVID-19 testing to be integrated into pandemic response plans for K-12 schools.
"Our interviews with K-12 schools show that COVID-19 testing is complex, but doable," said Laura Faherty, lead author and a physician policy researcher at nonprofit, nonpartisan RAND. "Many early adopters found it critical to partner with local public health departments, local health systems, their peers, and testing vendors to launch feasible COVID-19 testing programs."
UC San Diego Health relieved the school district of logistical burdens by providing staffing to administer tests; managing testing logistics, such as scheduling appointments; analyzing samples; and collecting and reporting testing data. The health system calls students, teachers, and staff with a positive test, relaying results as quickly as possible, and reports positive results to the county health department.
The school district pays UC San Diego Health to run its testing program out of its district budget. Funding the district received through the CARES Act helped cover a portion of the costs.
The neighboring Del Mar Union School District (DMUSD), a smaller, more affluent district with lower COVID-19 community transmission rates than SDUSD, also has partnered with UC San Diego Health to swab symptomatic students and staff at the health system's testing sites and analyze their samples at its labs.
Turnaround time for results has been fast—24-48 hours, compared with 4-5 days through the county—even as case numbers have risen, which has helped the district make faster quarantine decisions.
After trying different testing procedures to minimize disruptions during the school day, UNMC helped the pilot schools set up a testing hub in a low-traffic area of each school, according to the report. On testing days, each class is excused to go to the testing hub at a designated time where volunteers assist with collecting samples. Students may opt out if they choose.
UNMC also is conducting a study that involves regular sampling of air, wastewater, and surfaces within the pilot schools to understand the extent to which testing these sources can contribute to understanding COVID-19 transmission risk in schools.
Schools encountered varying degrees of hesitation around testing and used several strategies to encourage participation, the report says. Privacy concerns were most common; staff and parents worried their health information could be shared while others expressed concern about how their test samples would be used. Another hesitancy factor was doubt about the actual risk posed by COVID-19.
The report, funded by The Rockefeller Foundation, provides recommendations for how schools can develop, and policymakers can support, effective COVID-19 testing programs. Recommendations include:
Expand funding to ensure schools can access tests, hire additional staff, and contract with health systems and other vendors as needed to implement testing.
Provide incentives such as paid sick leave for teachers and families to participate in testing and isolate as needed.
Provide resources to strengthen state and local health departments so they’re fully equipped to help schools design testing programs and respond to positive tests.
"This pandemic has illuminated nurses' critical role in health and our economy," said Kate Judge, the foundation's executive director, in a press release. "Through these surveys, we're able to better understand what our nation's frontline providers need to continue caring for patients and our communities—and provide solutions."
Among the findings:
Early-career nurses under age 34 reported the most mental toll, with 81% reporting feeling exhausted, 71% feeling overwhelmed, 65% being anxious or unable to relax, and 47% feeling sad. Nurses 55 and older reported some mental distress, but less than half reported feeling exhausted (47%), overwhelmed (37%), sad (31%), or anxious or unable to relax (30%).
"Nurses' sustained exhaustion, stress, and depression is a hit to their overall well-being and also takes a toll on our health system," Judge said. "This is especially so when you look at the disproportionate impact the pandemic is having on nurses who are early in their careers. As the future of our nursing profession, it is critical we give Millennials and Gen Z nurses the tools and time to recover and rebuild."
While 70% of the nurses surveyed have received the COVID-19 vaccine, hesitancy still exists. Of the 30% of nurses surveyed who have not been vaccinated, nearly half (46%) identify as Black or African American. About one-fourth of surveyed nurses reported they are undecided about receiving the vaccine, with reasons including being fearful of short- or long-term side effects and not having enough information about the vaccines.
Personal Protective Equipment
Only 73%, report they currently have adequate PPE. They also report continued issues related to PPE, with 33% of nurses reporting that their practice site does not communicate the status of PPE inventory to clinicians and staff.
Family finances and debt is a top concern among surveyed nurses, with 41% reporting this as an issue they worry about outside of work. Nearly 20% say they are financially worse off now than prior to the COVID-19 outbreak. The foundation has addressed this problem, providing $2.6 million in financial aid to more than 2,000 nurses across 45 states since the start of the pandemic.
State of the Profession
Despite the adversity COVID-19 has caused, most nurses report they do not intend to leave the profession (85%) or their current position (60%). Among nurses who indicated they do intend to leave their current position, top reasons included work negatively affecting their health and well-being (47%) and insufficient staffing (45%).
"Prior to the pandemic, we faced a worldwide nursing shortage, and a need to fill more than one million nursing positions in the U.S. by 2022 to avoid a further shortage," said Judge. "Nurses' well-being and mental health—especially among Millennials and Gen Z—are of the upmost importance, and we will do all we can to ensure they receive the help they need."
The Board of Certification for Emergency Nursing (BCEN), which provides certification for nurses across the emergency care spectrum who have met and exceeded nationally recognized standards of proficiency, has announced its new mission and vision.
BCEN's board of directors approved the organization's new mission and vision at its meeting last month.
New mission: The Board of Certification for Emergency Nursing (BCEN) supports nurses to achieve excellence by being the industry leader in professional credentialing while promoting the value of certification and lifelong learning.
New vision: Every patient across the emergency spectrum receives care from a BCEN-certified nurse.
The move was announced as BCEN is preparing for the upcoming international Certified Nurses Day™, held every March 19 to acknowledge and honor nurses worldwide who earn and maintain the highest credentials in their specialty and contribute to better patient outcomes. BCEN will celebrate its certified emergency, trauma, and transport nurses on that day.
The date marks the birthday of Margretta "Gretta" Madden Styles, EdD, RN, FAAN, an accomplished nurse leader and educator who conceived and helped establish national standards for certifying nurses in pediatrics, cardiology, and other medical specialties.
"BCEN's new mission and vision retain our focus on advancing the professionalism and clinical excellence of emergency, trauma, and transport nurses through rigorous national board certification programs," said BCEN CEO Janie Schumaker, MBA, BSN, RN, CEN, CENP, CPHQ, FABC, in a press release. "They also underline the ever-increasing importance of continuing education and point to the ultimate contribution of board certified nursing care—better patient outcomes."
More than 57,000 BCEN credentials are held by RNs who specialize in emergency, pediatric emergency, critical care ground transport, flight, and trauma nursing.
"BCEN is proud to join certification and nursing organizations, employers, and citizens worldwide in celebrating the remarkable contributions of board certified nurses," Schumaker said.
When a large, nearby hospital system offered high-dollar enticements such as large sign-on bonuses, Summit Pacific lost several nurses, and when others left to take advantage of lucrative travelers' pandemic wages, Bernier knew that Summit Pacific needed to focus on other strategies to recruit and retain experienced nurses.
Summit Pacific is a standalone critical access hospital with a 10-bed acute care unit with telemetry, a 10-bed emergency department, diagnostic imaging, lab, urgent care clinic, and wellness center. Its nursing staff is comprised of about 35 RNs, along with a few CNA techs and a handful of LPNs.
Bernier joined Summit Pacific in September 2020. Coming from larger health systems in Oregon, such as Kaiser Permanente and St. Charles Health System, she knew the nurse staffing challenges faced by both large and small hospitals.
"Unfortunately, the larger hospitals have also had a really hard time staffing, even with a larger pool, because the demand is higher," Bernier says. "Some nurses are retiring early, and some are changing positions, so emergency room nursing, in particular, has been hit hard."
To combat those factors, larger systems have been offering big financial incentives to draw nurses to their organizations and away from smaller, rural hospitals.
"In our local area, within 30 miles of here, a bigger hospital system decided to open up some emergency department room and they offered very large sign-on bonuses. We're talking tens of thousands of dollars, and that's very attractive to be only 30 miles away and be able to get that sign-on bonus," she says. "So, unfortunately, we lost quite a bit of our emergency department nursing because of that."
That leaves small, rural hospitals like Summit Pacific at a disadvantage.
"They're using incentives like that and it causes a shortage in all the rurals," she says. "We're growing really great nurses in rurals and then when shifts like this happen in the nursing economy, the only thing [bigger hospital systems] can do is dangle this big carrot and, unfortunately, that's hard to pass up for some nurses."
Offering sign-on bonuses and recruiting high-priced travel nurses might lure nurses away from rural hospitals but it can also have some disadvantages.
Pacific Summit offers sign-on bonuses, but to experienced nurses only, Bernier says.
"Otherwise, we end up with a lot of nurses who are very inexperienced, and it can be a real safety issue," she says.
She's also careful about using too many travel nurses.
"We recruited travelers, but we were very picky about that; they had to be travelers with extensive experience," she says. "We want our caregivers that are here to feel good about the people they're working with."
Instead, Bernier works to find nurses who are looking for the other benefits that Summit Pacific can offer, she says.
"When we do recruiting, we really highlight the difference that Summit has; we're a smaller hospital that that can make decisions rather quickly and be a little bit more flexible in some areas," Bernier says. "We also talk about where we are. It's beautiful here and this lifestyle attracts some people to be in this small, rural setting."
Elma, with slightly more than 3,000 residents, lies within Grays Harbor County, known for lush forests and miles of beaches. Elma is located about 40 miles from the Pacific coast and 30 miles west of Olympia.
"We also talk about our healthy work experience," she says. "When we say we want to help build the healthiest community, we mean it and it starts with us, so our caregivers are given a lot of benefits around health and wellness that others may not get."
A focus on retention
Part of Bernier's retention strategy is to help Summit Pacific's nurses avoid burnout by providing flexibility in staffing, keeping staffing at healthy levels, and fostering a sense of community.
For example, she encourages enough rest between shifts.
"Sometimes caregivers opt to take lots of extra shifts; that's totally up to them. But we also really congratulate and support those who say, 'You know, I'm going to do just my shifts and I'm okay with that.' Nurses are at different stages in their lives. Some people have babies at home; some people are empty nesters; some are brand new grads … so you have to be flexible with where the person is at."
Summit Pacific shows appreciation to its nurses and other employees by creating family-friendly events for them and the small community, she says.
"Last year, the hospital rented the drive-in theater for our staff to all go and enjoy and then at Christmas, it partnered with a laser light show, not only for our caregivers but for our community," she says.
Such events let nurses know that Summit Pacific cares about their well-being, even if it can't pay the same wages as the large health system 30 miles away, Bernier says.
"We really do try to pay attention to that," she says, "and make sure they understand."
New ABNS survey reveals 148 credentials spanning 53 specialty and subspecialty areas.
More than 1 million U.S. registered nurses and advanced practice registered nurses (APRN) are specialty certified, according to the American Board of Nursing Specialties (ABNS), which has released the results of its first major survey of U.S.-based nursing specialty certification boards.
The 2020 ABNS Nursing Specialty Certification Board Survey's purpose was to describe the scope of nursing specialty credentials available to RNs and APRNs. Specialty certification, also called board certification, is the highest professional credential a nurse may earn. They must pass a rigorous, national exam that validates their clinical and professional knowledge and judgment in a well-defined specialty practice area.
"Specialty certified nurses play a significant role in improving patient care and a host of healthcare outcomes," ABNS president Janie Schumaker, MBA, BSN, RN, CEN, CPHQ, CENP, FABC, said in a media release. "The fact that over 1 million RNs and APRNs practicing across a wide range of specialties have demonstrated this level of excellence is a testament to the indispensable contributions nurses make."
ABNS invited 56 U.S.-based certifying bodies to describe, via an online survey during May and June 2020, the specialty credentials they offer to RNs and/or APRNs. The response rate was 79%.
The survey found:
More than 1 million RNs and APRNs are specialty certified.
86% of these credentials are available internationally.
Respondents offer 148 credentials spanning 53 specialty and subspecialty areas. Of the 148 credentials, 76 (51%) are for RNs and APRNs; 29 (20%) are for RNs only; and 43 (29%) are for APRNs only, of which 24 are for APRN initial licensure.
The survey respondents were asked to select up to three nursing specialty or subspecialty areas—from a list of 59 options—that best define the primary practice focus of the nurses holding that credential.
The 10 most-selected specialty areas, in descending order, were critical care, pediatrics, neonatal care, medical-surgical, wound/ostomy/continence, disease-specific, emergency, hospice/palliative care, ambulatory care, and cardiac care.
Specialty certification for RNs occurs after RN licensure and is voluntary. Individuals interested in becoming an APRN must earn an advanced practice specialty certification as part of their licensure requirements, according to ABNS.
Hunter will lead the UI Hospitals & Clinics Department of Nursing Services and Patient Care. She will also oversee nursing services, the division of care coordination, and the rehabilitation therapies and respiratory care departments.
"We are thrilled to have Kim as a member of our senior leadership team," said Suresh Gunasekaran, MBA, CEO of UI Hospitals & Clinics and associate vice president for UI Health Care. "She brings a wealth of experience and leadership in inpatient and ambulatory care management; staffing and resource allocation; continuous quality improvement; and nurse recruitment and retention."
Longtime CoxHealth nursing leader Beth Polivka is the Springfield, Missouri, health system's new CNO. She previously served as a director of nursing for eight years.
"A respected and proven leader, Beth has been instrumental in leading and growing our women's and children's service line," said Karen Kramer, senior vice president and chief hospital officer at CoxHealth. "Beth is passionate in her quest for nursing excellence, and we are so excited to see her share her talents through this role, which will bring great benefit to our staff and patients."
Polivka, whose roots are in southwest Missouri, has more than 25 years of nursing experience. In 2004, she joined CoxHealth, where she worked as a staff nurse in the post anesthesia care unit (PACU). She was promoted to nursing project coordinator in 2010, and in 2013, she became administrative director of nursing and oversaw the women and children's service line.
As CNO, Polivka will lead nursing practice throughout the organization, which includes planning, organizing, directing, and evaluating nursing care.
The bill, co-sponsored by four Republicans and three Democrats, would direct the federal Occupational Safety and Health Administration (OSHA) to issue an enforceable national standard requiring healthcare and social services employers to develop and implement workplace violence prevention plans within 42 months to protect nurses, physicians, social workers, emergency responders, and others.
"We applaud Rep. Courtney for introducing this critical legislation that will save so many lives," said NNU Executive Director Bonnie Castillo, RN. "Studies have shown that having a plan in place to stop healthcare workplace violence before it happens reduces incidents of violence—and yet, there is no federal requirement for healthcare employers to have a prevention plan. Now, in the midst of the deadliest pandemic of our lifetimes, it's more clear than ever before that we can't afford to lose one more nurse or healthcare worker. We urge Congress to swiftly pass Rep. Courtney's bill."
Courtney previously introduced similar legislation in February 2019. It passed the House by a 251-158 vote, but never came up for a vote in the Senate.
"Healthcare and social workers have been waiting for years, long before COVID-19, to have their safety taken seriously while they're working hard to ensure everyone else's," Courtney said in a press release. "Our nurses and healthcare professionals face more on-the-job violence than any other sector in the American economy and the rates have been on the rise for years, even during the COVID-19 crisis. These incidents are predictable and preventable, and it's time we ensure workplaces take the steps that we know work to avoid them."
About three-quarters of U.S. workplace assaults occur in healthcare settings, according to OSHA, and it's been particularly dangerous as of late. A day after the legislation was introduced, a patient being treated at a Pennsylvania hospital severely injured a doctor by stabbing her in the face and head; one person was killed and four injured two weeks ago when a shooter opened fire at the Allina Health clinic in Buffalo, Minnesota; and more than half of Texas nurses reported being subject to workplace violence in their career, a 2016 state study says.
Begley joined a panel of healthcare administrators Feb. 11 for the webinar, COVID-19 Vaccines: Preparing Your Organization for the Expanded Rollout to review what's been done and consider how to reach President Joe Biden's goal of 100 million vaccines by his 100th day in office.
"[He] recently suggested the nation could soon reach an average of 1.5 million shots a day," Begley said. "I believe there have been days where that number has been reached, but it hasn't been the average."
The Biden administration is working on providing predictability so vaccine locations know when they will receive vaccine supplies and can start using all of their supply, she said.
"Healthcare organizations and anybody administering the vaccine is hesitant to make the follow-up appointment until they know they have it in hand and the goal here is that distribution sites would get three weeks' notice of when they would receive the vaccine and how much," Begley said. "I know we've heard from our members that some healthcare organizations received two days' notice, so … it is problematic."
Some distribution sites likely are holding on to vaccines to ensure they have enough for the second dose, which slows the vaccination rate, she said.
"If we're able to provide predictability, this will enable everybody to use all their doses, and that will keep the flow going," she said.
Countering reluctance to get the vaccine also is key in the COVID-19 fight, she said.
"The administration announced it would deploy a more targeted vaccine campaign focusing on vaccine hesitancy groups—that is our own healthcare workers, minority communities, and members of the general public, where as many as 30%–35% are still hesitant to receive the vaccine," she said.
"We need to overcome vaccine hesitancy in order to reach the numbers required for herd immunity and that's in the 70% to 88% range," she said, "although there is some question about whether it is that high or could it be potentially lower."
One of the greatest challenges now is navigating registration for the vaccines, and public and private partnerships may be the answer, she said.
"The AHA did this early on with 100 Million Mask Challenge," she said. "We saw the need and we took the public initiative as well as solicited private partnerships with companies to be able to produce and distribute more masks."
The same can be done with vaccine registration and rollout, she said, referencing how Washington state partnered with Starbucks, Microsoft, Kaiser Permanente, Costco, Washington State Nurses Association, and others to create the Washington State Vaccine Command and Coordination Center. The center's goal is to vaccinate 45,000 citizens daily.
"The lessons to be learned here are best practices. AHA and our member healthcare organizations can help by sharing best practice [with other organizations] and what they are doing to augment the federal response," Begley said.
The collaboration she's witnessed has been inspiring, she said. "I really do need to say that I've never seen in my entire career such a willingness to help [by] dropping barriers, silos [and] turf wars," she said. "Everyone is in this to try to help us mitigate this pandemic."
"The AHA has also collaborated with the American Medical Association and the American Nurses Association to address vaccine hesitancy," she said. "These are three organizations that don't always see exactly eye to eye, but they have worked very closely together to increase public acceptance of the essential actions that we need to take to curb the spread."