Category: Clinical Corner

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Clinical Corner: Marijuana Law

Marijuana leaf and stethoscope.

Can a nurse or healthcare professional be fired for using recreational marijuana on his or her day off when recreational use is legal in that nurse’s state? The answer is yes.

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

The public is becoming more supportive of marijuana law reform every day, with new polls showing that more than half of the country is in favor of legalizing marijuana. In 2012, Colorado and Washington became the first states to legalize the recreational use and sale of marijuana. Since then, 23 other states and the District of Columbia have legalized medical marijuana and supporters are commending the ability to regulate, tax, and test marijuana. Even though there’s much support for legalization, in all states where medicinal and recreational use is allowed, employers may still enforce and comply with a drug-free workplace. So, what does this mean for hospitals and other companies in states where marijuana use is legal?

Many employers are navigating how state laws affect employment and have policies stating that a positive drug screen is grounds for termination. Whether or not an employer can test employees for drugs is controversial and laws on this vary from state to state. Industries like transportation and nuclear energy are heavily regulated by the federal government and don’t give much say to the employer. Local and state governments, on the other hand, may have different regulations and leave much of the decision up to the employer. If the employer chooses to drug test employees, they must follow their state’s rules and procedures, which are intended to prevent discrimination and inaccurate collection of samples. Many states allow testing based on the following guidelines:

  1. The applicant knows that testing will be a part of the screening process.
  2. The employer has already offered the applicant the job, contingent on passing the drug test.
  3. All applicants for similar jobs are tested in the same way.
  4. The tests are administered by a state-certified lab.

Today, most companies that conduct drug testing will have their applicants submit an agreement to the testing.

As a Traveler and healthcare professional, you are agreeing to drug testing under federal law. This poses a question that many may not know the answer to: Can a nurse or healthcare professional be fired for using recreational marijuana on his or her day off when recreational use is legal in that nurse’s state? The answer is yes. It is still illegal to use marijuana under federal law even if it is legal in your state. The take-home message is that you should never want to risk your career and the federal law trumps any state laws.

Legalizing marijuana will have many ramifications in the workplace. The biggest and most influential ramification is patient safety. The best way to ensure quality care and to make sure patients are safe is to keep the workplace drug free.

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Clinical Corner: Sentinel Event Alert #59 — Violence Against Healthcare Workers

Stop Violence

The Joint Commission’s recent Sentinel Event Alert #59 focuses on physical and verbal violence against healthcare workers.

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

According to the Occupational Safety and Health Administration (OSHA), workers in healthcare settings are four times more likely to be victims of workplace violence than workers in other industries. Workplace violence includes disruptive, violent events as well as the verbal abuse that many healthcare workers face daily.

In April 2018, The Joint Commission issued Sentinel Event Alert #59, which deals with physical and verbal violence against healthcare workers. This alert focuses not just on violence, but also serves as an aid to help organizations to recognize and acknowledge violent behaviors, better prepare staff to handle the threat and risk to safety, and more effectively address the aftermath.

Effective management of violence starts with an investigation of the contributing factors that may exist to precipitate violent situations or behaviors. One of the biggest factors is the setting in which healthcare workers operate. It comes at no surprise that the emergency department and inpatient psychiatric settings have the most recorded incidents. The home care setting presents unique challenges because of the disorganized and uncontrolled environment the patient care occurs in. Sixty-one percent of home care workers report workplace violence each year. The LTC setting for cognitively impaired patients also presents special challenges to managing violence and the most common characteristic exhibited by perpetrators of violence is altered mental status associated with underlying dementia, delirium, substance abuse, or other mental impairments.

Such elements associated with the perpetrators and the healthcare setting in which they exist are just a few of the contributing factors to violence. Other factors associated with violence are stressful conditions, long wait times, lack of organizational policies and training, domestic disputes amongst patients and families, inadequate security, understaffing, staff working in isolated areas, lack of access to emergency communication, unrestricted access to hospital rooms and clinics, and lack of community mental health care. These contributing factors can lead to low staff morale, lawsuits, and high worker turnover which leads to burnout. To combat the factors associated with workplace violence, The Joint Commission suggests several actions to take to look beyond solutions that merely increase security presence.

The first suggestion is to clearly define what workplace violence is and to put systems into place across the organization that enable staff to report the violence. The goal in establishing systems and procedures within an organization is zero harm to patients and staff, create a culture of reporting all events of physical and verbal violence, encourage conversations about violence, develop protocols, guidelines, or tools that make identifying potential perpetrators simple and easy. Another key step to reducing these incidents is tracking them and keeping records of the incidents. Gathering information on the different incidents and keeping a centralized database will be extremely beneficial to analyze and track worker injury and workplace violence.

Tracking each event will help to look for trends in the contributing factors associated with the violent act. It is also important to remember that follow-up should occur with the victims associated with the act. This follow-up is necessary to provide support to the victims but also the witnesses and this may include psychological counseling, debriefing, and trauma-informed care if necessary. Once a follow-up or debriefing has taken place it is always essential to analyze the contributing factors to the incident. According to OSHA, this includes a worksite analysis and hazard identification but furthermore, it is a demonstration on the value that reporting plays in communicating to staff the risk assessment and interventions taken in similar situations. Once the data has been analyzed and the problem has been identified implementation of cost-effective, evidence-based solutions specific to the problems identified at the local or unit level should be initiated.

Launching a new solution is more complex than just putting the procedure in place. Training all staff including security personnel on de-escalation, self-defense, and response to emergency codes is the next step in improvement with workplace violence. Self-defense training may include de-escalation techniques, alarms, security support, safe rooms, escape plans, and emergency communication procedures. The emergency response codes should be practiced with a variety of mock violent situations so that staff are adequately prepared to react in any types of violent events. Amidst the adoption of new strategies, keeping abreast of any changes will help to establish quality and an evidence-based practice approach in preventing any violence within the healthcare setting.

Click here to learn more about The Joint Commission’s Sentinel Event Alert #59.

 

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Clinical Corner: Differences in Hospitals

Hospital Differences

Not all hospitals are the same! Learn how that matters to you as a Travel Nurse.

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

Did you know that the total number of hospitals across the U.S. is nearly 5,534? States like California, Florida, and Texas have upwards of 200-300 hospitals in their state alone. Every day Travelers clock in and out at many of the nation’s hospitals, yet every hospital is different. Many misconceptions exist amongst all the different facilities and it is crucial for Travelers to know what these differences are so they can understand the impact that such variances can have on patient care.

One type of hospital that’s often misunderstood is the critical access hospital (CAH), as many healthcare workers don’t realize the limitations these facilities have on the resources that are available for patient care. A critical access hospital is a rural hospital with 25 or less acute care beds. It is also located at least 35 miles from another hospital and the average length of stay for acute care patients is 96 hours or less. The critical access hospital designation is given to reduce the financial vulnerability of rural hospitals and to improve access to healthcare for rural communities. Providing care in these facilities can be very different than any other hospitals. Most often the staff that work in these facilities (mostly nursing) are skilled in a variety of areas. For example, a medical-surgical nurse would be required to work the ER and may also float to take care of critical care patients. Some labor and delivery nurses will be required to work a variety of areas outside of their specialty including medical-surgical units or even the ER as well. Another important thing to remember is that CAH may not have some of the luxuries that bigger hospitals have. For example, they may have little to no help in terms of nursing aides. They also may not have secretaries, unit clerks, administration, etc. This will require nurses to know how to do more of these clerical tasks that they may not have had experience with while working in a larger facility.

Other types of facilities that are misunderstood are long-term care facilities (LTC) and sub-acute care facilities (LTAC). The main difference between these two facilities is the length of stay and the patient acuity. The acuity of the patients within an LTAC facility is much higher than the acuity within an LTC facility. Many times, the patients within an LTC facility need assistance with activities of daily living (ADLs). These patients are also receiving care for extended periods of time. The patients within an LTAC facility are getting care that is more complex. These patients need intensive medical treatment for an extended period (usually 25 days or greater). Much of the patient population within an LTAC facility will require chronic ventilator care and other complex medical treatments not offered in an LTC facility.

To better understand the differences in acuity amongst these facilities it is helpful to understand the treatment levels. The highest acuity and treatment level is a short-term acute care hospital. This would be considered your average hospital. The second acuity level would be the LTAC facility and then acute care rehab, sub-acute rehab, and lastly long-term care (LTC). Acute care rehab would be considered a rehab facility within a hospital setting. The sub-acute rehab setting would be considered a rehab unit within an LTAC facility. Understanding each of these facilities and the patients they care for is extremely important for travel nurses to know so they are aware of the expectations coming into their assignment.

Travel Nursing is not just about finding a hospital and working. It’s much more than that. It is finding the right hospital or facility for your skillset so that you can provide quality care to each patient. Knowing the difference amongst the number of hospitals or healthcare facilities around the nation is extremely important to know when you are embarking on your Travel Nurse adventures. Ask a lot of questions and advocate for yourself to make sure the contract you are accepting is the right fit for you!

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Clinical Corner: Autism Awareness

Autism awareness month

April is the prime time to recognize Autism, which affects so many patients and families year-round.

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

The stats on Autism speak volumes. This developmental disability affects nearly 2.8 million people and their families. Nearly one percent of the world’s population suffers from Autism Spectrum Disorders and it is one of the fastest-growing developmental disorders in the United States. On average, Autism costs a family nearly $60,000 a year and there is no medical detection or cure.

As we wrap up April, join us in celebrating National Autism Awareness Month. This year the Autism Society has pushed this nationwide effort beyond merely promoting Autism awareness and looks to encourage friends and families to become active partners in the movement towards acceptance and appreciation. For many years, Autism awareness has been about supporting individuals with Autism. Let’s embrace a new perspective, one in which we focus on the rest of us. We should aim to advocate for acceptance and inclusion in schools and communities. We, as a society, should promote appreciation for the unique aspects of all people and we should value these individuals for their unique talents and abilities.

To truly make an impact in our society, nurses across the country should push to promote patience and compassion for patients who suffer from Autism. To gain the trust of this patient population we first need to understand what exactly Autism Spectrum Disorders are. They are a cluster of disorders characterized by impaired social skills, communication difficulties, cognitive delays, and repetitive behaviors. It is highly likely that many nurses will take care of patients who suffer from Autism within their career and it is important to know how to care for them.

Some recommended tips and strategies to adequately provide the proper care for this patient population are to:

  • Secure a non-stimulating environment
  • Talk with the child’s parents first and include them in your nursing care
  • Perform physical assessment away from the child but progressively move centrally towards them
  • If needing to use medical equipment, use them on the child’s parent first
  • Lower yourself to the child’s height level
  • Be gentle and consistent with your behavior and actions
  • Limit encounters with healthcare personnel
  • Stick to a schedule
  • Reward good behaviors

These tactics can be helpful when you are working to establish rapport with your patient but to also get them the necessary care that is needed.

One of the biggest challenges with Autism is knowing what care is needed and the source of the problem. There is no known single cause for Autism Spectrum Disorder, but it is generally accepted that it is caused by abnormalities in brain structure or function. Although researchers do not know the exact cause of Autism, many theories are being investigated including links among heredity, genetics, and medical problems.

If you want to make a difference this month and raise awareness for Autism, there are several ways to get involved in your community. One way of getting involved is searching the Nationwide Autism-Related Services and Supports with Autism Source. This database will help to get you in contact with the Autism organization in your region. You can also reach out to your local affiliate for information and education on how to get involved.

Additionally, there’s free e-newsletter through the Autism Society that anyone can sign up for. It offers the latest updates, news, research, education, etc.

If you wish, you can also attend an Autism event or take a free online course on Autism that increases general knowledge on the disorder.

Lastly, if you simply want to make a small difference this month or any time throughout the year, please take any opportunity that you can to draw attention to the tens of thousands facing an Autism diagnosis each year. While this may seem small, the ripple effect that it will create is much larger in comparison.

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Clinical Corner: Fall Prevention Technology of 2018

Warning Fall

Learn the latest in fall prevention technology in this month’s Clinical Corner!

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

Did you know that every 11 seconds an older adult is treated in the emergency room for a fall? Or how about the fact that every 19 minutes an older adult dies from a fall?

Falls are the leading causes of fatal and non-fatal injuries for older Americans. The financial toll related to the falls of older adults is expected to increase as the population ages and it may reach $67.7 billion by the year 2020. This an astounding statistic and it’s no wonder that every healthcare facility around the country places a large emphasis on reducing falls in every way possible. Even though there are several successful fall prevention techniques that have been adopted throughout time, it is always important to stay abreast of changes and adopt new strategies as appropriate, so that falls can be prevented as much as possible!

A few current and widely used fall prevention interventions include locking the bed and keeping it in the lowest position, putting bed rails up and keeping call light and other personal belongings within reach, non-slip footwear, clutter-free room, appropriate use of sensory aids, dry floor and adequate lighting, hourly rounding, and patient and family education. These are just to name a few. Despite implementing these strategies, falls still occur and there’s further work to be done to further decrease fall rates.

New Strategies

One newer strategy that’s been adopted is the use of “virtual sitter” technology. This technology can monitor a patient’s movements under ambient light and it can also be used to create and draw virtual zones, trip wires, and other trigger points within the field of view. These lines or zones are used to detect when a patient moves across those boundaries and then an alert is sent to the monitor tech to warn them of the potential danger to the patient. Additional features of this continuous live video feed include two-way audio, voice recognition, patient privacy modes, and customizable alerting. When an alert is sent to the monitor technician, they can intervene in several ways: using two-way audio to direct the patient to remain in bed or assess the patients’ needs, contact the patient’s RN or nurse’s aide, or contact the unit supervisor for emergent situations. This modern technology has been shown to not only reduce the number of falls, but also that it can decrease fall-related costs for the hospital.

Lady Fall

Did you know that every 11 seconds an older adult is treated in the emergency room for a fall? Or how about the fact that every 19 minutes an older adult dies from a fall?

Another innovative way of using technology involves monitoring people with sensors to increase the ability to predict when falls can occur. Using sensor measurements to determine walking speeds and stride length has helped to correlate a slow walking pace to the risk of falling. The shortening of a person’s stride also determines the likelihood that a fall could occur within three weeks. When the sensor system detects notable changes in a person’s gait, an alert is sent to the caregiver so he or she can take steps or enhance precautions to prevent falls in the foreseeable future.

One unconventional way of predicting falls is considering what goes on in people’s brains. By tracking the brain activity with walking, talking, and walking while talking it has been determined that the front part of the brain works harder while multi-tasking. This could potentially explain why cognitively impaired people tend to fall at a higher rater than those with normal cognition. The goal with using this approach is to be able to detect if a person is at higher risk of falls before any physical symptoms manifest.

These innovative strategies are extremely important because they push us to think beyond the conventional prevention techniques. To get a true grasp on minimizing falls, we must understand why they are occurring and how to prevent them. Part of prevention includes focusing on ways to predict if and when a person is likely to fall. If we can implement emerging technologies with the techniques that we currently have in place, we may be onto something. When it comes to falls, the most important thing we must do is to stay up to date with changes in our patients but also changes in best practices.

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Clinical Corner: Combatting Compassion Fatigue

Nurse Consoling Young Female Doctor

Compassion fatigue can hit nurses hard. Strategies for combatting it are essential to your wellness and proper patient care!

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

Compassion fatigue is a real problem in today’s nursing staff. And even though it has been identified as an issue, compassion fatigue is often overlooked or ignored. This is an alarming fact!

Healthcare already suffers from a shortage of nurses, and to make matters worse, compassion fatigue is exhausting the nurses that we do have at the bedside. To combat this problem, it’s important to understand that compassion fatigue is more than just physical exhaustion. Compassion fatigue is emotional, physical, AND spiritual exhaustion resulting from caring for patients and witnessing the pain and suffering they are going through. This exhaustion is directly correlated with the diminished ability to provide compassionate care, a decrease in quality care, and decisions to leave the workplace all together. Despite these profound consequences, few institutions offer support for compassion fatigue.

Unresolved compassion fatigue not only influences the nurse, but it also affects organizations in terms of increases of absenteeism, performance issues, decreased quality care, interpersonal issues, and increased staff turnover. To intervene against these harmful effects, it becomes important for agencies that Travel Nurses are employed with and healthcare facilities to take a stand against compassion fatigue.

Strategies for preventing and managing compassion fatigue include a call for nurses to strive for and maintain a healthy work-life balance. Nurses must practice self-care and they need to focus on sustaining emotional health. One strategy to manage this problem is finding activities and practices that replenish, comfort, and rejuvenate the spirit. Activities may include physical exercise, journaling, reading, spending time with family — basically, anything that promotes rest and comfort. It may also be helpful for nurses to establish a method of shedding the professional role at the end of the day including rituals such as playing music at the completion of a shift, putting your stethoscope and equipment away, or simply reflecting on your drive home from work.

Perhaps the most important thing that nurses and facilities can do to contend with this problem is to endorse a keen sense of self-awareness. Realizing what you are feeling and when compassion fatigue is setting in can have a huge influence on minimizing the consequences of this neglected problem. Self-awareness requires open discussion and honesty. It may be helpful and beneficial for the nurse to discuss their feelings with other colleagues. In fact, most nurses prefer conversations with close friends or co-workers for support and feedback. The support that is provided through colleagues increases development of self-care strategies to stay physically and emotionally healthy. Adopting these strategies for healthy living is much easier when self-awareness is present. It takes less effort to combat compassion fatigue when you have the support that you need and the self-awareness to know when a problem exists. Ultimately, the key to keeping nurses at the bedside is to diminish any effects that compassion fatigue could have on our workforce.

Take care of yourself and your colleagues out there — and remember that your Career Consultant and Medical Solutions’ Clinical Team are always here to support you when you need us!

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Clinical Corner: 2018 Flu Season

Flu Season

How are you navigating the nasty 2018 flu season?

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

By now, you’ve no doubt heard that the 2018 flu season has made its way across the entire nation. So far this flu season, the influenza virus has claimed the lives of many Americans of all ages. In fact, this is the first year the flu’s had the same activity at the same time across the entire United States. Currently, the flu season is at its peak and we as nurses and healthcare providers must be diligent in preventing the spread and impact that it has for our patients across the nation. One way to prevent and minimize the chain reaction of events with the flu is to learn as much as possible about it including common myths about the flu, prevention techniques, treatment, and how the flu is spread.

Let’s first dive into how the flu is spread. Influenza can be spread between others from as far as approximately six feet away. It is spread by the droplets made by people when they sneeze, cough, or talk. These droplets can then either land in another’s mouth or nose. It can also be spread when a person touches a surface or object that has the flu virus on it and then touches their own mouth or nose. To avoid the spread of these germs you should stay away from others who are sick, wash your hands as often as possible, and avoid sharing any utensils, linens, or dishes belonging to someone who is sick. Most people will spread the flu up to one day prior to symptoms occurring and up to 5-7 days after getting sick. If you feel that you may have contracted the flu from someone, you should notice that symptoms will occur 1-4 days after the virus enters the body.

In addition to avoiding others who have the flu, it’s equally important to adopt other prevention strategies to minimize any risk of getting sick. The best way to prevent contracting the flu is to get vaccinated. The CDC recommends getting vaccinated by the end of October before the flu season hits. For the 2017-2018 flu season, the CDC recommends an injectable vaccine rather than the nasal spray that has been used in past flu seasons.

In the event that you do get sick with the flu, it’s imperative that you stay home at least 24 hours after your fever is gone. This will help tremendously in preventing any spreading of the flu virus to others. Other preventative techniques include covering your mouth when you sneeze or cough, to avoid touching eyes, nose, and mouth, and to clean and disinfect surfaces as often as possible.

If you do what you can to prevent the flu, but still manage to contract it in some way do not panic — there is treatment available. The treatment of choice for the flu is usually antiviral medications. When antivirals are used, they can lessen symptoms and shorten the amount of time that you are sick by 1-2 days. They can also help to prevent further complications related to the flu, like pneumonia. Studies show that antiviral drugs used to treat the flu work better when started within two days of getting sick. However, starting them later can be beneficial if the sick person has any risk factors for complications related to the flu. If you do not know for sure if you have the flu, it’s best to see a doctor if you’re displaying any of the following symptoms: fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue, and/or sometimes diarrhea and vomiting.

The last thing that’s important to understand about the flu are the common myths and misconceptions with the flu vaccine. First and foremost, many people often believe that getting the flu shot makes them sick. This is a common misconception because the flu vaccine cannot cause the flu because the vaccine is either an inactivated virus or it contains no flu viruses at all. If you happen to come down with a low-grade fever, headache, or muscles aches following the shot that does not mean you are sick; it is a side effect or reaction to the vaccine. Another common misconception from some is that even though they receive the vaccine they still manage to get sick during the flu season. The reason for this is one of the following explanations: they contracted another virus different than influenza, they got sick prior to developing immunity to the virus, or they were exposed to a flu virus that is different from the one that was contained in their vaccine. Understanding these misconceptions can help many — including nurses and healthcare professionals — not only remain healthy, but also able to educate patients so they can advocate for vaccines and prevention.

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Clinical Corner: HCAHPS Scores

HCAHPS scores

It’s crucial for Travelers to grasp the importance of HCAHPS scores!

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

“If I had a nickel for every time I heard the term ‘HCAHPS scores’ when talking about healthcare, I would be rich.”

Do you find this statement to be true? Do you even know what HCAHPS stands for? I mean, let’s be honest for a minute, if you have not heard the term HCAHPS scores while working on a travel contract, then you might be living under a rock!

The term “HCAHPS” stands for Hospital Consumer Assessment of Healthcare Providers and Systems. This survey and assessment has become so important for hospitals all around the country because they drive reimbursement. Not only that, but they have a massive impact on a hospital’s reputation and the HCAHPS survey gives patients a chance to be heard. It is important for all nurses to have a deep understanding of what HCAHPS scores are, what they tell us, and how they impact your employment as a travel nurse. Let’s investigate the significance that HCAHPS scores has on your future and the future state of healthcare in the United States.

The U.S. government and The Centers for Medicare and Medicaid mandates this patient satisfaction survey. The results are publicly reported on the internet for all to see and excellent survey results and hospital performance keeps the hospitals financially stable. The survey addresses the 10 HCAHPS measures including questions on nurse communication, doctor communication, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of hospital environment, quietness of hospital environment, overall rating of hospital, and willingness to recommend hospital.

The survey results are reported quarterly and there are four modes of administration to patients including mail, telephone, mail with telephone follow-up, and interactive voice response. About 4,000 hospitals participate in HCAHPS and over three million patients complete the survey each year.

The HCAHPS survey is also employed in the Hospital Value Based Purchasing Program as one of the measures that a hospital is scored on. It is scored within the patient care experience along with the other measures including clinical care, efficiency and cost reduction, and patient safety. The patient care experience score is calculated into the hospital’s Total Performance Score (TPS). This TPS score is correlated with the reimbursement that a hospital receives for the care they provide.

All of this is important to know as a Traveler because as our healthcare moves more towards this model of care, Travelers must understand the impact they have on these scores while on assignment. More and more facilities are hiring candidates based on their understanding of HCAHPS and VBP because their understanding converts to quality care. It is important that you know the implications of your care and the consequences that it has on the hospital and its ability to continue to provide healthcare to the people around you. It is your responsibility to understand our healthcare system and to be a change agent for these programs, and I encourage you to be an advocate for strong performance on all fronts within each healthcare organization!

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Clinical Corner: Sentinel Event Alert #58 on Proper Hand-off Communication

JC Sentinel Alert

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

According to The Joint Commission (TJC), a sentinel event is defined as any unanticipated event in a healthcare setting that results in death or a serious physical or psychological injury to a patient or patients that is not related to the natural course of a patient’s illness. Healthcare professionals take a lot of pride and are very diligent in their work to avoid any sentinel events. Recently the TJC released a Sentinel Event Alert that identifies specific types of events and high-risk conditions as well as corresponding underlying causes and recommendations to reduce risk and prevent future occurrences of these sentinel events. The purpose of the alert is for health professionals and organizations to consider designing or redesigning processes to prevent or minimize the effects of sentinel events.

The focus of the most recent Sentinel Event Alert released by TJC was inadequate hand-off communication. While it sounds simple to achieve a successful hand-off, in reality, the hand-off communication is much more complex than it seems. In 2010, after hand-off communication was addressed in the National Patient Safety Goals (NPSG), it became a Joint Commission standard that “an organization’s process for hand-off communication provides the opportunity for discussion between the giver and receiver of patient information.” This standard is important because hand-offs are becoming too casual and can be very disjointed and unclear. This creates a large gap in communication which leads to a huge safety risk and concern for patients. It can ultimately contribute and lead to sentinel events in the healthcare setting.

To combat the disconnect in hand-off communication it is important to know the contributing factors to hand-off communication breakdown. These factors include insufficient or misleading information, absence of safety in culture, ineffective communication methods, lack of timing, poor timing, interruptions/distractions, insufficient staffing, and lack of standardizing the hand off process. The Joint Commission offers the following suggestions on implementing successful hand offs:

  1. Demonstrate leadership’s commitment to successful hand-offs and other aspects of safety culture.
  2. Standardize the critical content communicated between caregivers using verbal and written hand-offs and standardize tools and methods using forms, templates, checklists, etc.
  3. Conduct face-to-face hand-off communication in locations that are free from interruptions or distractions.
  4. Standardize the training on how to conduct a successful hand-off from both the standpoint of the sender and receiver of the communication.
  5. Use the EHR (Electronic Health Record) and other technologies to enhance hand-offs.
  6. Monitor the success of interventions to make continuous improvements to hand-off communications.
  7. Sustain and spread best practices and make high-quality hand-offs a cultural priority for the department and healthcare facility.

Information reprinted with permission from The Joint Commission. To learn more about this Sentinel Event Alert, click here.

 

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Clinical Corner: Nurse Licensure Compact Changes

"Changes ahead" traffic sign

Prepare yourself for upcoming changes to the Nurse Licensure Compact as it transitions to the Enhanced Nurse Licensure Compact!

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

Did you know the first and original Nurse Licensure Compact (NLC) was drafted way back in 1998? It was later signed into law in 2000 and 25 states have joined since.

Why have we waited so long to enhance and make the NLC better? Healthcare has changed dramatically since then and the nursing shortage only seems to increase as time goes on. The Bureau of Labor Statistics estimates there will be more than one million registered nurse openings by 2024 — twice the rate seen in previous shortages. The industry is way overdue on making changes to the NLC so that more nurses can cross state borders resulting in less open nursing positions. The National Council of State Boards of Nursing (NCSBN) has made this change a priority and with this change comes the Enhanced Nurse Licensure Compact (eNLC). Under the new eNLC, nurses will be able to provide care to patients in other eNLC states without having to obtain additional licenses.

As a Traveler, this is very important and impactful to the care that you provide — so listen up, because this may affect your license(s)!

Nurses who hold an original NLC multistate license will be grandfathered into the eNLC. The eNLC implementation date is currently set for January 19, 2018.

That said, it is important to know that while many of the original NLC states have passed legislation enabling them to be a part of the eNLC, not all of them have done so. Currently, there are four states — Colorado, Rhode Island, Wisconsin, and New Mexico — that were a part of the NLC but have not passed legislation to be a part of the eNLC.

There are also several states that were not previously part of the NLC that have passed legislation enabling them to become a part of the eNLC. These NEW states include Florida, Wyoming, Georgia, West Virginia, and Oklahoma.

Additionally, there are several states — Wisconsin, Massachusetts, Michigan, and New Jersey — which currently having pending eNLC legislation. At this time, it’s likely that Rhode Island will not pass legislation in time, and that Colorado and New Mexico will introduce emergency legislation to become part of the eNLC before the January 19, 2018 implementation date. Wisconsin is likely to pass legislation by December 2017, as well.

Now that you know which states are affected with these new changes, how does this effect you?

If you hold a compact license in a state that was in the NLC and is now a part of the eNLC as well, you do not have to do anything. The exception to this rule is if you obtained your perm state compact license on or after July 20, 2017. If this applies to you, then you will be required to meet the new eNLC requirements. Contact your state BON to learn more on what you need to do to meet guidelines.

If you are licensed in a state that was not a part of the original NLC and will become a part of the eNLC then on January 19, 2018, you will automatically have compact privileges in the new eNLC states.

If you are licensed in a state that is a current member of the NLC but will not be a member of the eNLC, then you will lose multistate privileges. However, you will still hold privileges in the states that were a part of the NLC. For example, if you have a multistate license in Rhode Island you will lose multistate privileges but will still hold the NLC compact license that would allow you compact privileges in Colorado, Wisconsin, and New Mexico — if they do not pass legislation to become part of the eNLC. You will need to obtain a single state license to travel in any other state. Some states do not have a process set up for this yet.

Travelers will then lose privileges to practice in the NLC states that have not become part of the eNLC as well. For example, someone who has compact privileges with their Iowa license will still have compact privileges in the eNLC states, however they will lose privileges to practice in Colorado, New Mexico, Wisconsin, and Rhode Island — again, if they do not pass legislation.

The biggest takeaway from these compact changes is the importance of awareness of your licenses and the actions to take moving forward! It’s crucial to stay up to date with any changes to the eNLC and to be proactive with your licenses in these pending states. If you have any questions, contact your Career Consultant or the Medical Solutions Clinical Team and we would be happy to assist you in this process.

We’ve also put together these handy FAQs on the NLC to eNLC transition and will be sure to add any changing or updated information to this page as the transition nears.