Page 4 Ohio Nurse March 2017 Lori Chovanak continued from page 1 I would like to encourage you to reach out to the Ohio Nurses Association. We need to hear your stories; we need to represent you and the best way to do that is for us to know what you are up against. We are your professional organization, and we are grateful for the participation of the nurses we have heard from and we have heard from a lot. The Ohio Nurses Association has 25 staff that is highly skilled, very motivated and passionate about what we do as professionals. We have elective leaders who are sitting on our board driving our strategic plan, and we are member driven. I am so proud to lead this amazing team to help inform you on what we are doing. Not just on the behalf of nurses but also for the patients we represent in this state. Let us make Ohio healthcare great and be the strongest voice for nursing! Lori Chovanak, MN, APRN-BC President of the Ohio Nurses Foundation Find your career today! Search job listings in all 50 states, and filter by location and credentials. Browse our online database of articles and content. Find events for nursing professionals in your area. Your always-on resource for nursing jobs, research, and events. www.nursingALD.com When nurses reflect on the meaning and themes of nursing, terms like; productivity, scorecards and budgets are not usually used to describe nursing. Nursing is about patient care, serving others, education and health promotion. Nursing involves being an advocate for the patient and the profession. Nurses are leaders, innovators and voted one of the most trusted individuals in America. Those actions and characteristics are what provides quality patient care. When discussing terms like fiduciary responsibility and productive nursing hours, quantity seems to be the theme. How does quality turn into quantity? As a bed-side nurse, attempting to understand that concept, it can be difficult to achieve; especially because we have been taught from the beginning to provide quality in patient care. Many hospitals receive a scorecard report that provides numerical data representing the quality of care from the patient’s perspective. It may appear that the terms like advocacy and health promotion are getting lost in all the talk about productivity and budget reports. But, as health care changes, so does the way it is practiced. As a bed-side nurse, it may not seem like productivity or scorecard results are important, but being cognizant and having an understanding of these measures are not just the responsibility of the nurse manager. Practicing nurses need to be able to recognize how quality is measured into quantity when caring for patients because ultimately these tools and themes are being used for staffing plans, scheduling and unit funds. Evaluating Productivity Using measuring tools to meet productivity standards has become a popular trend in health care facilities. It seems confusing to attempt to put a numerical value to the skills of nursing and the delivery of patient care. Patient workload and the time given to each patient is such a flexible and unpredictable concept. How can it be fit into a value accurately? Productivity tools have been developed to somehow provide a numerical value that helps nursing see the quality of patient care in order to help efficiently run a nursing unit. What is productivity? In terms of being productive, you would think of it as performing the tasks needed to be done in the most efficient way. That is one of the goals of using a productivity tool for nursing. Another theme in productivity is the idea of measuring the intake and output from a financial aspect. Essentially that means how much (timing and finances) was spent using nursing hours to provide patient care. And then comparing that result against how much was used (staffing ratios and hours per job class). Then the difference based on an equation provides the productivity for that day. Different productivity tools have different equations but the similarity in the tools is that it provides a quantitative number that can be used to measure how efficiently a nursing unit can operate. One article regarding nursing productivity describes it as “the ratio of patient care hours per patient day to salary and benefit costs paid out to staff by the organization” (Kohr, Hickey, Curley, 2012, p. 421). Calculating the productivity can be done in several ways. Some factors include the hours of nursing worked, the amount of direct care given to a patient and relating it to how long the patient was hospitalized. It seems silly to think that a patient that stayed for a four hour outpatient procedure had greater than four hours of direct nursing care, but these productivity tools are starting to shed some light on how that may not always be true. Another concept that as a staff nurse may raise question on this tool, is that “nursing productivity models should take into account patients’ needs, nursing competencies, the availability of material resources, and services provided. Nursing workload is a direct reflection of these variables and effects the delivery of patient care, patient safety, as well as satisfaction of Nursing as a Business Sarah Strohminger nurses and of patients and their families” (Kohr, Hickey, Curley, 2012, p. 421). This tool can be used to promote effective staffing standards, however it may not be a collective and accurate measurement of the quality. Many tools are preprogrammed for specific units based on the patient acuity. That may seem appropriate, however the estimated time spent on a patient is random and individualized to each patient. Whether or not your nursing unit has a productivity tool may be a decision you could help influence. If it has not yet been implemented, be proactive and play a crucial role in planning for productivity and the financial parts of the unit. If it has been implemented, gain a solid understanding of how it measures you and your team’s practice. Collaborate with your team to pinpoint fluctuations in productivity to look for areas of improvement and advocate for your team and your patients! Evaluating Quality Patients receive surveys post discharge that have them evaluate aspects like nursing care and overall experience. These results are tallied into a report and then provides facilities with a score. The score results are some of the driving forces that help us know how well we are performing. For nursing leaders, it tells them where there might need to be a change in nursing practice for their specific unit. But another finding from these scores, is the results that affect facilities re-imbursement from insurance and governmental agencies like Medicare. These scores are posted on a national website and provides facilities with a ranking. Some patients may chose facilities for health care based on their score and rank. Achieving an average or above average score is relevant to all aspects of nursing because it governs the way we practice and the conditions in which we work. Although discussing these scores during a typical staff meeting may seem dry and maybe not always an accurate depiction, however it is important to have an understanding of the scores and their impact. Being able to take the low areas and look for innovative changes to implement helps grow nursing leaders. As a team, evaluating the scores could be a process improvement initiative for the unit’s nursing committees. Being able to see the scores broken down by categories such as quality, service, etc. helps guide the focus for improvement by each initiative. Running the Nursing Business LLC © So the question is, how can nursing be productive? There may never be an exact answer. Fortunately, the beauty of nursing is its everchanging capabilities and strong background in advocacy and driven leadership! Personal ways to be a leader in productivity may include using electronic documentation to its fullest capacity. Another way is to use your resources by delegation. To increase unit productivity, be inventive! Think small with something as little as placing a television in a family waiting area. Get involved in your unit’s committees and implement a new float staffing plan, for example. When thinking of improvement towards an efficient and functioning unit, consider that this is the time when professional and honest conversations should take place. Take charge of your nursing career and grow professionally to become a leader in the profession. Concentrate on incorporating quality in your practice. This means conversing with your patients honestly regarding their expectations of the care they wish to receive. Education is a huge part of nursing and should be woven into daily practice for patient’s health promotion and quality of care. By concentrating on the value of care given to each patient, quality scores will improve and nursing leaders will grow tremendously. Nursing requires critical thinking with patient care. Why not incorporate critical thinking in the way nursing practices as a business. Know that the ultimate goal is always high quality patient care, but be the leader in the business on how nursing can be portrayed in to the community. Sarah Strohminger, MSN, RN
March 2017 Ohio Nurse Page 5 The Realities of Nurse Bias Heidi Shank Logan Walker Effective nurses may recognize their nurse bias if they possess a good understanding of their personal moral limitations. When a nurse understands how bias corrupts care, they can increase their effectiveness of care and improve patient outcomes, safety, and overall quality of care. This article briefly describes some key benefits, concerns, and suggested changes for the nurse who recognizes bias and the impact it has. Patient safety and the quality of care should always be the highest regard on a nurses’ mind. Yet every day nurses’ go to work and put themselves as well as their patients in harm’s way without even realizing. When a nurse does not realize their bias may corrupt the quality of care for each patient, whether it’s conscious or subconscious, they are unable to make appropriate decisions regarding treatment. To offer the best safety and the highest quality of care, the nurse must be able to identify their own limitations and develop ways to modify them. When the nurse develops ways to understand their limitations and what triggers bias, they are then able to make appropriate decisions that will benefit each patient. Nurses should be accountable for themselves and consciously objective to care when it hinders their ability to act without bias. According to a recent article by Odell, Abhyankar, Malcom, & Rua, the definition of conscientious objection in nursing includes the objection of an action, by a nurse, because the action would violate deeply held convictions about what is right and wrong. By consciously refusing care, the nurse does what is best for the patient and may eliminate corrupt care. Thus, eliminating bias from care benefits the patient’s safety and quality of care. Concerns may arise with patient safety and the quality of care when personal bias corrupts care and the nurses do not object. Many nurses’ feel professional duty to care for patients, even though they have major internal conflicting interests. What’s concerning is when nurses’ act out of obligation without raising awareness of their bias; a nurse might believe that the sanctity of life trumps all. Research shows potential risk is especially critical in situations where nurses’ professional duty to care for patients comes into direct conflict with their personal wellbeing and safety. In these situations, the nurse should understand themselves and question their accountability and responsibility for that patient. That does not mean refusing care due to the patient’s acuity; it must be a conscious objection based on developmentally ingrained convictions that are morally profound in that nurses’ beliefs. Current experts agree that to ethically object to participating in an intervention, the intervention must challenge the moral integrity, and not be based on false motivation. It really has to violate a deeply held conviction of what’s right or wrong. The American Nurses Association (ANA) upholds that determinant and does not allow nurses to refuse care based on prejudice, discrimination or dislike. For example, they can’t refuse to take care of someone because the patient abuses alcohol just because the nurse doesn’t like alcoholics. Another concern would be not understanding the difference between objecting to provide care based on false motivations versus deep convictions. If alcohol holds a deep conviction then the nurse has the right to refuse care. For example, the nurse who lived with an alcoholic spouse who was abusive may not be equipped to cope with a similar patient. Serving a patient who abuses alcohol may trigger a response of her past causing personal bias in her care. It is never a nurse’s duty to act on anything that may cause them personal harm including emotional harm. Painful experiences such as abuse can cause frightening memories and the sense of constant danger. So, in this case, the appropriate action for the nurse is to discuss this with someone in charge and refuse care due to deep convictions. The ANA states that the nurse has the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm. In situations, where limitations are threatened, the appropriate action for a nurse to take is to examine the underlying issue and act accordingly. Having moral dilemmas is a part of life but, learning to manage them is a part of professionalism. At the end of the day, it is the job of a nurse to be a professional and offer what is best for the patient. When the nurse acts out of false motivation, objecting consciously, the nursing supervisor needs to be informed. When the supervisor is involved, sharing and clarity becomes part of the process. The nurse may be confused on what deep convictions are. Proactive discussions with informed leaders may help. On the other hand, bias care may be observed especially if the nurse is performing care out of professional duty with internal conflicting issues and leadership may need to be involved. The nursing supervisor needs to be informed and help the nurse understand biased care. If the education does not work, then the nurse should seek self-understanding through various resources including employee assistance, professional counseling, or discussions with trusted friends to find the underlying cause of their bias. It may be due to past painful experiences or false motivations, such as prejudice, jealousy, or discrimination. By eliminating bias, the nurse can offer the best safety and quality of care for each patient and maximize their full potential. To conclude, when a nurse knows their bias corrupts the safety and quality of care for the patient, the nurse should request reassignment. When caring for a patient endangers the nurse’s developmentally ingrained convictions, it is acceptable for the nurse to consciously object to provide care on the grounds of moral integrity based on deep convictions. Moral integrity implies having an internally consistent set of basic moral ideas and principles, and being able to live and act in accordance with these. When nurses live within accordance of their moral limitations they can recognize bias and make appropriate decisions that will benefit all. At the end of the day, the nurse who speaks up is caring for the patient, but they are also caring for themselves. Heidi Shank MSN, RN, DNP (c) is the Undergraduate Program Director and Instructor at the University of Toledo College of Nursing with 31 years of nursing and progressive administrative nursing and organizational leadership experience. Specialty areas include nursing leadership, organizational design, joint commission accreditation, and critical care with a specialty in stroke-related care initiatives and patient safety. Heidi also serves as the American Association of Critical-care Nurses, as the Region 9 Chapter Advisor for all of Ohio & Indiana. She is also a member and committee member of the Zeta Theta Chapter of Sigma Theta Tau. Logan C.S. Walker is a BSN 3 senior nursing student at the University of Toledo & College of Nursing. He currently resides in Toledo, Ohio but plans to relocate near his home town of McMinnville, Tennessee upon graduation. Logan is enjoys delving into Research and Evidence-based Practice to enhance his future nursing practice. He is passionate about using his nursing career to make a difference for others. CALL FOR ABSTRACTS 2017 Wellness Conference The Ohio Nurses Association and The Ohio State University are planning the First Annual Wellness Conference to be held on March 24-25, 2017 at the Ohio State University, Columbus, Ohio. Individuals are invited to submit proposals for a poster session. The conference is designed to enhance the participant’s approach to their personal healthcare that emphasizes prolonging life and the prevention of illness. If you have a program or project that you would like to present in poster format, please complete the Request for Proposal forms and submit by March 10, 2017. 1. Poster presenters must register and be available to present their poster during the poster session times. 2. Presenters will be supplied one easel and one chair per person for each poster presentation. No tables are available. 3. Posters should not exceed 30” by 39” in order to fit on the easel. 4. No audio-visual equipment will be available. 5. The fee for poster presenters is $50.00 for each presenter. This includes the lunch, easel, chair and handouts. If you are attending the conference, you do not need to pay the $50.00 fee. 6. Please note that participants will be able to receive contact hours for participating in the review of the posters and discussions with the presenters. For questions or the Request for Proposal forms, please contact Sandy Swearingen, Continuing Education, or Dodie Dowden, CE Specialist, Ohio Nurses Association, 4000 E. Main St., Columbus, Ohio 43213-2983. Phone: 614-448-1030; Fax: 614-237-6074; E-mail: email@example.com or ddowden@ ohnurses.org. The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91) Seeking qualified candidates for a full-time Director of the Holzer School of Nursing. MINIMUM QUALIFICATIONS: • Doctorate Degree • Two years of teaching experience in the Nursing field • Eligibility for Ohio RN License For additional details about the position visit our job opportunities page at www.rio.edu.