Repetitive needlesticks impact patients in the short and long term, says this CNO.
On this episode of HL Shorts, we hear from Michele Acito, executive vice president and chief nursing officer at Holy Name Medical Center, about how repetitive needlesticks and other uncomfortable procedures impact care delivery and the patient experience. Tune in to hear her insights.
Nurse leaders must determine what staffing model works best for both patients and nurses, says this CNO.
The nursing shortage continues to be one of the biggest concerns for CNOs across the country, and many are brainstorming creative staffing models to recruit and retain more nurses.
When implementing new staffing models, there are several factors to consider. CNOs must prioritize what works best for patients while also meeting the needs of their nurses.
According to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children's Healthcare, there are several innovative staffing models that CNOs could implement at their health systems.
Innovative staffing models
Staffing models have recently been expanding to include more specialized roles and nurses of different designations, Tilton explained. Leveraging advanced practice nurses can help enhance care delivery while filling gaps in the workforce.
"Contingency labor and role specialization to ensure operational efficiency and adaptability in meeting patient care demands are being leveraged as well," Tilton said.
There are four examples of new staffing models that Tilton emphasized, the first being team-based care, which promotes collaboration between nurses, nurse practitioners, physicians, physician assistants, pharmacists, social workers, and other healthcare professionals. This model empowers nurses to be more autonomous, Tilton explained, and to participate in decision-making by contributing their expertise.
"Team-based care enhances coordination, communication, and efficiency in healthcare delivery," Tilton said, "leading to improved patient outcomes and satisfaction."
The second model is flexible staffing, which, can help health systems adapt to fluctuations in patient volume and acuity as well as staffing shortages, according to Tilton.
"These strategies may include the use of float pools, cross-training programs, per diem staffing, and contingency staff," Tilton said. "Implementation of innovative scheduling practices such as self-scheduling, shift bidding, and predictive analytics-based staffing algorithms are being considered to optimize staffing levels and match resources with patient needs."
Care continuity models are also necessary to promote patient safety, reduce medical errors, and enhance the patient experience, Tilton emphasized.
"Care continuity models aim to maintain consistent nurse-patient relationships across care transitions and settings," Tilton said. "These models may involve assigning care coordinators or a primary nurse to patients throughout their healthcare journey."
The last innovative staffing model is telehealth nursing. Virtual care has revolutionized nursing and other aspects of healthcare in general, by providing new opportunities for nurses to work remotely and flexibly, while still providing patients with quality care. According to Tilton, nurses in telehealth roles can provide direct patient care, health education, counseling, and support through virtual consultations, remote patient monitoring, and tele-triage.
"Telehealth nursing enables greater access to care, especially for underserved populations," Tilton said. "It improves care coordination and enhances patient convenience and satisfaction."
Choosing for patients
The second piece of the puzzle is choosing which staffing model works best for patients. According to Tilton, there are several factors regarding patient needs, nursing practice, organizational resources, and external details that CNOs must consider when making the right decision.
First, CNOs need to assess the demographics, acuity levels, and care needs of their patient population, Tilton recommended, while working with their teams to make sure their workforce is experienced and competent to address those needs.
"This assessment helps CNOs determine the appropriate nurse-to-patient ratios, skill mix, and expertise needed to deliver safe and effective care," Tilton said.
Next, CNOs must remain in compliance with regulatory requirements, accreditation standards, professional staffing, and patient care guidelines, according to Tilton.
"They need to stay informed about state regulations, nurse licensure laws, staffing ratios mandated by regulatory agencies," Tilton said, "and recommendations from professional organizations such as the American Nurses Association and the National Council of State Boards of Nursing."
Then, CNOs should assess their health system's financial resources, budget constraints, and reimbursement mechanisms to decide a staffing model's feasibility.
"Analyze staffing costs, productive metrics, revenue generation opportunities, and return on investment associated with each model," Tilton said.
Finally, Tilton recommended that CNOs engage with key stakeholders during the decision-making process, including the nursing staff, interdisciplinary team members, healthcare executives, patients, families, and community partners.
"Through soliciting feedback, gathering input, and fostering collaboration, [CNOs] can ensure buy-in and support for the chosen staffing model," Tilton said.
Throughout this entire process, communication is key. Tilton emphasized the need for CNOs to promote transparency, communication, and shared decision-making to make successful changes to the organization.
"By considering these factors holistically and collaboratively," Tilton said, "CNOs can determine the staffing model that best meets the needs of their patients, optimizes nursing practice, and supports organizational goals and priorities."
Decreasing repetitive needlesticks will save time and improve patient experience, says this CNO.
HealthLeaders spoke to Michele Acito, executive vice president and chief nursing officer at Holy Name Medical Center, about the dangers of repetitive needlesticks and how new technology might eliminate them.
Repetitive needlesticks are impacting patient care, according to this survey.
Repetitive needlesticks can be a challenge in hospitals, from both a nurse and patient perspective.
A recent survey conducted by the Harris Poll revealed that out of the participants with a recent hospital stay, 59% of patients needed multiple needlestick attempts for IV insertion, and 71% for blood draws, with 11% needing 10 or more sticks to obtain a single blood sample.
These numbers are representative of a major issue. According to the survey, more than half of Americans report some fear of needles, and a top reason is fear of multiple insertions. The survey also reported that 77% of patients are not aware that they should expect no more than two needlestick attempts from one clinician, no matter what condition they have.
Here's what you need to know about the reality of repetitive needlesticks.
If you remove nurses, it's "no man's land," says this nurse leader.
On this episode of HL Shorts, we hear from Katie Boston-Leary, director of nursing programs at the American Nurses Association, and HealthLeaders Exchange member, about different ways that health systems could reflect the value of nursing in their budgets. Tune in to hear her insights.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
Repetitive needlesticks might no longer be necessary with new technology, say these nurse leaders.
Several new care delivery models are taking over the nursing industry and streamlining daily nursing practices, now including needlestick procedures.
Repetitive needlesticks can be a challenge in hospitals, from both a nurse and patient perspective. A recent survey conducted by the Harris Poll revealed that out of the participants with a recent hospital stay, 59% of patients needed multiple needlestick attempts for IV insertion, and 71% for blood draws, with 11% needing 10 or more sticks to obtain a single blood sample.
Impact on patients
These numbers are representative of a major issue. According to the survey, more than half of Americans report some fear of needles, and a top reason is fear of multiple insertions. The survey also reported that 77% of patients are not aware that they should expect no more than two needlestick attempts from one clinician, no matter what condition they have.
However, IV and blood draw procedures are a necessary part of the hospital stay, and according to Anna Kiger, system chief nurse officer at Sutter Health, they make the patient experience less positive.
"It is one of the most frequent tasks that a nurse or phlebotomist does," Kiger said, "so if you come for healthcare, it's a high probability we're going to stick you at least once, if not more."
There are several factors that can also make needlestick procedures more difficult, Kiger explained.
"Whether it's in the emergency department or later on in the acute care setting, we do need to obtain blood samples from them for a variety of reasons," Kiger said, "and unfortunately, due to the acuity of their diagnosis and their age, obtaining a clean single needlestick to get the blood can be very difficult."
According to Michele Acito, executive vice president and chief nursing officer at Holy Name Medical Center, repetitive needlesticks impact patients in both the short and long term. Not only do needlesticks increase anxiety and pain among patients, but incorrect vascular access practices in general can impact health literacy and lead to potential rehospitalizations or disease progression.
"When patients are more anxious, they're less likely to understand the procedures that are being explained to them," Acito said. "Short term, they're not hearing about their care, about their needs, about their diagnosis, and long term, they're not hearing about the things they need to do upon discharge."
Needlestick alternatives
Luckily, alternatives to repetitive needlesticks are on the horizon.
According to Kiger, there is now a device that can provide needleless blood draws.
"This particular technology, which allows a nurse to obtain a direct blood draw through an IV catheter, does eliminate the need for a needlestick," Kiger said, "and that particular device can be used in the ED or in the inpatient setting."
This new technology is called the PIVO™ device, currently owned by BD, which essentially enables a small tube to enter the blood vessel through the IV to avoid an additional needlestick when blood draws are necessary.
"It's an IV with a tail essentially coming out of it," Acito said. "The patient should expect one stick when they come into the hospital and they have the IV inserted, unless they need a special test like blood cultures, then this PIVO™ device would be used."
In patients Kiger has observed, the experience with the device is painless and the blood samples taken with it are of the same quality as those obtained through a needle aspiration.
"If you can remove the needle and obtain a quality blood sample and get to the test result that is required for a physician to make a decision, then I'm all in favor of doing that," Kiger said, "because it's one less penetration of the skin, which is our protection from infections, and the patient gets an entirely different experience, a painless experience for most, obtaining blood."
Acito said they oftentimes employ licensed practical nurses (LPNs) to do the blood draws with the device, which can greatly benefit them as well as the patient.
"This allows [the LPNs] to work at the top of their license, while reinforcing education that has already been provided to the patient, interacting with the patient, providing other needs while they're in the room," Acito said.
In addition to the PIVO™ device, Acito emphasized the importance of good IV care to help decrease repetitive needlesticks.
"Once you put in the IV, if you maintain it well and you choose the site properly, you can use devices that help you find the vein so that there's a decrease in the number of sticks," Acito said. "How many blood draws you get is really determined by your diagnosis and the number of tests that need to be run to find [it] or to see if the treatment is working."
There have already been positive outcomes from using this device as well, according to Acito.
"The positive outcome is that you don't waste more resources trying to find a vein, [and] trying to stick the patient," Acito said. "When you walk in, no longer do you have to check this arm and check that arm and find that vein. You already have access."
The bottom line is that it's better for the patient, Acito explained, because it decreases exposure to excessive bleeding, bruising, or infection.
"They know when they come in and they get that PIVO™ device because of education from the nurse that this is going to be the site where [they] get [their] medications [and] IV fluids, and it's also where we're going to draw [their] blood from," Acito said.
Training and education
Both nurses and patients need to be educated about needlesticks and vascular access procedures and their alternatives.
CNOs must ensure that nurses receive the proper training on how to make patients feel more comfortable during a needlestick experience.
"I think it's really important for the nurse to always recall for themselves what it would be like or even a personal experience with having had an IV," Acito said. "Completely engage the patient, distract them, [and] make sure that the patient is fully educated on what to expect."
Kiger said the most important thing leaders can do is educate other nursing and hospital leaders about the new technology alternatives that do allow for successful needleless blood draws, like the PIVO™ device.
"First of all, basic education, getting more literature out, getting more published research out, getting the experiences of those who actually use a device like this in clinical practice, and then also getting the patient's perspective out there," Kiger said. "Then I think it becomes a matter of showing that over time, this is actually an easier way to draw blood."
Organizations have a responsibility to understand how nurses contribute, says this nurse leader.
HealthLeaders spoke to Katie Boston-Leary, director of nursing programs at the American Nurses Association, and HealthLeaders Exchange member, about her thoughts on the prospect of nurse reimbursement and how organizations can demonstrate the value of nursing.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
There are many different ways to demonstrate the value of nursing, according to these nurse leaders.
What is the value of nursing?
It’s an age-old question that circulates throughout C-suite meeting rooms in health systems across the country. And as of now, nursing often does not have a separate line item on many budgets, despite making up a large portion of the healthcare workforce.
Here are some ways that health systems could show the value of nursing on paper, according to To Katie Boston-Leary, director of nursing programs at the American Nurses Association (ANA), and Rudy Jackson, senior vice president and chief nurse executive at UW Health. Both Boston-Leary and Jackson are also HealthLeaders Exchange members.
Nurses should be burning bright, not burning out, says this nurse leader.
On this episode of HL Shorts, we hear from Dr. Shakira Henderson, Dean, Chief Administrative Officer, and Associate Vice President for Nursing Education, Practice and Research at the University of Florida College of Nursing, and System Chief Nurse Executive of UF Health, about how nurse leaders should implement recruiting and retention strategies that address burnout as well as the nursing shortage. Tune in to hear her insights.
Nursing is often undervalued on paper. Some believe that reimbursement is the answer.
What is the value of nursing?
It’s an age-old question that circulates throughout C-suite meeting rooms in health systems across the country. And as of now, nursing often does not have a separate line item on many budgets, despite making up a large portion of the healthcare workforce.
To Katie Boston-Leary, director of nursing programs at the American Nurses Association (ANA), and a HealthLeaders Exchange member, that is a big part of why nursing is seemingly undervalued.
"I think a lot of it has to do with the fact that we're invisible in terms of how we contribute to the bottom line, particularly the financial well-being of institutions," Boston-Leary said. "We don't have a separate line item on the claim side and also on the reimbursement side."
In recent years, the idea of direct reimbursement for nurses has been making some headway.
The concept
According to the ANA, nursing costs are grouped in with patient room costs, and when the time comes for budget cuts, nursing is often the first to go. Direct-Reimbursement Nursing Model pilots "expand nursing practice and elevate the value of nursing through direct reimbursement for nursing care delivery, management, and coordination outcomes," says the ANA.
Anne Dabrow Woods, nurse practitioner and chief nurse of health learning, research and practice at Wolters Kluwer, says this model would impact both nurses and nurse practitioners, who provide primary care services but are not reimbursed in the same way that physicians are.
"They don't tend to see [nurse practitioners'] value as great as what a physician is, and all the research clearly shows that a lot of our care is equal to that of a physician," Woods said. "We're not saying we want to replace physicians, but we are saying we want to work collaboratively with them."
In terms of nursing, Woods argued that the lack of reimbursement communicates the lack of value for the work nurses do.
"Now as a nurse, it becomes really problematic if you're not getting reimbursed for the care you deliver … and you're lumped into that room and board charge," Woods said, "because it's very difficult to articulate the value that nurses bring to patient care in acute care settings or other settings if you can't reimburse."
Boston-Leary explained how in her experience as a chief nursing officer, she found that nursing was seen as an expense, which means it’s a liability and a cost that needs to be reduced.
"The way the system is set up, if organizations can reduce labor, particularly with nursing … and achieve excellent patient outcomes, that's the win," Boston-Leary said, "which doesn't help, because … nurses, in some cases, are going along with working [in] unhealthy work environments [with] unimaginable workloads."
"The harm is happening in the middle, which subsequently leads to issues with retention and ultimately recruitment," Boston-Leary said, "because word of mouth is a powerful thing."
Whether reimbursement is in the cards, Boston-Leary said, health systems are not properly valuing nursing.
"I think it's every institution's duty," Boston-Leary said, "it's more about the fact that there's a responsibility for every organization to understand how nurses contribute to the bottom line, because they do."
Reimbursement in practice
Many different reimbursement models could potentially be put in place if health systems decide to follow this strategy.
Woods said the first step is to look at nurses' impact on care and nurse-specific quality indicators. Some of the factors could include fall prevention, infections, and readmission rates.
The reimbursement process could be based on the model that physical therapists and occupational therapists use, according to Woods.
"They look at the overall patient acuity and they look at the time that is spent with the patient," Woods said.
Woods also suggested using the nurse equivalent to national provider numbers that others use to bill for their services.
"[Nurses] have a thing called a nurse's number, and you get that number when you pass your boards," Woods said. "If we could start associating the work of the nurse with their nurse's number, then you can start to really make a case for allowing nurses to bill for their services."
For payers, Woods said, change would likely begin at the federal level with the Centers for Medicare and Medicaid Services (CMS). This would provide a model for other payers.
"If we can get CMS to change, and there's been a lot of hesitancy for them to change up to this point," Woods said, "we would have a chance of changing other third-party payers."
Boston-Leary said there might be a pathway toward reimbursement in models that already exist for advanced practice nurses. However, Boston-Leary said, the system would have to undergo a total overhaul to make reimbursement a reality.
"Largely for all nurses, every single nurse getting directly reimbursed, I don’t know that the system itself and the people within the system have a tolerance for all that and the capacity for all that," Boston-Leary said, "because being set up for that in itself takes a lot."
To Rudy Jackson, senior vice president and chief nurse executive at UW Health, and a HealthLeaders Exchange member, the issue lies with making the concept a reality, especially in a time where the goal of many healthcare executives is to cut costs.
"Conceptually, the ability to recognize the care provided by nurses as a mechanism in reimbursement is incredibly interesting," Jackson said. "The challenge is [that] operationalizing a model such as this would require a complete restructuring of our entire healthcare reimbursement model."
Jackson also pointed out that there are already areas where nurses do get reimbursed.
"There are, in fact, certain skills completed by registered nurses that are reimbursable, such as Vascular Access Teams, however, not many," Jackson said. "There is an opportunity to look more aggressively at other skills provided by nurses."
Reimbursement would involve one process for submitting invoices or claims and getting reimbursed and another for denials and resubmissions.
“There's not much tolerance and ability and capacity for the system and the people within the system to make this happen," Boston-Leary said. "Not to mention, it's going to take a major reversal of the current processes and change for this to happen."
What about the cost?
As with any new program in healthcare, the first question on everyone's mind is how to pay for it.
According to Woods, the direct reimbursement process would not be taking money out of health systems.
"What we're saying is allow the nurses to get reimbursed for their work that they do,” Woods said. “And if they are employed by the healthcare organization, essentially that reimbursement goes back to that healthcare organization."
Reimbursement could act as a reinvestment in the health system, Woods explained, which would improve patient care along with recruitment and retention. If hospitals put a cost to the value of nursing, they would be in a better position to focus on developing nurses.
"If a nurse gets into a work situation and the situation is unsafe … the nurse is going to leave because its an uncertain work situation," Woods said. "If we can invest in our nurses and really articulate the value they bring, you're going to see better nurse retention."
To Boston-Leary, nurses do not always feel as respected as other members of the care team, and health systems need to understand how direct care nurses contribute to the bottom line.
"Understanding that piece, particularly when we do have to be more financially savvy as nurses and understand what things cost and how systems get reimbursed," Boston-Leary said, " adds to that piece of matter for nurses where they feel as if they are adding to the bottom line."
The alternatives
There are alternatives to reimbursement that could also demonstrate the value of nursing on paper.
To Jackson, the answer is that hospitals need to invest in nursing.
"Offer appropriate staffing ratios based on nursing's assessment of the care needed," Jackson said. "Leverage technology to support administrative tasks nurses are faced with."
Nursing is the single largest workforce in any hospital, according to Jackson, and so nurses must be included in leadership and decision-making processes.
"Nursing leadership should always be part of the senior leadership team with reporting responsibilities to the highest level of the organization,” Jackson said. "This ensures accountability and support."
Boston-Leary recommended looking at nurse-sensitive indicators, since nurses do have duties that directly impact outcomes. Health systems could look at the ROI when hiring new nurses in a similar way that they look at ROI when hiring new physicians.
"This is also a place where we can't afford to couch it in the space of soft dollars," Boston-Leary said, "because people hardly pay attention to soft dollars. It's more about hard numbers.”
CNOs should advocate for bringing in a finance partner who can crunch numbers and show how nurses are contributing to the bottom line, Boston-Leary said. Some health systems have even hired a nurse in the finance department to give input.
"I know this is going to be a struggle for most small critical access hospitals," Boston-Leary said, "but for the ones that can, they can lead the way to help set up the methodology for the smaller institutions and community hospitals that can't afford it."
Boston-Leary also recommended revisiting the metrics that health systems use to determine value.
One example is the average daily census, which only captures a certain number at a certain point in the day and doesn’t provide the full story. Another is productivity, which, according to Boston-Leary, is not the measure that people think it is.
"We should not be celebrating when nursing has 98% to 120% productivity," Boston-Leary said, "especially if you have a department that's not fully staffed. It may mean that you're overextending your people and it's impacting their wellness and overall health."
Health systems should also pay attention to the positions that tend to get cut when times get tough, since many of them are still necessary for a strong and resilient workforce, Boston-Leary said.
"I think these are all the things that require some research that CNOs can lead with the proper resources," Boston-Leary said, "and get the message out there, so that everyone sees it and understands how that could be applicable to where they are as well."
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
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