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2019 MHA-ONL Nursing Survey Executive Summary

Massachusetts Health & Hospital Association

and

Organization of Nurse Leaders MA, RI, NH, CT, VT (ONL)

The MHA/ONL 2019 Survey on Hospital Nurse Staffing Issues in Massachusetts was conducted to assess the current hospital-based nursing marketplace in the Commonwealth. The questions were designed to elicit information on nursing staff vacancies, nurse recruiting experiences, workload Management, nursing staff turnover, and union representation of hospital nursing staff.

The survey was sent to acute, speciality, and non-acute hospitals.

45 acute care hospitals representing 71% of total acute care hospitals responded to the survey.
5 non-acute care hospitals representing 36% of total non-acute care hospital responded to the survey.

Click here to view the Executive Summary

Resources for Clinicians and Support Staff

Seasonal Influenza A (H3N2) Activity & Antiviral Treatment of Patients with Influenza

In the United States (U.S.), influenza activity has increased significantly over recent weeks with influenza A(H3N2) viruses predominating so far this season. In the past, A(H3N2) virus-predominant influenza seasons have been associated with more hospitalizations and deaths in persons aged 65 years and older and young children compared to other age groups. In addition, influenza vaccine effectiven…» Full Article

Through the Eyes of the Workforce: Creating Joy, Meaning, & Safer Health Care

Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams. A new report from the Lucian Leape Institute looks at the current state of health care as a workplace, highlights vulnerabilities common in health care organizations, discusses the costs of inaction, and outlines what a healthy and safe workplace would look like. The report concludes with seven recommendations for actions that organizations need to pursue to effect real change.Read full report…

Scholarships & Educational Resources

Prime Scholarships Now Available

The Prime Scholarship is for students intending to pursue a career as a nurse upon graduation. The scholarship is open to applicants working toward a two year or four year college degree. Follow this link to see the site page and downloadable application.

 

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New Nursing Request for Proposals (RFP) has Been Released

Check out on Department of Higher Education  website  on Monday, February 2nd for summary information.   The Nursing RFP focuses on a wide variety of topics relating to academic progression.

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The MA Nursing Core Competencies:  A Toolkit for Implementation in Education and Practice

The purpose of this toolkit is to promote the integration of Nurse of the Future Nursing Core Compenentencies© (NOFNCC) in academic institutions and practice settings in the Commonwealth of Massachusetts. This toolkit has been organized in a format that is useful to both.  Read more...

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The Creativity and Connections Report

The Creativity and Connections report of the Nurse of the Future Nursing Core Competencies published in 2010 which summarized the work of the NOF Competency Committee. In the report, the committee describes the process it used to identify NOF Nursing Core Competencies, presents the NOF Core Competency Model©, and defines the ten NOF Nursing Core Competencies and the knowledge, attitudes and skills associated with each.

A mission statement was written to guide the future work: Establish a formal coalition to create a seamless progression through all levels of nursing that is based on consensus competencies which include transitioning nurses into their practice settings.   Read more...

Workforce Grants Available - The Healthcare Workforce Transformation Fund

The Healthcare Workforce Transformation Fund Planning Grant is designed to provide applicants with funds to support planning to address workforce challenges that occur as a result of the requirements of implementing Chapter 224.

Among the many workforce-focused elements of Chapter 224, the law created the Healthcare Workforce Transformation Fund to, among other things:

  1. support the development and implementation of programs to enhance healthcare worker retention rates;
  2. address critical healthcare workforce shortages;
  3. improve employment in the healthcare industry for low-income individuals and low-wage workers;
  4. provide training, educational, or career ladder services for currently employed or unemployed healthcare workers who are seeking new positions or responsibilities within the healthcare industry;
  5. provide training or educational services for healthcare workers in emerging fields of care delivery models.

The fund, through the administration of the Commonwealth Corporation is now accepting proposals from eligible applicants, including hospitals.    Read more.....

2015 Application Cycle is Closed! Nursing Education Loan Repayment Program (NELRP) & Nursing Scholarship Program (NSP)

The NELRP & the NSP now fall under NURSE Corps: Caring for Communities in Need. While this name may be new, these are still the same great programs which have supported a community of nurses and nurse practitioners since 2002 who provide quality health care to underserved areas throughout the U.S. and its Territories.

Through the NURSE Corps Scholarship Program (formerly the Nursing Scholarship Program) and the NURSE Corps Loan Repayment Program (formerly the Nursing Education Loan Repayment Program), NURSE Corps is empowering and enabling nurses to follow their passion for helping and healing others.

The NURSE Corps Loan Repayment Program (LRP) offers Registered Nurses (RNs) and advanced practice registered nurses, such as Nurse Practitioners (NPs), an opportunity to repay 60 percent of their outstanding qualifying educational loans in exchange for a two-year service commitment at a Critical Shortage Facility (CSF). NURSE Corps LRP participants may receive additional loan repayment for a third year of service.

The NURSE Corps LRP is adapting to the increasing demand for NPs by reserving up to half of the award funding for NPs; the remaining funding will continue to support RNs and nurse faculty. If there are more qualified applicants than available funding, applications will be prioritized based upon the level of financial need of the applicant and the community that the CSF serves.  Read more...

HHS Announces New Faculty Loan Repayment Program

The U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) announced this week the establishment of the new Faculty Loan Repayment Program (FLRP). The program provides nurses interested in teaching with loan repayments to serve as a faculty member in an accredited and eligible health professions school. FLRP participants contribute to the HRSA's Bureau of Clinician Recruitment and Service's goal of increasing the recruitment and retention of health professions faculty. Eligible participants can receive as much as $40,000 towards repayment of their student loans in exchange for participating in future educational programming.

 

Influenza Immunization

MHA strongly supports the goals of having a healthy workforce, which includes providing the necessary immunizations to ensure that our staff and our patients are protected.

We strongly support mandatory flu vaccination for all healthcare providers.  Healthcare providers are the front-line stewards of public health and we believe that our commitment to safe patient care should carry the day in convincing staff to obtain the flu shot.

In addition, we commend the MA Department of Public Health for continuing to advance this important goal - to reach a goal of immunizing at least 90% of a healthcare facility's workforce against influenza.  It is important that healthcare providers continue to learn from others, to find common solutions and best practices that can work in other healthcare facilities.

We encourage providers to review the following resources to promote vaccination of their healthcare workers:

DPH Flu Vaccine for Everyone!  A Guide to Reaching and Engaging Diverse Communities

CDC Strategies for Increasing Adult Vaccination Rates

Seasonal Influenza A (H3N2) Activity & Antiviral Treatment of Patients with Influenza

In the United States (U.S.), influenza activity has increased significantly over recent weeks with influenza A(H3N2) viruses predominating so far this season. In the past, A(H3N2) virus-predominant influenza seasons have been associated with more hospitalizations and deaths in persons aged 65 years and older and young children compared to other age groups. In addition, influenza vaccine effectiveness (VE) in general has been lower against A(H3N2) viruses than against influenza A(H1N1)pdm09 or influenza B viruses. Last season, VE against circulating influenza A(H3N2) viruses was estimated to be 32% in the U.S.

..>>Full Article

 

Venous Thromboembolism (VTE)

VTE Summary:

Venous thromboembolism (VTE) is a blood clot that starts in a vein. It is the third leading vascular diagnosis after heart attack and stroke, affecting about 300,000-600,000 Americans each year. There are two types: Deep vein thrombosis (DVT) is a clot in a deep vein, usually in the leg, but sometimes in the arm or other veins. Pulmonary embolism (PE) occurs when a DVT clot breaks free from a vein wall, travels to the lungs and blocks some or all of the blood supply. Blood clots in the thigh are more likely to break off and travel to the lungs than blood clots in the lower leg or other parts of the body.

What is the cause?

DVTs form in the legs when something slows or changes the flow of blood. The most common triggers for DVT and PE are surgery, cancer, immobilization and hospitalization. In women, pregnancy and use of hormones like oral contraceptive or estrogen for menopause symptoms are also important. Clotting is more likely to happen in people who are older, are obese or overweight or have conditions – such as cancer or autoimmune disorders such as lupus. It’s also more likely in people whose blood is thicker than normal because too many blood cells are made by bone marrow. Genetic causes of excessive blood clotting are also important. These occur when there are changes in the genetic code of some proteins needed for clotting or proteins that work to naturally dissolve blood clots in the body. VTE is most common in adults 60 and older, but they can occur at any age.

Symptoms:

If the clot moves into your lungs and you develop PE, you may have symptoms such as:

  • chest pain, which may get worse when you breathe deeply or cough
  • coughing
  • coughing up blood
  • dizziness or even fainting
  • rapid breathing (called tachypnea)
  • rapid heartbeat
  • irregular heartbeat
  • shortness of breath

Treatment

The primary objectives for the treatment of deep venous thrombosis (DVT) are to prevent pulmonary embolism (PE), reduce morbidity, and prevent or minimize the risk of developing the postthrombotic syndrome (PTS). The mainstay of medical therapy has been anticoagulation since the introduction of heparin in the 1930s.

VTE 2017 Top Ten, Evidenced Based Interventions 

HRET’s 2017 VTE Change Package

Eliminate Harm Across the Board HRET’s Days Since Last VTE

Airway Safety & Failure to Rescue (FTR)

Airway Safety

Approximately 25,000 potentially life-threatening errors occur daily in hospital intensive care units (ICUs), and up to 10 percent of these adverse events involve unintended incidents in airway management; more than half of these errors have been deemed preventable (Needham, et al., 2004). Airway safety events refers to complications related to high-risk patients for airway compromise, airway placement and airway maintenance. Airway management processes must be in place for critically ill patients in the ICU who are at risk for difficult intubations (Leeuwenburg, 2015).

Failure to Rescue (FTR)

Failure to rescue (FTR) is the failure to recognize and appropriately respond to early signs of patient deterioration. It is considered an indicator of the quality of care within a health care organization, irrespective of patient severity and other health factors (McKee, Coles & James, 1999). More specifically, FTR is the:

  • failure to recognize clinical deterioration;
  • failure to communicate and escalate concerns;
  • failure to physically assess the patient; and
  • failure to diagnose and treat appropriately (Moldenhauer et al., 2009).

Attentive bedside care is integral to being able to detect changes which could be a sign of an impending critical event; nurses, physicians and all caregivers are responsible for vigilance in patient assessment. Patients can display signs and symptoms of impending arrest for up to 72 hours before an event (Subbe & Welch, 2013). Reported FTR incidence is 8.0 to 16.9 percent and communication failures are a root cause of escation delays (Johnston et al., 2015).A common intervention is the implementation and use of a rapid response team (RRT) within the organization. RRTs are usually a multidisciplinary team of intensive care-trained staff, who are available at all times to respond to a deteriorating patient (Moldenhauer et al., 2009). The use of RRTs has been shown to reduce mortality in hospitals (Beitler et al., 2011). While RRTs are an important resource for clinicians and hospital staff, patients and families should also be educated on the hospital’s rapid response system and empowered to activate it should the need arise.

Airway Safety  2017 Top Ten, Evidence Based Interventions

HRET’s 2018  Airway Safety Change Package

The Five Guiding Principles

 1. Advancing Healthcare Quality and Patient Safety

  • PatientCareLink (PCL) assists participating healthcare organizations to monitor and report progress on their efforts to continuously improve quality of care and patient safety.
  • PCL provides proven patient safety strategies and best practices to guide healthcare organizations to improve their processes and outcomes of care.
  • Our care providers share a broad range of patient care Success Stories that recognize best practices and demonstrate visible improvements in patient outcomes.
  • PCL affords healthcare organizations the ability to monitor improvement trends over time on specific endeavors.

2. Providing Hospital Staffing that Meets Patient Needs

  • Massachusetts and HARI member hospitals voluntarily make staffing plans available to patients and the public by posting them on the PatientCareLink (PCL) website. These annual plans describe staffing in each hospital clinical unit (adult critical care, adult step-down, adult medical, adult surgical, adult medical/surgical combined, behavioral health, rehabilitation and emergency department) by shift.
  • The plans also describe the factors that nurse leaders must consider in determining how to care for each patient, and offer information on care provided on an "hours per patient day" basis. Nurse leaders who are responsible for putting their facility’s staffing plan together gather information and advice from nurses and other members of the patient care team.
  • Hospitals also submit annual aggregate staffing data, producing a planned versus actual staffing report. These reports also provide the hospitals an opportunity to include explanations for variations between staffing plans versus actual staffing that may occur for a variety of reasons.

3. Making Healthcare Data and Performance Measures Transparent and Publicly Available

  • PCL-participating hospitals and home care agencies are committed to a common framework to assess and report healthcare quality. Hospitals have been publicly reporting the same nursing-sensitive, evidence-based measures selected from the National Quality Forum (NQF) since 2007.
  • Performance measures from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare and Home Health Compare websites are also available on PCL.  This provides consumers with additional hospital and home care performance data to assist in making informed healthcare decisions.
  • The PCL  initiative  supports and encourages partnerships among healthcare organizations and leaders of business, government, consumer groups, and others to promote access to high-quality, safe care. Such efforts include expanding health insurance coverage, sustaining the capacity of the healthcare system to deliver care, and identifying ways to assist providers of care to obtain and deploy new technologies to advance patient safety.

4. Empowering Patients and Families in their Healthcare Choices

  • PCL places important healthcare information in the hands of consumers.  It is a transparent resource for staffing, quality and safety data from hospitals, home care agencies, government agencies and other independent sources.
  • PCL serves as a resource for information on a myriad of healthcare topics, all designed to encourage and assist individuals to participate in their care and make healthcare decisions that are right for them. Tools that can be found on the PCL website include advance care planning and healthcare proxies, information on preventing infections and/or hospital readmissions, and patient fact sheets on opioid risks.
  • These tools and resources are updated regularly and can be aids to promote health throughout one’s lifespan.

5. Promoting Development/Advancement of the Healthcare Workforce in a Safe, Respectful &
   Supportive Work Environment

  • PCL-affiliated organizations create hospital, home health and community-based initiatives and strategic partnerships to tackle the workforce shortages of nurses and other care professionals. Efforts include innovative "career ladders," residency programs, mentoring and preceptor opportunities, joint funding of nurse faculty positions in educational institutions, and employer initiatives to increase workforce diversity.  Highlights of the MHA and ONL annual survey results for hospital nurse staffing in Massachusetts are also available through PatientCareLink.
  • PCL supports the work of the Massachusetts Action Coalition (MAAC), created following the Institute of Medicine’s Future of Nursing report and subsequent Campaign for Action.  Goals of MAAC include fostering academic progression in nursing programs by creating accelerated pathways for nurses to achieve baccalaureate (or higher) degrees and promoting the integration of Nurse of the Future Core Competencies (NOFNCC©) in academic and practice settings partnerships.
  • PCL supports the sharing and adoption of recognized programs, practices and innovations that support performance excellence and a healthy and safe workplace. Examples include workforce health, wellness & recognition programs; safe patient handling guidelines and team communication tools such as TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety).
  • Our sponsors and participants support legislation and guidelines to promote workplace safety efforts and protect all patients and hospital, home health, and other provider employees from workplace violence. Participating caregivers monitor progress of efforts to improve the work environment. Examples of such 'practice environment assessments' include surveying caregivers and measuring improvement over time on specific employee satisfaction endeavors.