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When employees in any profession are asked what motivates them, time and again the things that top the list are interesting work, appreciation from managers, and recognition that their efforts matter. Salary is important, of course, but it doesn't motivate people to show up every day and give their heart and soul to their work.
Opportunities for giving back to the communities where they live and helping people in need both locally and around the globe are the types of things employees can put their heart and soul into, and these initiatives also have a healthy influence on an organization's standing in the community.
Many healthcare organizations tie volunteerism and other aspects of giving back to communities into their mission and values statements, and encourage employees to become involved in such endeavors.
And some organizations are even tying such efforts to nurses' professional development. Cox Health in Springfield, MO, encourages staff to use community work as part of professional development—or clinical ladder—programs for bedside nurses.
Bonnie Clair, MSN, RN, retention project manager at Cox Health, says that including community outreach projects as evidence for moving up the clinical ladder, "acknowledges efforts to expand [nurses'] professionalism, expand their skill base, and expand their perspective."
She adds that all of these occur when nurses take medical mission trips. These can happen on a local and national level, such as to underserved local communities or in response to disasters like Hurricane Katrina. And they can also be international efforts, such as involvement with charity work overseas.
Clair went on a medical mission trip to Haiti for a week in March and it was seven days she'll never forget. In the span of a week, Clair and a group of 25 other healthcare professionals saw 2,196 patients and gave out 6,500 prescriptions. The dentist saw more than 200 patients and pulled 205 teeth.
Clair traveled with a medical team from Hand of Hope, a Christian organization that sends teams across the globe to provide medical care in places where modern healthcare rarely reaches. It also provides services such as creating safe sources of drinking water and operating children's homes.
Clair encountered a different world in Haiti. "So much of the disease they have is completely preventable," she says. "There were animal feces all over the ground; most of the kids had bare feet, and that's how they pick up hookworms and parasites. In addition to the lack of nutrition, worms cause tremendous malnutrition and anemia. In a region where malnutrition is already ravaging people, this is catastrophic. And to know its just basic hygiene principles that could prevent it is an almost overpowering realization. It's like walking into a National Geographic picture. It was truly overwhelming."
Clair spent her first day on the medical mission bagging medications the team had brought with them into individual prescriptions, and the next day traveled into the mountains to facilitate a mobile clinic. After that, the team stayed at the children's home funded by Hand of Hope, and people traveled from around the countryside and mountains to reach them. She says people walked for hours, or even days, to reach the clinic, which they heard about through solar powered radios.
Clair worked with an interpreter to triage patients. "My job was to find out what each patient's primary complaint was, take vital signs, and send them to the appropriate physician or nurse practitioner or dentist. Sometimes it was very challenging to ascertain exactly what the primary complaint was.
The most challenging moment for her came on the last day when they traveled to a small village. "That was the pivotal moment for me," she remembers. "The clinics all week were what I had anticipated and the overwhelming poverty was what I expected. But after we walked through that village, I just stood there and cried. They have nothing. I mean nothing. So much of the disease they have is completely preventable."
The trip was so life changing that she plans to take more. Indeed, her next trip is already scheduled for February and she is returning to Haiti.
Clair says the best part about coming home has been telling people about her experience and raising awareness. "It helps people see beyond themselves. The world is so much bigger than our own backyard."
At Cox Health in Springfield, medical mission trips and other acts of volunteerism—whether local, national, or global—are considered acts that advance healthcare in the community and can be used as points on the clinical ladder.
"As nurses advance on the clinical ladder, they are increasing their own nursing expertise, they are advancing in professional growth, and that means better care of patients," notes Clair.
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Senate Majority Leader Harry M. Reid announced that he will include a government-backed insurance plan in the chamber's healthcare reform legislation. Reid's decision was a reversal from two weeks ago, when he appeared inclined to set aside the idea in an attempt to avoid alienating party moderates. Doubts remain about whether he has the votes to guarantee passage, but he said he concluded that adding a public option was the best way of bringing the strongest possible bill to the Senate floor in November.
The Senate majority leader, Harry Reid, sided with his party's liberals and announced that he would include a government-run insurance plan in healthcare legislation that he plans to take to the Senate floor within a few weeks. Under the proposal, however, a state could refuse to participate in the public insurance plan by adopting a law to opt out.
In letters sent to 10 health IT companies, Sen. Chuck Grassley says that he has "received complaints" about systems that allow doctors to enter medical orders by computer. Grassley asks the companies to send him copies of "complaints and/or concerns" that healthcare providers have expressed about the systems. He also wants to know whether the companies typically include legal provisions in their contracts that "shift responsibility for errors in the . . . systems to physicians, nurses, pharmacists, and other healthcare providers." The federal stimulus bill provides billions of dollars in federal incentives to encourage doctors and hospitals to start using these sorts of systems, the Wall Street Journal Health Blog notes.
Remote monitoring is offering a high-tech solution to the growing problem of how to care for the sickest patients amid a worsening shortage of intensivists, the critical-care specialists trained in caring for life-threatening injuries or illnesses. Studies show that mortality rates are 30% to 40% lower in hospitals where intensivists are providing round-the-clock care to prevent complications and minimize errors, but only about a third of patients in the ICU today receive care from an intensivist.
A new study suggests there are already fewer doctors practicing than had been estimated because of a lag in reporting retirements. The new study, published in The Journal of the American Medical Association, estimates that the United States has 788,000 active doctors—65,000 fewer than calculations have suggested. The doctor work force is also younger than previously estimated, with a greater proportion of doctors in their 20s and 30s and fewer who are 65 and older. By 2020, there will be 957,000 physicians, the new estimates show, rather than the 1.05 million previously projected.
While there has been a huge push for U.S. healthcare providers to go digital, the effectiveness of health information technology products is questionable, critics say. Washington Post interviews with more than two dozen doctors, academics, patients, and computer programmers suggest that computer systems can increase errors, add hours to doctors' workloads, and compromise patient care. "Health IT can be beneficial, but many current systems are clunky, counterintuitive and in some cases dangerous," Ross Koppel, a sociologist at the University of Pennsylvania School of Medicine who published a key study on electronic medical records in 2005, told the Post.
In a brief afternoon press conference Monday, Senate Majority Leader Harry Reid announced that a public insurance option, which will permit states to opt-out if they choose by 2014, will be included in the healthcare reform bill that will be sent to the Senate floor soon. However, the big question remains: Does he have the votes to make it a reality?
To get approved, the measure would need at least 60 votes on the floor. At yesterday's news conference, he remained noncommittal about whether all Senate Democrats and an independent would be onboard. "I feel good about the consensus' reach within our caucus and with the White House. And we are all optimistic about reform because of the investment in momentum that now exists," he said.
"We've spent countless hours over the last few days in consultation with senators who show a genuine desire to reform the healthcare system. And I believed there is a strong consensus for it in this direction," Reid continued. He said that sending the proposal to the Congressional Budget Office for scoring "will make it a step closer to achieving a bill."
Reid said he had spoken to Sen. Olympia Snowe (R-ME), the lone GOP vote on the Senate Finance reform bill approved two weeks ago. He said she continued to not support a bill with a public option in it.
Earlier this year, she had proposed a "trigger plan," which would feature nonprofit agencies offering health insurance only in instances in which private insurers could not cover 95% of the residents in their regions with plans costing no more than about 15% of the individual's or household's annual income. The trigger plan is not included in the proposed bill, Reid said.
"I'm always looking for Republicans," Reid said. "It's just been a little hard to find them," he said, referring to the numbers of moderate GOP senators as being "extremely limited . . . I could count then on two fingers . . . [It] makes it really hard to get help from them."
Reid did not discuss in detail how the public option will work. However, some sources have said that the public option plan would be required to negotiate rates directly with healthcare providers—rather than base payments on Medicare rates (which had been called for in House bill). The Senate Finance Committee bill provision allowing for creation of health insurance cooperatives in the states will remain in the version of the bill going to the Senate floor, Reid said.
Republican senators remained wary of the provision. Senate Minority Whip Jon Kyl (R-AZ), speaking on the Senate floor later in the day, said the proposal—even with a state opt-out provision—places the government too far into the private sector. "No matter what you call it—or how you dress it up—the Democrats' proposal is government run insurance," he said.
For now, the war drums in New York state can stop beating.
In an about-face, New York Governor David Paterson announced last week the suspension of a new rule that healthcare workers in the state be required to obtain seasonal or H1N1 flu vaccinations as a condition of employment.
It's hard to win a battle against nurses. They collectively fuel the engine that runs healthcare, and they also possess a powerful voice. Some nurses get their flu shots, some don't. What was shown by New York's initial rule and subsequent U-turn is that nurses don't want the government making those decisions.
Paterson's announcement appears, at least for now, to scrap the debate's day in court. Only a few weeks back, a judge temporarily halted the mandatory vaccination program until a formal hearing could take place.
Paterson said the change of heart resulted from concerns about limited supplies of flu vaccinations in the state.
"Over the last week, the Centers for Disease Control and Prevention acknowledged that New York would only receive approximately 23% of its anticipated vaccine supply by the end of the month," Paterson said in his statement. "As a result, we need to be as resourceful as we can with the limited supplies of vaccine currently coming into the state and make sure that those who are at the highest risk for complications from the H1N1 flu receive the first vaccine being distributed right now in New York state."
The statement said nothing about the legal battles created by nurses suing the state over the forced vaccinations. However, there is little doubt that opposition to the mandatory vaccinations put pressure on the state government to rethink its position.
The CDC indicates in its H1N1 vaccination priority list that "healthcare and emergency medical services personnel who have direct contact with patients or infectious material" are among subsets of the population who should be first in line for shots even when vaccine supplies are limited—which on the surface differs from the official stance of New York officials that supply concerns stopped the mandatory healthcare worker inoculations.
Pregnant women and children are also subsets established by the CDC, but the agency does not give special priority to one subset over the other. In other words, at least by the CDC's wording, healthcare workers with direct patient care duties, pregnant women, and children all lay equal claim to limited H1N1 vaccine.
Regardless, Paterson still encouraged healthcare workers to voluntarily obtain flu shots as an infection control measure, which is a softer approach that nurses in New York can accept.
Across the country, some healthcare systems have been slower to adopt electronic health record (EHR) systems than others.
But a new report in an online edition of the journal Health Affairs indicates that as of 2008, hospitals that treat the largest share of poor patients are less likely to have adopted IT systems than other facilities, a factor that may expand disparities of care in a new way: the so-called "digital divide."
"Some hospitals that disproportionately care for poor patients are falling behind in adopting electronic medical records," the authors said. "These same hospitals lagged others in quality performance as well, but those with EHR systems seemed to have eliminated the quality gap."
Electronic systems, such as computerized provider order entry for tests or medications, are widely believed to improve efficiency, quality, and accuracy of care as well as reduce redundancies.
The authors added, "These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients."
Unfortunately, some wide gaps exist between those hospitals that treat large numbers of the poor and those that don't.
The survey, presented in the form of a questionnaire in partnership with the American Hospital Association, was sent to chief executive officers of 3,747 acute care non-federal hospitals. A total of 2,368, or 63.1%, of the CEOs responded to the survey.
The report divided EHR functions into 24 categories of clinical application, such as whether the system recorded demographic characteristics, medication lists, nursing assessments, physician notes, discharge summaries, and advance directives.
Hospitals were separated into four categories depending on how many poor people they treated, as indicated in a federal "disproportionate share" (DSH) index.
"High-DSH hospitals had lower rates of adoption of all 24 compared to low-DSH hospitals, although the magnitude of the gap varied greatly and not all differences were statistically significant," the report said.
But some were very significant. For example, of those hospitals treating the highest numbers of the poor, those in the first quartile, 27% have bar coding for medication administration whereas 41% of hospitals that treat the lowest numbers of the poor, those in the fourth quartile, had the bar code system.
For electronic clinical documentation of medication lists, 62% of high-DSH hospitals had such a system in place compared with 74% of low-DSH hospitals.
Asked what impediments to adopting EHR prevented them from doing so, the biggest reason given was inadequate funding, although high-DSH hospitals were more likely to give that as a reason than low-DSH hospitals.
Other concerns include the return on investment, cost of maintenance, resistance from physicians, and concerns about lack of future support.
Through the American Recovery and Reinvestment Act of 2009, the federal government is earmarking $30 billion to establish a national health IT infrastructure that uses financial incentives through Medicare and Medicaid to promote EHR by hospitals and physicians.
"Although there is broad support for helping healthcare providers adopt EHRs, some worry that such efforts might exacerbate existing disparities in care by creating a new healthcare 'digital divide' between providers that disproportionately care for the poor and those that do not," the authors said.
They pointed to the need to address a "central policy question" about whether the ARRA will be used to reduce this gap.
"Given the potential of EHRs to improve the efficiency and effectiveness of care, these providers' ability to furnish high-quality healthcare may be further compromised if they lag in EHR adoption."
The report was authored by Ashish Jha, associate professor of the Harvard School of Public Health in Boston and colleagues at Massachusetts General Hospital's Institute for Health Policy; the Harvard/MGH Center for Genomics, Vulnerable Populations and Health Disparities; and George Washington University in Washington, D.C.
