Thanks so much for publishing the November 2011 editorial “Check Your Ego at the Door” by Editor-in-Chief Richard Hader. I, too, am astounded at leaders throwing their team under the bus to divert attention away from themselves and their own accountability. I've been on the receiving end of such diversions and it's disheartening to see leaders continue to do this to their team members. By the same token, it's also disheartening to see team members do the same to their leaders—it's so unprofessional.
When you step into a leadership position, you have to be willing to be accountable for decisions and their outcomes. It requires courage and integrity. I've seen leaders scapegoat teams and even certain team members. It's counterproductive and demoralizing.
Respect for all involved, including oneself. Thanks for giving voice to a practice that many have experienced.
HAPUs can happen
Thank you for your recent article “Preventing Heel Pressure Ulcers: Economic and Legal Implications” by Courtney H. Lyder, ND, GNP, FAAN in the November 2011 issue. As a director of risk management and patient safety, I constantly review the literatu re for evidence-based practices that we can implement to decrease the incidence of hospital-acquir ed pressure ulcers (HAPUs) in our patient population. In hospitals all across America, there's a sense of urgency and focus on preventing pressure ulcers in light of the Centers for Medicare and Medicaid Services' policy to deny reimbursements to hospitals for HAPUs that have been determined to be reasonably preventable.
HAPUs aren't simple wounds that heal quickly; they can have long-lasting effects on patients and their families. According to the National Pressure Ulcer Advisory Panel, nearly 60,000 of the 2.5 million patients who develop pressure ulcers in acute care facilities die. The key to preventing HAPUs is increasing nurses' awareness of their role in prevention. Nurses need to perform full-body skin assessments on admission and during shift change, as well as completing an accurate Braden scale. The reality is that not all HAPUs are preventable. We are continually challenged by how to effectively prevent them.
Don't forget the basics!
I would like to thank you for publishing “Wherefore Art Thou, ACOs?” by Katie C. Brewer, MSN, RN in the October 2011 issue. I'm the director of a medical-surgical unit and I'm faced with the challenge of creating a culture in which nurses provide quality-based care on a daily basis. Although accountable care organizations (ACOs) were formed to reduce the nation's debt, specifically the Medicare program, they're based on the premise that healthcare organizations should provide quality care while reducing costs. We've become a nation of waste, and with that wastefulness we've created unnecessary spending. Ms. Brewer acknowledged that ACOs were developed to change the system in which a fee-for-service program had once been the norm. ACOs provide a system for hospitals to be reimbur sed for services that were rendered with quality care and a customer service focus.
There are many factors in the ACO that require improvement. At my facility, nurses and physicians have refocused their practice on quality, evidence-based care, creating an increase in quality and patient-satisfaction scores. I've found that the challenge of maintaining a quality improvement plan with a focus on improving scores requires a lot of data monitoring. The challenge for nurses is to be able to provide the evidence-based quality care mandated by the Centers for Medicare and Medicaid Services and ACOs without taking away time spent on the basic needs of the patient.
Basic services are often lost in our quest for greatness. Remember Maslow's hierarchy of needs? My goal as a nurse leader is to inspire our nurses to continue to focus on evidence-based, quality care without forgetting our basic foundations of nursing. Perhaps the political debates over ACOs will lead us back to focusing on what's right in healthcare: quality, evidence-based care with a focus on the needs of our customers. In the end, healthcare reimbursement will benefit providers, but ultimately the patient will be the overall winner.
I was impressed by the results described in the November 2011 article “Safe Patient Handling: Is Your Facility Ready for a Culture Change?” by Edna Cadmus, PhD, RN, NEA-BC; Patricia Brigley, BSN, RN, COHN-S; and Madelyn Pearson, MA, RN, NEA-BC. An 80.5% reduction in lost days and a 57.1% reduction in workplace injuries over 2 years combined with a 155% return on investment in less than 30 months are convincing arguments for this type of equipment investment and culture change. With these results, I was equally surprised to see that there was only a 6% increase in RN satisfaction regarding having enough help to lift/move patients, with 23% of RNs still dissatisfied with the amount of lift/move help available.
The safe patient-handling program seemed to focus on preventing single traumatic events that result in injury. There are other factors that can be addressed to extend this program to be even more effective in increasing RN satisfaction and reducing injuries. Indeed, a single traumatic event may be the source of an injury, but injuries may also be the result of years of repetitive microtraumas known as cumulative trauma disorder. The U.S. Department of Health and Human Services reports the median age of nurses in 2008 was 46 years old. Older nurses are more prone to musculoskeletal injuries due not only to degenerating discs and joints, but also to years of cumulative traumas.
As an RN older than this median age, I would suggest that the safe patient-handling program be extended beyond those patients needing special equipment to lift or move them. Healthcare leadership should support educators in teaching and promoting healthy musculoskeletal practices in daily activities that may not necessarily be considered high-risk activities for injury. This includes not only lifting, transferring, and repositioning patients, but also reaching, standing, walking, and working at the computer. We're each given only one body and we must take care of it every day in everything we do, not just with high-risk activities.
Denise Hopkins, RN
Case Manager St. Francis Hospital—Bartlett, Tenet Health System Bartlett, Tenn.
Courtney Stephenson, BSN, RN
Director of Risk Management and Patient Safety Plaza Medical Center Fort Worth, Tex.
Bobbie Lueking, BSN, RN
College Station, Tex.
Dinah Peters, BSN, RN