The Richard and Hinda Rosenthal Lectures 2003 Keeping Patients Safe -- Transforming the Work Environment of Nurses (2004) / Chapter Skim
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Discussion
Discussion
Pages 19-30
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From page 19... ...
It is clear, too, that organizations, and Bill could have talked about this, are going to have to invest different amounts of resources to move ahead because each organization is going to have areas in which they have some strengths and some serious weaknesses, but I think there is a very positive message here that when you look at what you need to do to improve patient safety you are also addressing those issues that reduce nursing turnover. Turnover is expensive.
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From page 20... ...
One is a very clear sense that we need to move ahead on research that measures patient acuity in ways that are useful in staffing and to use it in standardized ways across the organizations to be able to produce and share staffing data. This report suggests having staffing data available and hospital report cards and nursing report cards in ways that are useful as well to hospital managers, to nurses, and others who have to use that information.
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From page 21... ...
We actually probably haven't spent enough time saying what our plan is for getting this out to multiple sites, but there are a number of other areas that we can bring in as we begin to publicize this, the 80 different hospitals that are magnet hospitals, for example, that also have low turnover rates. Mine isn't the only one.
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From page 22... ...
, because the IOM has been very concerned about dissemination and getting the information into the field and actually beginning to track what kind of impact we may have had with these different kinds of reports. Already I know some of us on the committee have been asked by Janet Corrigan and by Ann Page which groups do we need to get to first; how do we prioritize these groups; how do we get into their conference agendas; how do we get into their literature, etc., and really begin to get the information out.
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From page 23... ...
PARTICIPANT: Yes, I'm with the National Center for Patient Safety. I practiced cardiovascular surgery for 20 years, and a couple of years ago I worked for Senator Kennedy as a Robert Woods Johnson fellow.
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From page 24... ...
I asked them the question, and they said that it was about career track and opportunities to advance in their profession that are just not there in the private sector nearly as much. That was why a lot of males told me they were in the nursing profession.
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From page 25... ...
These have been very exciting institutions that do both recruit easily, in fact usually have waiting lists and do retain nurses, and there are several characteristics that come through in the research literature, both Aiken and her colleagues' work and Marlene Kramer and Schmallenberg's work. Those characteristics primarily have to do with adequate staffing, autonomy, and control of their own nursing practice, very visible leadership that has a trust for the staff workers and uses decentralized decision making, increased educational opportunities both formal and informal in the area, and a culture of very strong interprofessional relationships, particularly the physician-nurse relationship.
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From page 26... ...
You know, they haven't looked at why a house officer really only spends 2.5 hours doing direct patient care and like the data you got spends 4.5 hours looking up things and another 2.5 hours where we are not really quite clear what it is. It is usually waiting for a staff person or moving a patient around or finding things.
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From page 27... ...
I have become very sensitized to this by a recently completed study by one of our young colleagues where she has instituted an intervention for families of hospitalized elders where she has nurses working with families to contract to work with the nurses to prevent certain kinds of high-risk complications in hospitalized elders, for example, decubiti and acute delirium. The work that she has completed in a pilot study shows a direct impact of that kind of collaborative work between nurses and families in reducing those kinds of complications.
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From page 28... ...
Since doctor's offices have all sorts of staff but as you move into the outpatient arena, as the Crossing the Quality Chasm talks to, really the potential for errors rises tremendously and you are much more reliant on the
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From page 29... ...
In home care we had almost all data. It is an excellent testimony, but no actual data that we could work with, and that was also true in ambulatory care sites and in primary care, as Don suggests.
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From page 30... ...
I think nobody has really done this in a coherent way thus far, and it probably is something that should be considered because it is really more effective at getting the end result you want rather than this blunt instrument because one of the reasons it has failed is 80 hours from when, from when you got up in the morning? You are coming on at night shift.
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