Nursing Management

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Think About It

A forum for discussion of the latest news and ideas in nursing management and healthcare.

Wednesday, July 21, 2021

​The highly contagious Delta variant of the SARS-CoV-2 virus now makes up an estimated 83% of new COVID-19 cases in the US, according to the CDC.

Dr. Rochelle Walensky, the director of the CDC, announced the new estimates during a hearing of the Senate Committee on Health, Education, Labor, and Pensions. The new data can now be found on the CDC's website.

Cases of the Delta variant have surged in the US. The variant had accounted for approximately 32% of COVID-19 cases in the US as of June 19 and 62% of cases as of July 3, according to CDC data.

The rise of the variant coincides with a significant increase in coronavirus cases across every state over the last 2 weeks. COVID-19 hospitalizations and deaths are also on the rise, according to the CDC, but new cases, hospitalizations, and deaths are still far lower than they were at their peaks in January and February 2021.

However, the vast majority of new cases, hospitalizations, and deaths are among people who are not vaccinated. Tuesday's hearing before Congress followed a White House briefing last week in which Walensky warned that COVID-19 is “becoming a pandemic of the unvaccinated." Officials at that briefing said that more of 97% of people who are being hospitalized with COVID-19 are unvaccinated, and 99.5% of new deaths are among the unvaccinated.

CDC data show that nearly 60% of adults and nearly 50% of the total population are fully vaccinated in the US, but vaccination rates have slowed since the spring.

Tuesday, July 6, 2021

According to the Occupational Safety and Health Administration, 75% of the workplace assaults recorded each year occur in healthcare—a fact that most nurse leaders know all too well. Many call workplace violence a “silent epidemic" because, according to The Joint Commission, only 30% of nurses report incidents of violence. And, unfortunately, workplace violence is increasing: According to US Bureau of Labor Statistics data, the incidence of violence-related healthcare worker injuries has steadily increased for at least a decade. Exposure to workplace violence can impair effective patient care and lead to psychological distress, job dissatisfaction, high turnover, and increased costs.

To help combat this unsettling rise in workplace violence in healthcare, The Joint Commission has released new and revised workplace violence prevention requirements that will be applicable to all Joint Commission accredited hospitals and critical access hospitals effective January 1, 2022. The new and revised requirements will help hospitals and critical access hospitals develop strong workplace violence prevention systems and address the following concepts:

• Defining workplace violence, including a formal definition
• ​Leadership oversight
• ​Worksite analysis
• Developing policies and procedures for the prevention of workplace violence
• Reporting systems, data collection, and analysis
• ​Post-incident strategies
• ​Training and education to decrease workplace violence

The Joint Commission has made their new requirements available online in prepublication for both critical access hospitals and hospitals along with a compendium of their workplace violence requirements.

Friday, June 18, 2021

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Nearly 18% of new RNs resign from their first nursing jobs within the first year—and almost a third leave within 2 years. With the impact that nurse turnover has on a hospital's margins, many are looking for new ways to keep new nurses happy in their jobs. Yale New Haven Health System is betting on personal coaches to support new nurses and make them want to stay.

In a recent HealthLeaders Media article, Carol Davis reports on a “Clinical Nurse Transition" program at Yale New Haven Health System where experienced nurses serve as personal coaches to newly graduated RNs. Offsetting the health system's preceptor program, this program aims to provide support for nurses who no longer have their preceptor by their side and are feeling especially vulnerable. The new RNs participate in the program for at least 1 year and can stay for 2 years.

To be a personal coach, experienced nurses must have been preceptors for at least 2 years and have strong leadership and social skills, as well as exceptional interpersonal and listening skills. They need to be able to manage conflicts, organize priorities, solve problems, and manage resources. The personal coaches oversee 10 nurses at a time (depending on hiring). They're on call for the new nurse from 7 pm to 7 am on weekdays, and 24/7 on weekends to make nurses feel supported during vulnerable times.

The program was started at Yale New Haven Health in response to an influx of new nurse hires—from 132 in 2013 to more than 400 currently. After a year and a half, the program is doing what it was designed to do. According to a qualitative survey, 75% of the new nurses agree or strongly agree that the program reduced their stress levels in unfamiliar situations; 75% agreed or strongly agreed that the program improved their confidence in caring for high-risk patients; 76% agreed or strongly agreed that the program eased their transition into clinical practice; and 77% agreed or strongly agreed that the program enhanced patient safety.

The program also provides benefits to the coaches, who feel empowered being able to share their knowledge and get a chance to serve as a professional role model. And many coaches find fulfillment in helping new nurses learn and grow in their profession.  

Could personal coaches inspire your new hires to stay on the job? It might be worth a try.

Monday, June 7, 2021

​The US Food and Drug Administration (FDA) approved the use of a new drug, aducanumab, to treat Alzheimer disease for the first time in nearly 20 years on Monday, June 7. The experimental drug was approved via the FDA's “accelerated approval" program, which allows for the earlier approval of drugs that treat serious or life-threatening illnesses and fill an unmet medical need.

Aducanumab, which is being marketed as Aduhelm, is the first novel drug approved for Alzheimer since 2003. According to the American pharmaceutical company Biogen, which developed the drug in partnership with Japanese pharmaceutical company Eisai, clinical trials on patients with mild cognitive impairment due to Alzheimer disease and mild Alzheimer disease demonstrate that aducanumab has the potential to slow the progression of Alzheimer.

The drug marks the first treatment that targets the underlying pathophysiology of Alzheimer disease—the presence of the amyloid beta protein in the brain. Clinical trials for aducanumab showed a reduction in amyloid beta plaques for the first time. According to an FDA statement on the approval, this is expected to lead to a reduction in clinical decline.

However, the drug's approval process has been controversial. Even though the approval process had moved forward, opponents have argued that there is insufficient evidence of the drug's effectiveness.

According to a Biogen statement, phase 3 clinical trials were discontinued in March 2019 after the results of an independently conducted futility analysis indicated that the trials were “unlikely to meet their primary endpoint upon completion." Seven months later, Biogen and Eisai announced that they would ultimately pursue regulatory approval for aducanumab after a more comprehensive analysis of the Phase 3 clinical trial showed that the drug reduced clinical decline in patients with early Alzheimer disease who had received higher doses of the drug over a longer period of time.

The FDA said the drug's developers will need to conduct a post-approval study, called a phase 4 confirmatory trial, to show that the drug provides a clinical benefit. If it is not shown to work, the drug may be removed from the market.

Monday, May 3, 2021

By Michelle Sanchez, MSN, RN, CPHQ

Incorporating equity, diversity, and inclusion (EDI) initiatives on your unit with coworkers, patients, and staff can be rewarding and create a culture that welcomes differences and diverse thinking. Success in this work begins with the vulnerability it takes to explore EDI and understand your own bias and privilege. This helps you engage with authenticity and encourages trust.

Nurse leaders need to be mindful and thoughtful at all times:

• Be mindful of the things you express verbally, through body language, or in written format.

• Be thoughtful of how the things you say may be received by others.

A simple “Hi! How are you today?" can be answered very differently when you're fully present. After asking, give the person to whom you're speaking time for a response or invite more than the typical “Good, how are you?" Explore what challenges or barriers that the individual may be encountering or anticipating encountering. Some questions you can ask include:

• “How do you think today will be for you?"

• “What could help you have a better day?"

These aren't new questions, but changing the focus of what you're listening for inevitably brings up what needs improvement, which you must welcome and be open to. Being fully present and actively listening when asking these questions can help you identify:

• gaps in nursing care that present an opportunity for process improvement

• ways to help staff provide safe and effective care differently

• barriers created through facility policies and practices that aren't supportive of its mission, vision, and values.

Nurse leaders can influence the behavior on their unit based on their behavior. The more knowledge and experience you gain, the more you'll increase your mindfulness. As this mindfulness influences your behavior, you'll begin to see positive changes in those around you. Ultimately, your staff members will begin to ask their patients and coworkers the same questions, creating an empowered and engaged unit culture that fosters EDI.


Michelle Sanchez is the Beacon Award for Excellence program manager at the American Association of Critical-Care Nurses in Aliso Viejo, Calif.