One Nurse, One Patient, One Shift

Transforming Care at the Bedside initiative takes hold across Florida

Phyllis Class, RN
Editorial Director Florida/Southeastern/South Central editions

Mention snorkeling to Florida nurses and most conjure up images of tropical waters, coral reefs, and exotic fish. But to nurses working on Transforming Care at the Bedside (TCAB) units, it means something else altogether. Nurses "snorkel" or brainstorm ideas on improving patient care in the trenches.

The American Association of Nurse Executives (AONE) is leading the Transforming Care at the Bedside initiative, supported by a grant from the Robert Wood Johnson Foundation. The program's goal is to improve quality of care on medical/surgical units, says Pamela Thompson, RN, MS, FAAN, chief executive officer of AONE, who recently addressed The Nursing Consortium of South Florida.

TCAB's initiatives include multidisciplinary rounds at the bedside, a color-coded system to manage RN patient load, standardized change-of-shift reports, streamlined documentation, liberalized diets, and rapid response teams. The results so far have been impressive. Turnover on pilot units dropped from 5.8% to 3.4% in 2006, and time at the bedside increased from 40% to 50%, says Thompson.

The program's themes include safe and reliable care, vitality and teamwork, transformational leadership, patient-centered care, nurse autonomy, and ownership of practice. Front-line nurses on TCAB units use rapid-cycle testing methodology to develop, test, and implement change. Their mantra is "one nurse, one patient, one shift."

Participants gather periodically at strategic meetings across the nation. Mercy Hospital in Miami is one of 68 hospitals nationwide with TCAB units. "The energy that comes back from these meetings is incredible," says Claudia DiStrito, RN, BSN, MSH, senior vice president/nursing and patient services at Mercy.

Since Nursing Spectrum explored the TCAB unit at James A. Haley VA Hospital in Tampa one year ago, TCAB has been introduced to all inpatient units, says Daniel J. O'Neal III, RN, GCNS-BC, CNL-BC, evidence-based practice specialist. Best practices at the facility as a result of TCAB include electronic change-of-shift reports with handoff at the bedside, post-discharge follow-up calls using a script, hand-held wireless PDAs for documentation in isolation rooms, medication lists for patients, a newsletter to enhance communication, and markers on hall baseboards to measure how far postop patients walk.

Nurse executives agree one of the toughest things about TCAB is letting go and allowing nurses to be autonomous. Yet engaging front-line staff helps identify talent and helps with succession planning, says O'Neal. Problems are now "owned" by staff nurses. Instead of saying, "They ought to fix this," they say, "Let's get together to work on this problem."

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To comment, e-mail pclass@gannetthg.com.

http://include.nurse.com/apps/pbcs.dll/article?AID=/20080728/FL02/107280033

Nurse's aide gets 3 1/2 years in prison

Stole at least $7,000 in jewelry from disabled patient

BY DAN ROZEK Staff Reporter/drozek@suntimes.com

A nurse's aide who stole at least $7,000 in jewelry from the quadriplegic woman she was caring for was sentenced Wednesday to 3½ years in prison for the thefts.

Latasha Powell, 36, was convicted last month of stealing rings, chains and other jewelry from the 61-year-old Bensenville woman, who is disabled by polio and uses a respirator to help her breathe.

In a written statement, the victim said she remained angry about the 2006 thefts, many of which she said took place while she was sleeping.

"Ms. Powell obviously studied my sleep patterns and assessed the noise levels that would awaken me so that she could steal from me while I was in a deep sleep," the victim wrote.

Powell argued unsuccessfully during her trial that she received much of the jewelry as gifts from her employer. The victim dismissed those claims in her statement.

"I find it unacceptable that Ms. Powell would come along and take from me, many of the items that I worked so hard to purchase," wrote the victim, whose condition has worsened over the years.

DuPage County State's Attorney Joseph Birkett called Powell's actions "absolutely deplorable."

http://www.suntimes.com/news/24-7/1072475,CST-NWS-care24.article

Travelers reap benefits of nurse vacancy rate

By LJ Anderson / Daily News Columnist

In a high-demand field like nursing, traveling nurses or "travelers" reap the benefits of this demand by working wherever and whenever they want. With a national RN vacancy rate of over eight percent, according to a 2007 American Hospital Association survey, one of the ways in which hospitals fill the staffing gap is through the use of traveling nurses. It's an expensive option for the hospital, but for the traveler, short-term assignments and benefits, such as free housing, offer an attractive career option. These nurses need to adapt quickly in a new environment, but for many, it's well worth the adjustment.

Dialysis nurse Donna Shultz, RN, and her husband lived on a farm in New Hampshire for 25 years where they raised their four children. They relocated to Arizona, rented out their home, and now pursue the traveling nurse lifestyle. Shultz is currently on a six-month assignment at Lucile Packard Children's Hospital until October of 2008.
Q: Where, and in what clinical situations, have you worked as a traveling nurse?

A: Generally, I work in hospitals in which there is a dialysis unit where patients come for treatment. However, when the patient is too unstable, such as on telemetry or in the ICU or CCU, dialysis is done at the bedside - since the machine and water purifier are portable.

I have been in nursing for 16 years, and traveled for four of them. I have worked in several states, including
MaineGeneral Hospital, Dartmouth-Hitchcock Medical Center in New Hampshire, Banner-Good Samaritan in Arizona, Washington Hospital Center in Washington, D.C., and here at Lucile Packard Children's and at Stanford University Hospital. By far these two hospitals - Lucile Packard and Stanford - make it hard for travelers. Once you start working at one, you want to stay and stop traveling.

Q: What does it take to adapt quickly to a new clinical environment?

A: My philosophy is "When in Rome, do as the Romans." There is more than one way to do things, but as a traveler, it is important to follow the procedures of each facility. I focus on being safe, and dialysis is pretty much the same procedure wherever I go. Most places have a preceptor and a short orientation period, and I will typically use the preceptor as a go-to person after orientation is over. (As for the patients), I say to them, "I'm new to this facility, but I do this all over the country. I'm a traveler." That intrigues them, and helps them feel more comfortable and at ease.

Q: Have you had any negative experiences, and if so, why was that?

A: Yes. I have been expected to, and have worked 16-hour days without a break. I've worked with substandard equipment, and I've had to do extensive computer charting without any training on the computer program. In general, this was due to a severe lack of staff. I was hired onto a 100-bed outpatient dialysis unit and by the time I arrived, one of the two charge nurses had gone out on maternity leave, and the other one had quit. I was the charge nurse, didn't know the doctors and had to handle all the issues. You learn to get along, but those three months felt like an eternity.

Q: What are the benefits of being a traveling nurse?

A: I can travel all over the United States, and I am able to get assignments in cities that I choose for a minimum of three months. If there is a need and I like the facility, I can renew the contract for several more months. Because we live in each place an average of six months, we get to settle down and meet the people around us. You would never meet the number and diversity of people that we've met while living in a small town in New Hampshire. We live in a place long enough to get a flavor of it, and we're invested in the area. It's nice because when you feel homesick, you go visit your kids.

My travel company, Medical Express, provides the housing, rents the furniture, pays the electric bills, and I have retirement benefits and health insurance. My husband is retired and travels with me. I call him my "kept husband," and I'm his "sugar mama." He loves it. I like that I am not involved in the workplace politics. My theory is when I know enough to have an opinion, it is time to move on. Travel has enabled me to stay with dialysis but to have varied jobs. Typically, most travelers might do one assignment, or sporadically. Few people will actually go from one job to another, but it works for us, and I want to do this for another 10 years.

Q: What kind of situation would you not consider?

A: I would not consider a workplace which is unsafe, such as if the patient-to-nurse ratio is high, or if I have little to no resources.
I showed up at one clinic, and they pointed me to the supplies and said "good-bye." There was no orientation, but I learned quickly, and I made it. There are other places like Stanford where the orientation is long and involved. Through experience I have found it important to ask key questions on the first phone interview of the facility. If I'm having trouble, who can I call? I've learned what to ask in an interview

Source:
http://www.redwoodcitydailynews.com/article/2008-7-23-anderson

Nursing home investigations go back to 2001

By Beth Musgrave

bmusgrave@herald-leader.com

State investigators started investigating the relationship between a recently fired state employee and a nursing home operator as early as 2001.

A 46-page report released Tuesday by the Cabinet for Health and Family Serv­ices shows that the cabinet had investigated possible ethical problems between state employees and Garrard Convalescent Home owner Ralph Stacey Jr. at least three times over the past eight years.

In one of the investigations, there was an allegation that Stacey was being tipped off before inspectors visited the Covington area nursing home.

Sharon Harris, a nurse administrator with the Department of Public Health, and Moses Young, an assistant director with the Office of Inspector General, were fired by the cabinet in May after Inspector General Sadiqa Reynolds got a tip in March that the two were living in Lexington homes owned by Stacey.

Young and Harris did not provide the cabinet with documents showing they paid rent to Stacey. Cabinet officials allege the two had lived in the Griffin Gate area homes since 2005.

In the investigative report released Tuesday, investigators say Harris has been secretly taped saying that she had never paid rent to Stacey. On the tape, Harris said she thinks that Stacey might be the one giving information to state investigators.

”She believes he wants her out of her home because she ended her relationship with him. She states he has offered to move her to Florida and give her a job at one of his facilities there,“ the report said of the secret recording.

Harris and Young also have a relationship that goes back several years. Cabinet investigators note that Harris lists Young as his beneficiary on his life insurance form. Young has also said that he and Harris were roommates for several years.

Harris and Young have appealed their firings to the state Personnel Board. They allege that they have been singled out by the Inspector General and that the cabinet failed to follow policy by not allowing them to have attorneys present when questioned about their living arrangements.

Neither Young nor Harris could be located for comment. Paul Fauri, an attorney who represents Young and Harris, did not return calls asking for comment. Stacey has not returned phone messages left at his business in Covington.

Harris, according to personnel records, was fired in 2002 over questions about whether she was working for Stacey while she was a nurse in the Medicaid division. The state Personnel Board eventually overturned the firing by a 6-0 vote, and Harris was reinstated with back pay.

But according to new information released by the cabinet Tuesday, there were at least two other Office of Inspector General investigations involving Garrard Convalescent Center.

In October 2001, the office of Inspector General conducted an investigation that involved Harris, Young and Stacey. At the time, Harris was working for the Office of Inspector General.

During an interview at the end of an inspection at Garrard Convalescent Center, Harris said she would talk to Young about Stacey's concerns regarding two problems found during the inspection. The comment disturbed other investigators present because Young was not Harris' immediate supervisor.

When a tape of the conversation was requested, Harris refused to turn it over for more than a week, the documents said. When the tape was turned over, it was blank in the area where Harris allegedly made the comments, according to a synopsis of the 2001 inspector general investigation.

No action was taken as a result of the investigation, the report states. The allegation was part of a larger investigation into whether state investigators were falsifying travel reports.

Harris later left the Office of Inspector General and moved to the state Medicaid office as a nurse administrator. While in that job, state investigators raised concerns that she was at the Garrard facility in 2002 during an inspection.

Harris was fired for allegedly working for Stacey without permission. But the state Personnel Board voted unanimously to reinstate her after a hearing.

Harris was eventually moved to the Department for Public Health as a nurse administrator. The Office of Inspector General, Medicaid and Department for Public Health are all under the auspices of the Cabinet for Health and Family Services.

In a separate Office of Inspector General investigation in 2006, there were allegations that Stacey was getting prior notice of surprise inspections. That allegation was ultimately unsubstantiated, documents show.

But interviews conducted during the 2008 investigation of Young's living arrangements show that at least one employee of Stacey felt that their employer knew when state inspectors were coming. One nurse said that Stacey had pulled charts, and even brought up an activity director from a Florida nursing home he owned, before an inspection at Garrard.

There was no allegation that Harris or Young had tipped Stacey off in 2006. However, the investigative report includes charts of phone calls between Stacey and Young around the time annual inspections and surprise inspections occurred.

Vikki Franklin, a spokeswoman for the Cabinet for Health and Family Services, said there is no way for the cabinet to go back and reinvestigate past complaints against the facility.

”It's not possible for us to revisit the allegations,“ Franklin said. ”But what we are able to do is to make sure that we are protecting the health, safety and welfare of the residents there now and in every other nursing facility in the state.“

The attorney general and other regulatory agencies are also investigating allegations of misconduct by Young and Harris.

Source:

http://www.kentucky.com/210/story/468769.html