Just Culture Must Begin in School

I have been reading peer-reviewed and industry-published articles about "Just Culture" for well over a decade now. However, I cannot widely find this espoused environment of transparency, learning and sharing, personal accountability, and non-punitive error reporting. "Just Culture" seems to be not discussed or viewed either an impossible goal in both hospitals and the schools preparing our future nurses and other healthcare professionals. Why do we still cling to meting out punishment when errors are found? We certainly have seen how successful the aviation industry has been with implementing Just Culture policies and procedures and the resulting increased safety. I wonder if punishment for wrongdoing is one of nursing's most sacred cows because so many nurses experienced abuse for their own errors that they cannot get past their learned way of dealing with errors. When teaching pediatric nursing and explaining the decades' of solid evidence of harm from spanking children, I inevitably have students who say, "But I was spanked as a child, and look how well I turned out!" Perhaps a punitive approach to errors is the same thing. As nurses and leaders, we must get past the idea that because we trained in rules-based, authoritarian programs in which we constantly feared "write-ups," and we "turned out okay" that this should continue.

Wow! 15 years gone by already!

California Hospital Association Vice President Denies Increased Nurse Staffing Improves Quality of Care

Yesterday, while perusing my guilty-pleasure, Facebook, I noticed this cartoon. Funny, because it sure has a ring of truth to it, doesn't it?! Auspiciously, this morning, I read a comment from B.J. Bartleson, vice president of Nursing and Clinical Services at the California Hospital Association denying that increased nurse presence in the hospitals improves quality of care. Wow! The comment was in response to a study which, according to its own authors, requires more research follow-up in order to draw conclusions about the efficacy of the California nurse:patient ratio law. I think it's fair to say there are many, many variables to study when looking at quality of care. One factor that influenced my own workload when the ratio law was implemented was the cost-cutting measure of eliminating many ancillary positions. This RN rarely has a nurse aide, has to strip rooms and do many housekeeping tasks, lift and transport her own patients, etc. In this instance, the ratio law may not have lead to improved quality as some studies do suggest. BUT, to state that increased nurses do not lead to improved quality of care is, in my mind, so obviously financially self-serving as to be ludicrous. So, when Bartleson is a patient and his nurse has 10 other patients to care for, we should ask again if he believes staffing doesn't affect quality.

 http://www.californiahealthline.org/features/2012/study-nurse-ratio-law-has-mixed-results-on-quality-of-care.aspx

California Leads Other States in Implementation of the "Future of Nursing"

Last spring I had the privilege of convening with approximately 100 other nurses in Humboldt County, CA, to brainstorm obstacles and opportunities to implementation of the IOM's white paper report, "Future of Nursing: Leading Change, Advancing Health." I was thrilled to read the following interview and learn that California is leading the way towards healthcare change. I hope other states will jump aboard because it is exciting news for nurses and healthcare consumers alike. I am particularly interested, being a nurse educator myself, in the transitioning towards BSN degrees through articulated agreements between community colleges and state universities. How exciting to think that getting a BSN will be all the more convenient. http://news.nurse.com/article/20121203/CA02/112030017

Free CEUs from the National Institute of Nursing Research

Previously, nurses interested in becoming researchers could travel all the way to Bethesda, MD to attend a four day course called "Developing Nurse Scientists." Now, the NINR has turned that class into a free online program worth four CEUs. It really did take me about that much time because the information was so new to me, but I feel I have a much better understanding of how the research which has advanced nursing so much was conducted. The free class is available at this link: www.ninr.nih.gov/Training/OnlineDevelopingNurseScientists/

Saturday Night and I'm Officially a Nerd (with a thanks to Orrin Hatch)

Okay, okay, I admit it: I am a nursey nerd. But I have to share with you this great opportunity for a free book! I am only partly into it but already learning so much about our history of nursing and research in the National Institute of Nursing Research's History Book.

Apparently, despite a presidential veto (Reagan!), the Center for Nursing Research, a part of the National Institute for Health, was created in 1985. It was Senator Orrin Hatch who helped our profession so much when he championed others to override President Reagan, "The notion that the $5 million for nursing research within NIH’s $5.5 billion budget was “too much,” Hatch said, was “preposterous. A proposal for nursing research to have one one-thousandth of the NIH budget is too much? My fellow Senators, don’t you believe it,” he admonished. “It is high time that nursing research took its rightful place in those NIH halls of ivy.” Most senators agreed. They voted to override the veto, 89 to 7"(NINR, 2012).

 This NINR (as it is now an Institute and not a Center) has continued to support nursing research and has trained more scientists, as a percentage of its budget, than any other Institute (NINR, 2012). Its history book is now available for FREE download here:  http://www.ninr.nih.gov/NewsAndInformation/NINRPublications/HistoryBook

New Study Indicates Benefit of IV Inotropics for Hospice Patients at Home

Just yesterday I discharged a CHF patient from the hospital to home with hospice. He had an ejection fraction of only 10% and all of his meds, except the usual oxygen and morphine drops, had been discontinued. I worried for his comfort at home, despite knowing that hospice was involved. This morning I awoke to find reference to a new study which indicates that IV inotropics given to the heart failure (HF) hospice  patient in the home setting can be safely administered. 64.5% of HF patients receiving this therapy were able to remain at home compared to 35.9% not receiving it. Inotropics for palliative care of the HF patient is no new topic, but this study really seems to support the financial and psychosocial benefits of the treatment as well. The following links to a summary of the findings:

Patients at home benefit from inotropic infusion