INSIDE

Vol. 5 No. 3March 2005

Interdisciplinary care cornerRead how a collaborative effortamong caregivers helps managedifficult patients on p. 4.

Performance evaluationsPerformance evaluations don’thave to be a burden. Find outhow to make them more effective on p. 6.

TeamworkDo you and your nurses work in groups or teams? Read about the difference on p. 8.

Health and wellnessOut of gas? Fight fatigue with the advice offered on p. 9.

Time managementCheck out the time-saving tips to stay on top of your workloadon p. 10.

plan. Standard HR.1.30 states thathospitals must assess staffing effect-iveness by using clinical, service,and human resource screening in-dicators data.

“We had 90% of what [the survey-or] was looking for,” says Reed.The one thing the surveyor saidwas missing was that the plan didnot include follow-up actionstaken as a result of the data analy-sis. SNHMC has since updated theplan to include benchmarking,Reed says, although it is not astandards requirement.

The surveyor liked that the hospi-tal presented data in graphs andtables, which is a standards require-ment. Reed says the surveyormentioned that hospitals too oftenlook for correlations when otherstatistical methods are useful.

Make measures specific The hospital spent time creatingthe appropriate measures forbehavioral health and birthing sodata analysis is specific to staff inthese units, although it is not astandard requirement, Reed says.For example, the birthing unitdoes not have many patient falls,so its measures were different thanthose of other units.

In addition, the plan

If a candidate for a nursing posi-tion walked in the front door toapply, would he or she get an in-terview that same day?

A JCAHO surveyor posed thisquestion to the nurse recruitmentcoordinator during Southern NewHampshire Medical Center’s(SNHMC) triennial survey in March2004. Surveyors focused on ensur-ing that the hospital is respondingto the nursing shortage, as well ason staffing effectiveness and cre-dentialing, during the competenceassessment process meeting, saysKaren Reed, MS, director of qual-ity management at the Nashua-based hospital.

The recruiter’s answer satisfiedsurveyors: She has granted same-day interviews many times in thepast to accommodate nursing can-didates. A problem scheduling asame-day interview only arises ifthe director is out for the day, saysReed.

“The point is that you need to beon your toes with this and go outof your way to bring in [nursingcandidates],” she says.

Ensure complete staffing effectiveness plans JCAHO surveyors also examinedthe hospital’s staffing effectiveness

JCAHO

Survey focuses on nursing shortage, staffing, and credentialing

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More quarterly continuing education credits areavailable this month. This special benefit to Strate-gies for Nurse Managers subscribers means thatin addition to staying on top of the hottest topicsin your field, you qualify for four contact hourseach year.

Check out the following courses available to you:

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JCAHO

includes the initiatives and actions the hospital willtake as a result of the study, says Reed. SNHMC’sstudies did not show that staffing was related to fallsand other areas examined by the hospital.

Reed and her team predicted that per diem staffwould document taking fewer comfort measures,such as rocking or supplying pacifiers to newborns,than employed staff. “This turned out not to be thecase and was the only surprising result,” she says.

Involve staff every step of the way“What made us successful is that our staff were real-ly prepared,” says Reed. Conducting mock tracersboosted staff members’ confidence to answer survey-or questions.

Get FREE nursing education contact hours with your Strategies for Nurse Managers subscription!

“They felt comfortable and knew how to give survey-ors the information they were looking for,” she says.

During the survey, the staff responsible for escortingsurveyors met each day while the surveyors took alunch break. They pooled the information they gath-ered earlier in the day and highlighted the mostimportant results in an e-mail to all employees.

E-mails included information about areas surveyorshad visited that day and questions they asked staffand patients. “It was very motivating for staff to beinvolved,” says Reed.

Source: Briefings on JCAHO, January 2005,HCPro, Inc.

Survey < p. 1

Page 3Strategies for Nurse Managers—March 2005 © 2005 HCPro, Inc.

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Get organized: Leave 2004 in the past

You’re three months into the New Year, but do youstill have remaining agenda items from 2004?

Many nurse managers have difficulty focusing onwhat is really important for the new year whenthey have numerous unresolved issues from last year.

Following are tips for keeping your focus, purpose,and direction for 2005:

Make of list of the items/issues from 2004 and ask yourself the following questions:

• Are any of the items left over from 2003 and, ifso, how important are they at this time?

• Are any of the items things you should have delegated but chose not to?

• Which of the items, if completed, would affectpatient care the most?

• Which of the items, if completed, wouldenhance staff satisfaction the most?

Identify the challenges for 2005 and prioritizethem in order of importance.

Determine if you are due for a regulatory agencyvisit in 2005 and reprioritize your agenda itemsaround this visit.

Post a working list of agenda items from 2004 and 2005. Ask them to prioritize the items.

Schedule a meeting with your manager. Listen to his or her thoughts about the direction and focus for 2005 from an organ-izational perspective.

When you take the time to put these tips into action,you send an important message to staff that youneed and want their input.

You also send a strong leadership message to your manager by including him or her in theprocess.

Your efforts for 2005 will be clear and focused, and although daily challenges will interrupt yourmomentum, you and your staff will always beaware of where you’re heading.

Source: “Manager Tip of the Month” by ShelleyCohen, RN, BS, CEN, Health Resources Unlimited,www.hru.net. Adapted with permission.

Organizational skills

Page 4 Strategies for Nurse Managers—March 2005© 2005 HCPro, Inc.

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Interdisciplinary care corner

Collaborative approach to managing difficult patients improves safety

Collaboration among pharma-cists, nurses, physicians, and

administrators can improve safety for you and yourdifficult patients.

Forming interdisciplinary care teams to assess andtreat your patients opens lines ofcommunication and increasesyour facility’s overall quality ofcare.

After completing an assessment,disciplines must share their find-ings with each other so careproviders can meet the following responsibilities:

• Identifying and prioritizing a patient’s problems orneed for care, treatment, or service

• Developing and modifying an individual plan of care to address a patient’s problems or needs

Everyone benefitsAn interdisciplinary approach to care planning anddelivery has been proven to carry real benefits forpatients and staff. Below are some of the most sig-nificant benefits to this approach:

• Improve patient outcomes. An interdisciplinaryapproach has the potential to make patients’progress smoother and therefore decrease theirlengths of stay (LOS). When all staff on the careteam are aware of patients’ problems and goals,they can coordinate efforts and eliminate situa-tions in which disciplines have conflicting goals.Also, when all team members are involved inrevising plans of care during patients’ stays, thereis less chance that something will be missedwhen the time comes to prepare patients for discharge.

• Increase efficiency by eliminating duplica-tion of efforts. By working together to identifyand prioritize problems, your efforts (and those

of your colleagues in other disciplines) candirectly focus on patients’ needs. It can increasethe efficiency of the care team and reduce thepossibility of teams getting bogged down withirrelevant or less important problems. It can alsoidentify interventions that involve more than

one discipline, thereby maximiz-ing the benefits of everyone’sefforts.• Prevent medication error.Forming an interdisciplinary teamis one of the best ways to pre-vent medication errors and in-crease staff collaboration and

patient safety. A team can delegate various tasksto subcommittees, all of which report findingsthat allow the hospital to decide which medica-tions to stock. Subcommittees may include thefollowing:

- Drug selection- Adverse drug events- Financial risk- Prescribing

Results of effective managementThe benefits of early identification and effectivemanagement of difficult patient populations includethe following:

• Reduce the additional strain these patients place on your time and your organization’sresources

• Decrease the risk for negative encounters andoutcomes

• Avoid prolonged LOS• Decrease the likelihood of staff dissatisfaction

Source: Handling Difficult Patients: Managementtools for staff preparedness by Richard A. Bryan,BSN, RN, CCM, and Linda Childers, published byHCPro, Inc.

Forming an interdisciplinaryteam is one of the best ways toprevent medication errors andincrease staff collaboration and

patient safety.

Page 5Strategies for Nurse Managers—March 2005 © 2005 HCPro, Inc.

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Celebrating nurses

In an annual Gallup poll, Americans identified nurs-ing as the most honest and ethical profession for thethird year in a row.

The professional honesty and ethical standards sur-vey, which was first distributed in 1976, added nurs-ing to the list of 21 professions in 1999.

The only year nursing didn’t receive top ranking was2001 because firefighters clinched the spotlight.

More than 1,000 adults ages 18 and older rated thehonesty and ethical standards, and 79% of respon-dents assigned nurses a “high” or “very high” rating.Grade-school teachers (73%), pharmacists (72%), andmilitary officers (72%) received the next highestrankings, suggesting a general trend of trust in pub-lic service professions.

Building trustNursing’s close, intimate relationships with patientsand families make it a trusted profession, saysKatherine Riley, BSN, RN, director of integratedclinical services and Magnet coordinator at South-western Vermont Medical Center in Bennington, VT.

“Nurses are such strong patient advocates, advocat-ing for the patient’s wishes, that it seems only natur-al that we are viewed as a profession that is honestand ethical,” says Riley.

In the public eyeThe nursing profession’s high ranking often resultsfrom respondents’ personal experiences with theirown care or that of family members.

Direct contact with nurses affects the public’s per-ception of the profession and combats the negativeportrayal of nursing occasionally found in the mediaas a “stereotypical sexy woman who is a male doc-tor’s handmaiden,” says Anne Jadwin, RN, MSN,AOCN, CNA, director of nursing at Fox Chase Can-cer Center in Philadelphia.

Although nursing receives high ratings as an ethicaland honest profession, a review of current literatureshows that the public does not fully understand thenursing profession, says Laura Caramanica, RN,PhD, vice president for nursing at Hartford (CT)Hospital.

“Patients that have had an experience with a nursemay in fact know on some level what nurses do,but the literature reports that often the patient ex-periences the nurse as doing [things uniquely] forhim or her only,” says Caramanica. Her currentstudy of the image of nursing provides her withsuggestions for practice changes to help the publiccomprehend the role of nursing in the healthcarespectrum.

As the public’s perception of nursing continues toevolve, patient care provided in various settingshelps people grasp the many duties a nurse per-forms and the empathy and patience required.

“Our profession keeps the patient’s needs in theforefront and, at times, in front of [nurses’] ownneeds, health, and well-being,” says Caramanica.“We always have and we always will.”

Survey says: Nursing is the most ethical profession

Authoring, coauthoring, andreviewing publications are greatways to get recognized as a nurs-ing expert. Visit the HCPro Web

site at www.hcpro.com/about/manuscript_submissions.cfm if you’re thinking about author-ing or reviewing a nursing book but don’t knowwhere to start.

Or e-mail jgisonde@hcpro.com to be interviewedfor a future issue of Strategies for Nurse Man-agers or to suggest a story idea.

Get published!

Page 6 Strategies for Nurse Managers—March 2005© 2005 HCPro, Inc.

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Spare time is not a luxury nurse managers can afford.Unfortunately, some tasks, such as performance eval-uations (PE), can’t wait. However, if performed ef-fectively, the benefits of PEs outweigh the extra effort.

One common obstacle is time. Make it a priority toschedule evaluations in advance and stick to thatschedule. You can either conduct your annual evalu-ations during a certain time of year or hold them onthe anniversary of each nurse’s date of hire.

Unpleasant PE memories are another impediment. Totake the dread out of evaluations, don’t focus on thenegatives. Compliment employees on what they dowell, says consultant Keith Solinsky, manager forThe Coker Group, a healthcare consulting firm inRoswell, GA.

Compare apples to applesUse a standard form or tool with specific criteria toevaluate all employees. A good form will provideyou with objective data that are easy to understand,Solinsky says. A tool that allows you to rate employ-ees on a scale not only meets these criteria, but isless time-consuming than writing paragraphs abouteach employee’s performance. However, thereshould be a small section for written comments.

For all employees, address performance matters suchas attendance, punctuality, quality of work, and pa-tient satisfaction, Solinsky says. To evaluate employees’effects on patient satisfaction, average the scores onyour patient satisfaction surveys and benchmark themagainst other departmental scores. Hold everyone inyour department accountable for the scores. “Youwant employees who are providing good customerservice and understand that everything they say anddo could potentially negatively impact the practice,”says Solinsky.

Remember to commend high patient-satisfactionscores and positive comments written on patient sur-veys, especially when they mention a specific employ-ee. “Employees need to see that when they get those

Performance evaluations

Get the most from your performance evaluationskudos, it’s recognized on their evaluation,” he says.

Set goalsWork with employees to establish new goals andareas of improvement for the upcoming year. Includea timeline to meet goals and identify consequencesfor unmet requirements, Solinsky says. For example,if you set a goal for an employee to not be latemore than once in the next month, let the personknow that the second tardy day will result in a ver-bal warning, the third in a written warning, and soon. Document these details.

Include objectives so employees can grow profes-sionally, says consultant Kay Stanley, CMPE, associ-ate partner at The Coker Group. “As a manager,nothing is more rewarding than to see an employeeimprove and grow.”

Managers should determine how they will assist theiremployees with reaching their goals, Solinsky says.For example, if it is agreed that an employee willreceive additional training in a certain area, the super-visor should help provide or arrange that training.

Employees should sign the evaluation form indicat-ing they have read—but not necessarily agree withtheir plans, and both supervisors and their employ-ees should keep a copy.

Evaluate year-roundIt’s not unusual for lagging employees to suddenlyshape up several weeks before review time, Stanleysays. Supervisors often fall prey to this “halo effect,”wanting to see the best in an employee, only to wit-ness another backslide after the evaluation.

She suggests keeping an ongoing file to note perfor-mance aspects needing improvement or incidentsthat you may not recall come review time. If thenotes start adding up, establish consequences.

Source: Private Practice Success, January 2005,HCPro, Inc.

Page 7Strategies for Nurse Managers—March 2005 © 2005 HCPro, Inc.

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Patient safety

One of the JCAHO’s new National Patient SafetyGoals requires hospitals to reduce the risk of patientharm resulting from falls by assessing—and periodi-cally reviewing—each patient’s risk for falling. Areyou ready?

Hospitals must make improvements or take othernecessary actions based on these identified risks,says Teresa Sumner, BSN, RNC, CDONA-LTC, pa-tient safety coordinator at Lenoir Memorial Hospitalin Kinston, NC. Most hospital falls occur whenpatients try to get in or out of bed or use the bath-room. Because of this, those areas are good placesto start assessing the risks of falls and developingpolicies for them, Sumner says. Remember toinclude an evaluation of any potential risks associat-ed with the patient’s medications.

At Lenoir, falls occurred in the bathroom when pa-tients mistook shower curtains for walls, typicallywhen it was dark in the room. As a result, the hospitalinstalled more lights in the bathrooms and increased

staff rounds for at-risk patients, says Sumner.

Staff education is an important part of this effort. Ifyour hospital has a patient safety committee, safetyofficers should check in with this group to see howthe environment of care interweaves with the overalleffort to reduce falls.

Simple steps can sometimes prevent problems. Forexample, if personal items are out of the reach of at-risk patients, they may be more likely to get out ofbed to grab them. Extension cords may be exposedon the floor and should be taped down for safertravel. And wet floors can cause anyone to slip, in-cluding patients who are already unsteady on theirfeet. Also contact any long-term care facilities withinyour hospital’s chain or community, as administra-tors working there are likely familiar with fall pre-vention techniques.

Source: Briefings on Hospital Safety, January2005, HCPro, Inc.

Preventing patient falls starts with risk assessment

A nurse noticed air bubbles in the IV tubing of aninsulin drip (two units/hour) on a 9-year-old pa-tient. She attempted to promote proper flow byremoving the air bubbles from the tubing andpump chamber.

She disconnected the tubing from the patient andincreased the pump rate to 200 mL/hour. Aftereliminating the air bubbles, she reconnected thetubing and restarted the infusion.

What did the nurse forget to do? The nurse forgot to reset the infusion rate totwo units/hour. The child received about 50units of insulin before the error was detected.Luckily, the patient was treated with a dextrose

Don’t let air bubbles snag the safety of your IV drips

injection and sustained no permanent harm.

What is the safe way to clear air from IV lines?When attempting to remove air bubbles, disconnectthe tubing from the patient, remove the entire in-fusion set from the pump, and establish gravityflow while using the flow-control clamp so thepump settings are not changed.

By increasing the flow rate on the pump, you add astep that another nurse must later correct—one thathe or she could forget.

Source: Adapted from Nurse Advise-ERR, January2005, Institute for Safe Medication Practices, www.ismp.org.

Case scenario

Q.

A.

Q.

A.

Page 8 Strategies for Nurse Managers—March 2005© 2005 HCPro, Inc.

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Turn your group into a team to achieve your goals

Teamwork

them to do the job effectively. They know what isexpected of them and do whatever it takes to ac-complish their tasks. Less effective groups havelittle or no organization, an inefficient structure,and unmotivated members.

• Competent team members. People on a win-ning team have the combined necessary skills toaccomplish their goals. Less effective groups lackone or more key skills.

• Unified commitment. People on successfulteams share a commitment to their jobs and toone another. They put the team’s goals abovetheir own. For some, this commitment may seemlike a sacrifice, but for members of a winningteam, the personal rewards outweigh the effort.

• Collaborative climate. People on successfulteams trust and support one another. Members ofunsuccessful groups look out for themselves first.

• Standards of excellence. Winning teams expectoutstanding work. In less successful groups, theminimum effort is the standard.

• Principled leadership. A winning team usuallyhas a leader who represents the team’s purpose.He or she creates the changes necessary to ac-complish tasks and has the ability to tap into theteam’s talent.

Make the switchThe transformation from a group to a team is notalways simple. Before assembling a team, managersshould first assess the work environment. Teams donot work in a vacuum; the environment influencesthe way members communicate and relate. Second,examine your staff relationships. Team membersneed to understand each other, particularly theirindividual work and behavior styles.

Finally, evaluate the characteristics of a winning teamlisted above. Ask yourself whether you communicateand relate in a way that will allow your group totransform into a winning and effective team.

Source: Private Practice Success, January 2005,HCPro, Inc.

By Angel A. Norman, MBA

Working with others is a vital part of virtually everyjob. In healthcare, groups must perform at a high-er—team—level in their crusade to deliver high-quality patient care.

Whether it’s a unit, an interdisciplinary team, or aMagnet subcommittee, nurses at all levels worktoward departmental and organizational goals withtheir fellow colleagues. But why do some groupswork well while others seem ineffective?

First, we must clarify our definitions of “group” and“team.” An effective group is a small, interdependentcollection of people with a common identity who in-teract, usually face to face, to reach a goal. An effec-tive team has the attributes of an effective group, buthas other qualities that make it more productive.

Researchers Carl Larson and Frank LaFusto discussthe attributes of an effective team in their bookTeamwork: What Must Go Right/What Can Go Wrong:

“It is a sense of loyalty and dedication to the team. Itis an unrestrained sense of excitement and enthusi-asm about the team. It is a willingness to do any-thing that has to be done to help the team succeed. Itis an intense identification with a group of people. Itis a loss of self.”

The face of successLarson and LaFusto spent nearly three years inter-viewing members of more than 75 successful teams.Although the practices pursued widely differentgoals, the authors isolated the following importantcharacteristics possessed by these successful teams: • Clear and inspiring shared goals. Members of

a winning team know why the team exists andbelieve the purpose is important and worthwhile.Ineffective groups either lose sight of their pur-pose or do not believe in their goal.

• A results-driven structure. Members of winningteams organize themselves in a way that allows

Page 9Strategies for Nurse Managers—March 2005 © 2005 HCPro, Inc.

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grams, include in your proposal the potential effectof not offering the programs in your proposal.

Incorporate data about the problem the program isdesigned to address (e.g., obesity, smoking, etc.),and explain how such problems affect job perform-ance. For example, include information aboutfatigue, its causes, and the ways in which it jeopar-dizes patient safety.

• Offer the information in another format. Ifthere is not enough interest or the organization isunable or unwilling to finance multiple offeringsof the same program, the information could per-haps be made available to employees in anotherformat (e.g., e-mail, online, self-learning packets).Because many programs such as weight loss andsmoking cessation depend on the mutual supportof attendees, employees using such programs ontheir own time could meet informally, at timesconvenient for them, if the organization offered aclassroom or meeting room for this purpose.

• Track the efficacy of the program. Even afterthe program has been successfully implemented,your work is not done. Track the effects of sucheducation in terms of reduced sick days, reducedmedical errors, and enhanced job performance.

The point of this exercise is to determine what yourorganization can do to facilitate employees’ healthand wellness. Help your organization achieve thisgoal—it’s not enough to recognize that a problemexists.

Be creative when you problem-solve and alwaysgather objective data to support your ideas.

Source: This is an excerpt from Fight Fatigue: ANurse Manager’s Guide to Reduce Risk and Revital-ize Staff by Adrianne E. Avillion, DEd, RN, and pub-lished by HCPro, Inc. Call customer service at800/650-6787 or visit www.hcmarketplace.com toorder.

Health and wellness

Nurses are notorious for neglecting their own healthand well-being in order to focus on providing carefor others, including patients, families, and friends.

It’s no surprise that physical illness and injury causefatigue, but how many of your staff follow their ownadvice about maintaining health and wellness whenthey aren’t ill?

Wake up! Nurses have needs, tooIt’s difficult to determine which staff members arefailing to receive preventive healthcare becausethere are issues of patient/physician confidentiality.

However, during staff meetings, explain to your staffthat physical health is important in the fight againstfatigue and consequential medical errors. Ask themto complete self-assessments concerning their healthand tell them that they don’t need to share that in-formation with anyone, including you, unless theywant to.

I’ve found that having staff complete written assess-ments sometimes clarifies needs for them—especiallythose that I’ve ignored. For example, some staff maynot be aware of certain preventive screening tests rec-ommended for their age groups. This self-assessmentcan therefore also be used as a teaching tool.

Make healthy choicesThe following suggestions will help you to justifyexpanding or adding health-related endeavors foryour staff:

• Determine whether there is an actual needfor additional programs at additional times.Determine how many employees would attendthe additional program. The program is offeredfree of charge to employees, so make sure theorganization is willing to spend money to offer itat additional times.

When proposing either multiple offerings of thesame program or new health-related education pro-

Provide fatigued staff with the help they need

Page 10 Strategies for Nurse Managers—March 2005© 2005 HCPro, Inc.

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Time management

Time is one of your most precious resources. It’s theonly resource you can’t buy, borrow, rent, or pro-duce. Managers often complain that they don’t haveenough of it, but unfortunately, that will neverchange. The solution is for managers to focus onusing their time more efficiently.

All managers have 24 hours per day. Instead ofmanaging time, they manage and prioritize theactivities in those 24 hours. And they accomplisheverything they perceive as important. Before younix the idea that people complete the tasks that aremost important to them, pause a moment and recallthe most important activity in your professional life.How often have you been unable to devote enoughtime to that activity? It probably doesn’t happenvery often.

Got a minute?Your work is characterized by constant interruptionsfrom phone calls, beepers, voicemail, e-mail, employ-ees, and colleagues. In fact, for most managers, inter-ruptions have increased greatly.

The reason for these burdensome interruptions isthat people abuse the technology available to them.For example, 10 years ago, if you had an importantdocument to get to someone, you would send it byregistered mail. Today, you mail it overnight deliv-ery, send a follow-up e-mail, and then leave a voice-mail just to let the other person know that it’s on theway.

Divide your time into chunksFor most managers, uninterrupted time is almostnonexistent. Managers move from one crisis toanother. Instead of having time to make importantdecisions, such as hiring new nurses or developing anew strategy for better care delivery, most of youare busy putting out one fire after another. However,if you want to make sound decisions and solveimportant, long-term problems, you must divideyour time into chunks.

Routinize crisisLearn how to manage a crisis instead of allowingthe crisis to manage you. You can accomplish thatby first putting out the fire, and then going one stepfurther and analyzing the crisis. Ask yourself whatthe pattern is, why it occurred, what can be done toavoid it in the future, and who can be trained tohelp prevent this from recurring. Then implementactions designed to prevent it from happeningagain.

If you think you’re already too busy solving prob-lems and don’t have time for extensive, time-con-suming analysis, you’re probably stuck in a timetrap. To get out of this trap, you must

• analyze how you spend your time

• get rid of time-wasters

• learn how to prioritize activities

Take the first step toward maximizing time by eval-uating your current time utilization in part two ofthis series—a time management quiz, available innext month’s issue.

Source: W.J. Rinke, “Time Management,” MAKE It aWINNING Life: Strategies to help you succeed fastere-Newsletter, Vol. 5, No. 4, 2003.

Time-saving tips for managers to stay on track

Contact Associate Editor Jamie Gisonde

Telephone: 781/639-1872,

Ext. 3278

E-mail:jgisonde@hcpro.com

Questions? Comments? Ideas?

Page 11Strategies for Nurse Managers—March 2005 © 2005 HCPro, Inc.

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The Missouri Hospital Association (MHA) awardedsix grants totaling $1 million to expand the capacityof the state’s nursing schools. The grants will enablethe participating schools to add 120 students overtwo years.

Participants will use the funds for various projects,including hiring additional faculty, offering alterna-tive classroom schedules, and expanding classroomand laboratory space.

“During the past several years, Missouri’s nursingschools have seen a steady increase in nursing school

enrollment,” said MHA President Marc Smith.

“This increase can be attributed to the heightenedawareness of shortages in nursing and the alliedhealth professions, as well as the realization thatthese professions offer highly rewarding and securecareers,” Smith added.

U.S. nursing schools turned away thousands of qual-ified applicants last year due to a shortage of facultyand other capacity constraints.

Source: AHA News Now.

Nursing in the news

Missouri Hospital Association awards nursing schools $1 million to expand programs

To register, call customer service at 800/650-6787or visit www.hcmarketplace.com.

Audioconferences:

March 23—Beyond LOS: Efficient Resource Utilization Strategies to Improve Your BottomLine

April 19—Physician-nurse CommunicationApril 21—Case Managers Using Data to

Influence Physician Practice

MARCH Upcomingevents

Nursing in the news

Two studies in the Journal of the American MedicalAssociation claim that doctors, paramedics, and nurs-es perform cardiopulmonary resuscitation (CPR) in-adequately during cardiac arrest.

The studies found that clinicians often fail to followthe guidelines for performing CPR in a hospital andwhen a patient is en route to a hospital. Commonproblems include rescuers

• not pushing hard or frequently enough on thevictim’s chest

• breathing air too often into the lungs

Both studies used an experimental monitor that as-sesses CPR quality. In one of the studies, involving67 adult patients at the University of Chicago, doc-tors and nurses failed to follow at least one CPRguideline 80% of the time. The researchers explainedthat skills taught in training can fall by the waysidein stress-filled, real-life emergencies.

The studies add to evidence that the guidelines needto be simplified so they “can be readily used in the

real world,” say Gordon Ewy and Arthur Sanders,emergency medicine specialists at the University ofArizona.

Source: Lansing State Journal, 2005.

Studies suggest practitioners fall short on CPR

Page 12 Strategies for Nurse Managers—March 2005© 2005 HCPro, Inc.

www.hcpro.com

JCAHO urges hospitals to avoid ‘PCA-by-proxy’ errors through training

Training

The JCAHO urges hospitals and other healthcarefacilities to educate staff and patients’ family mem-bers about the proper use of patient-controlled anal-gesia (PCA), according to a Sentinel Event Alert theagency released late last year.

PCA—which is intended solely for patient self-administration—is a controlled system that allowspatients to press a button and receive appropriateamounts of pain medication intravenously. When thebutton is pushed, opiates are released, helpingpatients to manage their pain.

However, when the analgesia is administered bysomeone other than the patients, including care-givers and unauthorized clinicians, there is anincreased risk for oversedation with possible fatalconsequences. This process is known as PCA byproxy, and the U.S. Pharmacopeia recorded 460

fatalities or serious injuries due to PCA--by-proxy-related errors, reported the Alert.

The JCAHO suggests the following safeguards forpatients:

• Educate patients, family members, and staff aboutthe proper use of PCA and the risks related toPCA by proxy. Provide written instructions for itscorrect use.

• Post warnings in the area where PCA delivery sys-tems are used.

Editor’s note: To view the JCAHO’s Sentinel EventAlert, visit www.jcaho.org/about+us/news+letters/sentinel+event+alert/sea_33.htm. HCPro is not affiliated with the JCAHO, which owns the JCAHOtrademark. Source: Healthcare Training Weekly,HCPro, Inc.

Strategies for Nurse Managers

Editorial Advisory Board

Shelley Cohen, RN, BS, CENPresident Health Resources UnlimitedHohenwald, TN

Sue FitzsimonsSenior Vice PresidentPatient ServicesYale-New Haven HospitalNew Haven, CT

David MoonExecutive Vice PresidentModern Management, Inc.Lake Bluff, IL

Bob Nelson, PhDPresidentNelson Motivation, Inc.San Diego, CA

Tim Porter-O’Grady, EdD, RN, CS, CNAA, FAANSenior PartnerTim Porter-O’Grady Associates, Inc.Otto, NC

Dennis Sherrod, EdD, RN Forsyth Medical Center Distinguished Chair of Recruitment and Retention Winston-Salem State University Winston-Salem, NC

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