Nursing’s Finest Hour: A Call To Healthcare Leadership For .

September 2014Ohio NurseJoin theOhio NursesAssociationRegistration Form:Select the studies you are taking:Nursing’s Finest Hour: A Call to Healthcare Leadership for the 21st CenturyBeing an Expert WitnessRadon: A Public Health RiskName:Address:StreetCityStateZipDay phone number: Email Address:RN or LPN?RNLPNONA Member:YESNOONA Member # (if applicable):ONA MEMBERS:Each study in this edition of the Ohio Nurse is free to members of ONA if postmarked by 11/30/14. Please send posttest and this completed form to: Ohio Nurses Association, 4000 East Main Street, Columbus, OH 43213. Studies canalso be completed for free by going to www.CE4Nurses.org/ohionurse.NON-ONA MEMBERS:Each study in this edition of the Ohio Nurse is 15.00 for non-ONA Members. The studies can also be completedonline at www.CE4Nurses.org/ohionurse for 12. Please send check payable to the Ohio Nurses Association alongwith post-test and this completed form to: Ohio Nurses Association, 4000 East Main Street, Columbus, OH 43213.Credit cards will not be accepted.ADDITIONAL INDEPENDENT STUDIESAdditional independent studies can be purchased for 15.00 plus shipping/handling for both ONA members andnon-members. ( 12.00 if taken online). A list is available online at www.CE4Nurses.orgONA OFFICE USE ONLYDate received: Amount: Check No.:Independent Study InstructionsTo help Ohio’s nurses meet their obligation to stay currentin their practice, three independent studies are published inthis issue of the Ohio Nurse.To Complete Online Go to www.CE4Nurses.org/ohionurse and follow theinstructions.Post-testThe post-test will be scored immediately. If a score of 70percent or better is achieved, you will be emailed a certificateand test results. If a score of 70 percent is not achieved, youmay take the test a second time. We recommend that theindependent study be reviewed prior to taking the secondpost-test. If a score of 70 percent is achieved on the secondpost-test, a certificate will be e-mailed to you.Instructions to Complete By Mail1. Please read the independent study carefully.2. Complete the post-test and evaluation form for each study.3. Fill out the registration form indicating which studiesyou have completed, and return originals or copies of theregistration form, post test, evaluation and payment (ifapplicable) to:Ohio Nurses Association, 4000 East Main Street, Columbus,OH 43213ReferencesReferences will be sent upon request.QuestionsContact Sandy Swearingen (614-448-1030, sswearingen@ohnurses.org), or Zandra Ohri, MA, MS, RN, Director,Continuing Education (614-448-1027, zohri@ohnurses.org).Disclaimer: The information in the studies published in thisissue is intended for educational purposes only. It is not intendedto provide legal and/or medical advice.The Ohio Nurses Association (OBN-001-91) is accreditedas a provider of continuing nursing education by the AmericanNurses Credentialing Center’s Commission on Accreditation.Page 3The Ohio Nurses Association does a lot for the nursingprofession as a whole, but what does ONA do for itsmembers?FREE AND DISCOUNTED PRODUCTS ANDSERVICES Members take advantage of a wide array ofdiscounts on products and services, including professionalliability insurance, continuing education, and specialtuition rates to partner RN-to-BSN programs.WORKPLACE ADVOCACY ONA provides membersaccess to a wide range of resources to help them make areal difference in the workplace, regardless of work setting.ONA provides members with resources to create healthyand safe work environments in all health care settingsby providing tools to help nurses navigate workplacechallenges, optimize patient outcomes and maximizecareer benefits.EDUCATION Whether you’ve just begun your nursingcareer or are seeking to enhance or maintain your currentpractice, ONA offers numerous resources to guide you.For example, the Ohio Nurses Foundation awards severalscholarships annually with preference to ONA members.Members also save up to 120 on certification throughANCC, and can earn contact hours for free throughthe independent studies in the Ohio Nurse or onlineat a discounted rate, among many other educationalopportunities.NURSING PRACTICE ONA staff includes expertsin nursing practice and policy that serve our members byinterpreting the complexities of the Nurse Practice Act andaddressing practice issues with a focus of ethical, legal andprofessional standards on a case-by-case basis.LEGISLATIVE ADVOCACY ONA gives members adirect link to the legislators that make decisions that affectnursing practice. Members can become Legislative Liaisonsfor their district, join the Health Policy Council andparticipate in the legislative process in many other waysthrough their ONA membership.These are just a few of the benefits nurses receive asONA members. Dues range from 33– 50 a month and weoffer reduced dues rates to new graduates, unemployedand retired nurses. Go to www.ohnurses.org Join/Renew to start taking advantage of what ONA has to offer.Go towww.ohnurses.orgto join today!

Page 4Ohio NurseNursing’s Finest Hour continued from page 1national health care cost growth slow significantly andwe want to continue that trend by helping to improve thedelivery of health care by testing new models of paying forquality care.”4Further increases in healthcare spending areunsustainable and carefully chosen cost containmentmeasures are essential. The global recession has reducedresources available for healthcare services whether thesystem is one of universal access/single payer or the mixedfee-for service, insurance mediated access model used inthe US.Quality of HealthcareConsumers expect safety and quality whetherpurchasing a car or healthcare. Healthcare providersassure consumers that they deliver quality care. Yet there isongoing evidence of deficiencies in the safety of care; at aminimum, healthcare must be safe.The Institute of Medicine (IOM) 1999 Report To Err isHuman: Building a Safer Health System publicly acknowledgedthat too many mistakes were being made in health caredelivery. The report enumerated the human toll ofmistakes: unnecessary suffering and needless deaths, lossof trust in the system as well as frustration and loweringof morale among health care professionals. The IOMidentified systems problems as the chief culprit andrecommended strategies for the improved functioning ofhealth care delivery. A goal of a 50% reduction in medicalerrors in five years was established. 5 Problems with healthcare errors remained sufficiently unresolved in 2007 tothe extent that the CMS announced, beginning in 2009,Medicare would no longer pay for the costs of preventableconditions, mistakes and infections resulting from ahospital stay. Such errors include surgical and catheterrelated infections, pneumonia, falls, bed sores, and airemboli.6 It is obvious that most of these problems are nursePROVIDING CAREMEANS PROVIDINGLEADERSHIP, TOO.CLINICAL NURSE SPECIALISTAchieve Prescriptive AuthorityImplement Solutions for Improved Clinical OutcomesDirect and Indirect Patient r 2014sensitive and that nurses can and should play leadershiproles in solving systems problems.The American Nurses Association (ANA) joined theInstitute for Healthcare Improvement (IHI) in 2006for its 5 Million Lives Campaign focused on reducingharm to five million patients in both hospitals and thecommunity between 2006 and 2008. Strategies focusedon the conditions the CMS identified as preventableand not reimbursable. This goal was based on estimatesthat there are 40-50 incidents of harm per 100 hospitaladmissions.7 Evidence-based practice of nursing, with 24/7responsibilities in hospitals and presence in all communitysettings, is key to reducing nurse sensitive errors throughproblem solving at the unit and systems levels.Patient safety remains a significant component of theUS national agenda for healthcare because the outcomesof today’s system are unacceptable. The IHI estimatesthat 40,000 instances of harm occur every day in just ourhospitals; 15 million mistakes per year.8 HealthGrades,a leading healthcare rating organization, reported in2011 that “patient safety events” in hospitals cost thefederal Medicare system 7.3 billon and resulted in 79,670preventable deaths among Medicare patients between 20072009.9 Hospitalized Medicare patients who experiencea healthcare error have a one in five chance of dying asa result.10 The Harvard School of Medicine reports thatapproximately 18% of all hospitalized patients are harmedby mistakes; many of these injuries are life threatening orfatal. If the Centers for Disease Control (CDC) classifiedpreventable errors with other causes of death, mistakeswould be the sixth ranked cause of death in the US.11Hospitals value reputations for safe care as ahumanitarian component of mission and, in part, topreserve market share. It is significant that in a March2012 report from Johns Hopkins University it is notedthat risk adjusted data bases on safety contain aggregatedata, without institutional identifiers, for such problemsas surgical site infections. Public reporting laws on safetyincidents vary widely from state to state. This study’s leadauthor concluded that “Nothing motivates hospitals toimprove quality and listen to their front line staff likepublic reporting.”12 The industry provides too little usefulinformation to either researchers or to consumers. Muchof what is available is limited to hospitalized Medicarepatients; data on safety in community-based care deliverysystems are even less accessible. It is likely that healthcareerrors are underreported.American hospitals do take the prevention of errorsquite seriously as does the Joint Commission (TJC). In theJoint Commission Annual Report on Quality and Safety 2013,detailed information on improvements in quality over timeis provided and top performing hospitals are identified.13The public is understandably very interested in thequality of healthcare. Seventy percent of adults surveyedin 2011 by the Commonwealth Fund said the healthcaresystem needs fundamental change or complete rebuilding.Respondents reported receiving wasteful, inefficient careand have fears about getting safe care in the future.14The press regularly reports on the quality of hospitalcare through various ratings systems, some of theirown devising. National News and World Report lists arewidely read. Safe hospital care is a standard topic forthe American Association of Retired Persons (AARP)magazine readers. The July 2012 Consumer Reports providedits analysis of safety in 1159 US hospitals based on measuresof communication, infections, repeat CT radiationexposure, complications, readmissions, and mortality. Thestudy included data from only 11% of hospitals because“data on patient harm are still not reported fully orconsistently nationwide.”15Rowe and Calnan, writing in the European Journal ofPublic Health in 2006, noted that public trust in healthcare providers and institutions is steadily eroding in theUK. They state that “beliefs about the limits of medicalexpertize together with concerns about the effectiveness ofprofessional regulatory systems to ensure high standards ofclinical care, highlighted by the media coverage of medicalerrors and examples of medical incompetence, haveeroded trust in health care organizations, in the medicalprofessions in general, and in health systems as a whole.”16Safe care is a global concern.Year after year the Gallup Poll identifies nursing asthe most trusted profession based on perceptions of thehonesty and ethics of nurses.17 Advocating for patient safetyrequires moral courage when nurses suffer reprisals fortheir advocacy. To illustrate, two Winkler County, Texasnurses were fired and criminally prosecuted for reportingan unsafe practitioner at their facility to the state medicalboard. They were ultimately exonerated after a long legalprocess.18 The voluminous literature on hospital quality,error reduction, and litigation prevention rarely mentionsnursing. Focus falls on the practice of physicians. Why? Isnursing invisible?Access to HealthcareAccess to healthcare in the US is financed through oneor often a combination of 1) self pay; 2) privately purchasedhealthcare insurance; 3) employer provided/subsidizedhealth insurance; 4) government funded Medicare,Medicaid, and CHIP; and 4) emergency room visitssubsidized by hospitals and state reimbursement. Insurancecoverage for particular health problems varies widelyby insurer and type of policy leaving many patients withunpayable bills. Americans have also gone without healthinsurance due to the cost of a policy, rejection of coveragefor prior conditions or as a result of lifetime limits,unemployment/underemployment, and a belief prevalentamong younger people that they will not need healthcareand therefore don’t need healthcare insurance.According to the Kaiser Family Foundation, over 47million nonelderly Americans were uninsured in 2012.Decreasing the numbers of the uninsured is a key goalof the ACA and state insurance exchanges which beganin 2014 to provide Medicaid or subsidized coverageto qualifying individuals with incomes up to 400% ofpoverty.19Americans without healthcare insurance generallyforego primary care and enter the system when healthcareconcerns are acute and most expensive. If more Americanshave access to primary care, healthy behaviors can bepromoted, chronic illnesses will be better managed, andmany costly hospitalizations avoided. Nurse practitioners(NPs) are prepared to improve systems of primaryhealthcare delivery.If the present primary care system were to remainfundamentally the same in 2020, there will be a projectedshortage of 20,400 primary care physicians. Undera scenario in which primary care NPs and physicianassistants (PAs) are fully integrated into health caredelivery, such as in patient-centered medical homes thatemphasize team-based care, the projected shortage ofprimary care practitioners in 2020 could be somewhatalleviated.20 In many parts of the country NPs do notpractice to the full scope of their education (IOMrecommendation #1); overly restrictive state laws requirerevision.The Health Resources and Services Administration(HRSA), an agency of the U.S. Department of Healthand Human Services, is the primary Federal agency forimproving access to health care services for people who areNursing’s Finest Hour continued on page 5

September 2014Nursing’s Finest Hour continued from page 4uninsured, isolated or medically vulnerable. Its mission is to improve health and achievehealth equity through access to quality services, a skilled health workforce and innovativeprograms. Mary Wakefield, PhD, RN, was named administrator of the Health Resources andServices Administration (HRSA) by President Barack Obama in 2009. Dr. Wakefield oversees theagency’s 8.1 billion annual budget and brings the perspectives of an experienced nurse leader to theinterrelated problems of healthcare cost, quality and access.21Nurse EducationThe US Nurse Education InfrastructureEducation of nurses in the US did not follow the model created by FlorenceNightingale in England for the establishment of autonomously operated schools focusedon the learning needs of students. The Nightingale School at St. Thomas Hospital inLondon was financially independent, endowed with money contributed by a gratefulBritish public after the Crimean War. Scientist and gifted administrator, Nightingaleraised the stature of nursing through credible education.Nurse scholar Dr. JoAnne Ashley, writing in Hospitals, Paternalism, and the Role of theNurse (1976), described early US nursing students as “housekeepers for the sick.” Since the1870s, American hospitals have needed caregivers and young women needed a respectableway to earn a living and to answer spiritual calls to serve. Hospital-based diploma nursingschools represented American problem solving. Room, board, and service on the wardswere exchanged for education in a barter system with focus on the needs of the hospital.Early diploma program education was of variable quality since society viewed educationfor women as unnecessary. For nursing, the further view was that the practice of nursingwas maternally instinctive without need of specialized science and art.22 These schoolsof nursing, operated by hospital boards of trustees, conferred a diploma in nursing andprepared a significant number of the country’s nurses throughout the 20th century. Overa century later, demographics show that nursing is still viewed as the work of women.In 1889 the University of Cincinnati College of Nursing was founded as the CincinnatiTraining School for Nurses. By 1896 the school was integrated into the College ofMedicine as a professional school and in 1916 became the first nursing school to grantthe Baccalaureate of Science in Nursing (BSN) degree.23 Three years of nursing educationwere combined with two years of study in science and the liberal arts in early universityprograms; these programs multiplied more slowly than diploma schools. Today 36% ofnew nurses begin with the BSN and 3% enter practice through graduate degree entryprograms.24Both diploma and university programs used service learning on the wards inapprentice style learning with diploma program students generally working longer hours.The study of nursing is a formidable undertaking in any era. Students formed close bondsunder stressful learning conditions as well as pride in their identities as “diploma” or“BSN” graduates. Distinctive caps and pins once proclaimed the educational programs arethe background of the wearer.Nursing is the holistic practice of nursing science, art, and the spirit of compassion.Nursing is the only profession prepared to care for people throughout the life span inboth health and illness. Nurses are prepared to lead in the redesign of health systemsbecause they are systems thinkers and problem solvers.At the outset of World War II it was feared that a draft would be needed to provideadequate numbers of nurses for the war effort and to maintain civilian hospitals. Nurseleaders assured members of Congress that nursing could meet recruiting challenges.Although black nurses had served in France in WW I, the Army Nurse Corps wouldnot accept their services. Mabel K. Staupers RN, Executive Secretary of the NationalAssociation of Colored Graduate Nurses, lobbied with other nurse leaders for therecruitment of all nurses in a concerted political effort. Recognizing the need for action,First Lady Eleanor Roosevelt urge

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