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OBJECTIVE: The purposes of this study were to determine whether positive work environments affect clinician wellbeing and mental health, and to identify participants' priority interventions to improve clinician wellbeing. This study was designed to determine the potential benefit of modifying the aforementioned factors for clinicians and hospitals to impact positive patient outcomes. BACKGROUND: The SARS-CoV-2 virus pandemic has become one of the leading causes of death in the United States and worldwide, and has exacerbated widespread burnout among health care professionals. This has resulted in negative collateral implications for the stability of the clinician workforce. A Clinician Wellbeing study (CWS) was launched in two Magnet®-designated hospitals in the southeast. The CWS was part of a multi-site collaborative research project led by the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing. METHOD: A cross-sectional observational study design was implemented. Data were collected through anonymous surveys of 708 registered nurses (RNs) and advanced practice providers (APPs) working in two Magnet hospitals in the southeastern United States. Each participant completed 8 surveys. RESULTS: Clinicians' self-reported level of burnout was higher for both RNs and APPs at Emory University Hospital than Emory Saint Joseph's Hospital including intent to leave and dissatisfaction with their jobs. RNs and APPs self-reported their overall health to be good or excellent and they reported sleep quality as fair. Both groups in both hospitals indicated that they experienced anxiety, depression, and stress. The APPs reported a higher percent that their work did not leave enough time for personal and family life. Data also indicated that the primary work environment concern was related to inadequate nurse staffing. CONCLUSIONS: The data illuminated opportunities for the two hospitals to employ continuous improvement interventions to positively transform the work environment.
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Esgotamento Profissional , COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Esgotamento Profissional/psicologia , Estudos Transversais , Feminino , Masculino , Adulto , Satisfação no Emprego , Inquéritos e Questionários , Pessoa de Meia-Idade , Pandemias , Saúde Mental , SARS-CoV-2RESUMO
Development of nursing in the postpandemic future will require active engagement of all nurses. Complex relational leadership in complex adaptive systems is explored through 3 focused areas: professional governance, equitable and inclusive relationships, and clinical practice. Pragmatic examples for each area of focus are offered as a framework for the postpandemic future. A conceptual model was developed to illustrate these relationships.
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Liderança , HumanosRESUMO
OBJECTIVES: Following institution of a hand hygiene (HH) program at an academic medical center, HH compliance increased from 58% to 92% for 3 years. Some inpatient units modeled early, sustained increases, and others exhibited protracted improvement rates. We examined the association between patterns of HH compliance improvement and unit characteristics. METHODS: Adult inpatient units (N = 35) were categorized into the following three tiers based on their pattern of HH compliance: early adopters, nonsustained and late adopters, and laggards. Unit-based culture measures were collected, including nursing practice environment scores (National Database of Nursing Quality Indicators [NDNQI]), patient rated quality and teamwork (Hospital Consumer Assessment of Healthcare Provider and Systems), patient complaint rates, case mix index, staff turnover rates, and patient volume. Associations between variables and the binary outcome of laggard (n = 18) versus nonlaggard (n = 17) were tested using a Mann-Whitney U test. Multivariate analysis was performed using an ordinal regression model. RESULTS: In direct comparison, laggard units had clinically relevant differences in NDNQI scores, Hospital Consumer Assessment of Healthcare Provider and Systems scores, case mix index, patient complaints, patient volume, and staff turnover. The results were not statistically significant. In the multivariate model, the predictor variables explained a significant proportion of the variability associated with laggard status, (R2 = 0.35, P = 0.0481) and identified NDNQI scores and patient complaints as statistically significant. CONCLUSIONS: Uptake of an HH program was associated with factors related to a unit's safety culture. In particular, NDNQI scores and patient complaint rates might be used to assist in identifying units that may require additional attention during implementation of an HH quality improvement program.
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Infecção Hospitalar , Higiene das Mãos , Adulto , Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes , Pessoal de Saúde , Humanos , Controle de Infecções , Pacientes InternadosRESUMO
BACKGROUND: Fear surrounds Ebola Virus Disease (EVD) because it is highly infectious. Yet members of the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital (EUH) had to overcome that fear when caring for patients with EVD. PURPOSE: The analysis reported here illustrates how the members of EUH's SCDU tacitly enacted high reliability (HR) principles while caring for patients with EVD. METHODS: A qualitative study was conducted to describe the experience of members of the EUH SCDU who worked with EVD patients in 2014. We completed 17 semi-structured interviews involving registered nurses, physicians, and support personnel (eg, laboratory technicians). Interview recordings were transcribed and analyzed using conventional content analysis. Exploring HR principles was not among the questions guiding this exploration, but the participants repeatedly described concepts related to HR. RESULTS: The goal of the SCDU team was to save patients' lives while protecting their own lives. Rigorous training and meeting high standards were required to make the team. The fear surrounding EVD set in motion the enactment of HR principles. HR principles served to alleviate failures or breakdowns in infection prevention and control, thus keeping patients and staff safe. CONCLUSIONS: These findings illustrate that it is possible to move HR principles from theory to practice in high-risk situations. HR principles were essential to safety and to infection prevention and control.
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Surtos de Doenças/prevenção & controle , Pessoal de Saúde/educação , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/transmissão , Controle de Infecções/métodos , Feminino , Humanos , Controle de Infecções/normas , MasculinoRESUMO
This department column highlights leadership perspectives of quality and patient safety practice. The purpose of this article is to provide strategic direction for transformational quality and safety leadership as the chief nursing officer (CNO) within the academic medical center environment.
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Centros Médicos Acadêmicos/organização & administração , Atitude do Pessoal de Saúde , Liderança , Enfermeiros Administradores/psicologia , Inovação Organizacional , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de EnfermagemRESUMO
David Stephens and colleagues describe their experience of treating patients with Ebola virus disease at Emory University in the United States.
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Doença pelo Vírus Ebola/terapia , Controle de Infecções/organização & administração , Tomada de Decisões , Surtos de Doenças/história , Georgia , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/história , História do Século XXI , Hospitais Universitários , Humanos , Isolamento de Pacientes/organização & administraçãoRESUMO
Caring for patients with Ebola virus disease requires strict biosafety protocols to eliminate exposure and ensure containment. Training and competency verification were critical to creation of a safe environment for nursing staff involved in the direct care of two patients with Ebola virus disease at Emory University Hospital.
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Educação Continuada em Enfermagem/métodos , Doença pelo Vírus Ebola/enfermagem , Profissionais Controladores de Infecções , Isolamento de Pacientes/métodos , Desenvolvimento de Pessoal/métodos , Hospitais Universitários , Humanos , Recursos Humanos de Enfermagem Hospitalar/educaçãoRESUMO
OBJECTIVE: Exposure of healthcare personnel to bloodborne pathogens (BBPs) can be prevented in part by using safety-engineered sharp devices (SESDs) and other safe practices, such as double gloving. In some instances, however, safer devices and practices cannot be utilized because of procedural factors or the lack of a manufactured safety device for the specific clinical use. In these situations, a standardized system to examine requests for waiver from expected practices is necessary. DESIGN: Before-after program analysis. SETTING: Large academic medical center. INTERVENTIONS: Vanderbilt University Medical Center developed a formalized system for an improved waiver process, including an online submission and tracking site, and standards surrounding implementation of core safe practices. The program's impact on sharp device injuries and utilization of double gloving and blunt sutures was examined. RESULTS: Following implementation of the enhanced program, there was an increase in the amount of undergloves and blunt sutures purchased for surgical procedures, suggesting larger utilization of these practices. The rate of sharp device injuries of all at-risk employees decreased from 2.32% to 2.12%, but this decline was not statistically significant (P = .14). The proportion of reported injuries that were deemed preventable significantly decreased from 72.7% (386/531) before implementation to 63.9% (334/523; P = .002) after implementation of the enhanced program. CONCLUSIONS: An enhanced BBP protection program was successful at providing guidance to increase safe practices and at improving the management of SESD waiver requests and was associated with a reduction in preventable sharp device injuries.
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Centros Médicos Acadêmicos/organização & administração , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Exposição Ocupacional/prevenção & controle , Saúde Ocupacional/normas , Traumatismos Ocupacionais/prevenção & controle , Política Organizacional , Patógenos Transmitidos pelo Sangue , Desenho de Equipamento , Luvas Protetoras , Guias como Assunto , Humanos , Desenvolvimento de Programas , Procedimentos Cirúrgicos Operatórios , SuturasRESUMO
The quest for decreased cost of care and improved outcomes has created the need for highly effective clinical roles and teams. This article describes the role of a unit-based advanced practice registered nurse (APRN) within a proof-of-concept implementation of a new care delivery model, the Vanderbilt Anticipatory Care Team. Role clarity is central to both structural empowerment of the APRN and team effectiveness. A modified PeaceHealth Team Development Measure tool measured baseline role clarity as a component of overall team effectiveness. A role description for the unit-based APRN based on a comprehensive assessment of the proof-of-concept unit is provided.
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Prática Avançada de Enfermagem , Profissionais de Enfermagem , Papel do Profissional de Enfermagem , Equipe de Assistência ao Paciente , Poder Psicológico , Humanos , Recursos HumanosRESUMO
OBJECTIVE: To evaluate the impact of an institutional hand hygiene accountability program on healthcare personnel hand hygiene adherence. DESIGN: Time-series design with correlation analysis. SETTING: Tertiary care academic medical center, including outpatient clinics and procedural areas. PARTICIPANTS: Medical center healthcare personnel. METHODS: A comprehensive hand hygiene initiative was implemented in 2 major phases starting in July 2009. Key facets of the initiative included extensive project planning, leadership buy-in and goal setting, financial incentives linked to performance, and use of a system-wide shared accountability model. Adherence was measured by designated hand hygiene observers. Adherence rates were compared between baseline and implementation phases, and monthly hand hygiene adherence rates were correlated with monthly rates of device-associated infection. RESULTS: A total of 109,988 observations were completed during the study period, with a sustained increase in hand hygiene adherence throughout each implementation phase (P < .001) as well as from one phase to the next (P < .001), such that adherence greater than 85% has been achieved since January 2011. Medical center departments were able to reclaim some rebate dollars allocated through a self-insurance trust, but during the study period, departments did not achieve full reimbursement. Hand hygiene adherence rates were inversely correlated with device-associated standardized infection ratios (R(@) = 0.70). CONCLUSIONS: Implementation of this multifaceted, observational hand hygiene program was associated with sustained improvement in hand hygiene adherence. The principles of this program could be applied to other medical centers pursuing improved hand hygiene adherence among healthcare personnel.
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Centros Médicos Acadêmicos/normas , Fidelidade a Diretrizes , Higiene das Mãos/normas , Pessoal de Saúde/organização & administração , Planos para Motivação de Pessoal , Pessoal de Saúde/economia , Humanos , Liderança , Observação , Cultura Organizacional , Objetivos Organizacionais , Guias de Prática Clínica como Assunto , Responsabilidade SocialRESUMO
BACKGROUND: Despite evidence that use of a checklist during the pre-incision time out improves patient morbidity and mortality, compliance with performing the required elements of the checklist has been low. In an effort to improve compliance, a standardized time out interactive Electronic Checklist System [iECS] was implemented in all hospital operating room (OR) suites at 1 institution. The purpose of this 12-month prospective observational study was to assess whether an iECS in the OR improves and sustains improved surgical team compliance with the pre-incision time out. METHODS: Direct observational analyses of preprocedural time outs were performed on 80 cases 1 month before, and 1 and 9 months after implementation of the iECS, for a total of 240 observed cases. Three observers, who achieved high interrater reliability (kappa = 0.83), recorded a compliance score (yes, 1; no, 0) on each element of the time out. An element was scored as compliant if it was clearly verbalized by the surgical team. RESULTS: Pre-intervention observations indicated that surgical staff verbally communicated the core elements of the time out procedure 49.7 ± 12.9% of the time. After implementation of the iECS, direct observation of 80 surgical cases at 1 and 9 months indicated that surgical staff verbally communicated the core elements of the time out procedure 81.6 ± 11.4% and 85.8 ± 6.8% of the time, respectively, resulting in a statistically significant (P < .0001) increase in time out procedural compliance. CONCLUSION: Implementation of a standardized, iECS can dramatically increase compliance with preprocedural time outs in the OR, an important and necessary step in improving patient outcomes and reducing preventable complications and deaths.
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Lista de Checagem/instrumentação , Cirurgia Geral/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Salas Cirúrgicas/normas , Segurança do Paciente , Humanos , Variações Dependentes do Observador , Guias de Prática Clínica como Assunto , Estudos ProspectivosRESUMO
BACKGROUND: Acknowledging the need to improve team communication and coordination among health care providers, health care administrators and improvement officers have been quick to endorse and invest in aviation crew resource management (CRM). Despite the increased interest in CRM there exists limited data on the effectiveness of CRM to change team behavior and performance in clinical settings. METHODS: Direct observational analyses were performed on 30 surgical teams (15 neurosurgery cases and 15 cardiac cases) to evaluate surgical team compliance with integrated safety and CRM practices after extensive CRM training. RESULTS: Observed surgical teams were compliant with only 60% of the CRM and perioperative safety practices emphasized in the training program. CONCLUSIONS: The results highlight many of the challenges the health care industry faces in its efforts to adapt CRM from aviation to medicine. Additional research is needed to develop and test new team training methods and performance feedback mechanisms for clinical teams.