Nod If You Can Hear Me - Latest Comments

Re: Transforming the Clinical Workspace - GTD?

rosemetoo — Mon, 12 Oct 2009 00:02:18 -0000

without nurses doctors cant work properly, they serve as one important vein in a hospital. acting like a mother in every patient.

Re: Transforming the Clinical Workspace - GTD?

isis_avent11 — Sat, 03 Oct 2009 12:54:58 -0000

Nurses should be trained properly.Nurses should be given more importance.This article really provides the real story of nurses.

Re: Transforming the Clinical Workspace - GTD?

igeekrn — Wed, 30 Sep 2009 11:09:38 -0000

GTD (Getting Things Done) is a productivity strategy created by David Allen and espoused in his book of the same name. The strategy takes into account the human minds' capacity to track multiple projects or tasks and the need to quickly make decisions on an items' disposition (individual task, email, save it for reference, etc.) The book is inexpensive and priceless at the same time. I'd highly recommend it for anyone who has multiple things to coordinate (meaning everyone).

Re: Health Care

socialmaker — Wed, 23 Sep 2009 05:57:31 -0000

I think people need a more personal approach when it comes to doctors. I know i have a doctor which takes care of my problems(vigrx) and he is so nice. He always knows me by name, he's friendly and i gladly attent every meeting.

Re: Transforming the Clinical Workspace - GTD?

Talu — Fri, 11 Sep 2009 06:54:28 -0000

I am also not getting it. Did you come to know anything about this?

Re: Transforming the Clinical Workspace - GTD?

takeshi18 — Sun, 06 Sep 2009 20:53:40 -0000

Without Nurses there so hospital will run successfully because nurses take care of our health.

Re: Health Care

emrboy — Fri, 28 Aug 2009 15:52:39 -0000

Nice article. Health care sector requires much care and attention, things are not shapping good. Introduce of Emr would really help to improve the overall system of health care.

Re: Health Care

takeshi07 — Fri, 28 Aug 2009 02:26:47 -0000

Thank for sharing, Great issue on how to why we should give concern on our health. I hope will appreciate the true meaning of health.

Re: Health Care

husnain — Sun, 16 Aug 2009 14:31:16 -0000

"They have great topics like this one on www.energytalkradio.com and donate 30% to charity! Check them out."

Re: Transforming the Clinical Workspace - GTD?

889 — Fri, 10 Jul 2009 06:21:26 -0000

What is GTD? I couldnot get anything. Please let me know.

Re: Transforming the Clinical Workspace - GTD?

david788990 — Fri, 10 Jul 2009 05:31:01 -0000

Nurses should be given equal importance as they take maximum care of the patients.

Re: Transforming the Clinical Workspace - GTD?

suchi788 — Fri, 29 May 2009 01:41:49 -0000

Nurses are the backbone of every hospital,clinics.So they must be trained properly.At the same time,their needs should be taken care of.This article really provides the real story of nurses.It should be considered.

Re: Health Care

mpbb — Fri, 03 Apr 2009 03:23:51 -0000

Good stuff, this article will really help us specially health concerns.

Re: Nod If You Can Hear Me - Industry News | Healthcare Finance News

igeekrn — Fri, 13 Mar 2009 15:36:00 -0000

I'd love to chat about this stuff anytime your in the area. I'm a Coke drinker myself, so we'd both drink soda :)

Re: Nursing as a Second Career: Trading One Problem for Another

igeekrn — Fri, 13 Mar 2009 15:32:30 -0000

There has been a bottle-neck at the nursing program admissions office since before I went to my first nursing program in 1992. A 2-year wait was typical, and many prospective students worked on alternative career paths or took classes towards an eventual BSN while waiting. It's not a new problem, and I think you hit on some of the causative factors.

One of the factors is cost containment. Empoyers don't fill all stated vacant positions. They have traditionally relied on mandatory overtime to address staffing shortages rather than hire additional staff, because it is cheaper. In doing this, they avoid carrying the burden of funding an orientation (which, in some estimates, can approach 50K per new hire), employee benefits, and certification reimbursement.

You can see from the cost of new employee orientation, why health care organizations are hesitant to only retain the "good ones." Once they've got a wad of cash invested, they want to get something back. That's why I don't understand why they aren't pressuring universities to graduate students who are ready to work on day one. This would require a major change in the way students are educated, but would help defray costs felt by the employers. It would also necessitate that programs are lengthened (I suggest the BSN as the entry point for all RN's). What this would do is effectively move the cost of orientation onto the nursing student where it probably should be anyway. This would also decrease teh incidence of job-jumpers (nurses who go from one institution to another, leaving after their orientation period is over).

Online quality indicators are having an impact on patient choice, but you are correct in stating that increasing competition would only improve the quality of care. As you state, regulatory and policy restrictions prevent patients from making significant changes in provider/institution. Provider is easier to change, though institution not so much. Interhospital transfers can be a reimbursement nightmare... and know that patient's suffer because of financial and beucratic hurdles leading to delays/refusals of treatment/transfer.

Fortunately, regulatory organizations are requiring adherence to standards of care established by national and international specialty groups and backed by hard science and enforced by surveillance mechanisms. Thus, the variability in quality of care should decrease and outcomes should stabilize across institutions. Reimbursement incentives are driving these changes, though there is a tension between obligation to treat and liklihood of compensation that I view as somewhat unfair to the viability of the hospital as a business. I see a period of hospital failures and consolidation in the near future, for better or worse.

I think I answered many of your questions about nursing/education in another post. With regards to delegating non-critical tasks, there have been unsuccessful attempts in the past to try and redesign the nursing workflow to do just that. Some thought that delegating things like personal care, toileting, passing medications, and such might free up the nurses to have a larger patient load. The problem is that bathing patients is when we teach them and assess their skin, toileting is when we assess their GI/GU function and perhaps their capacity for physical activity. Administration of meds is governed by law and requires licensure. It is also a tiem when we teach patients. When one nurse was dedicated as the med nurse, they had such a tight schedule to pass meds that patients described it as having their meds "thrown at them." Little to no teaching took place, and med errors would be more prevelant as the med nurse wouldn't know the patients lab values or other factors that might influence the apropriateness of the ordered meds at that time. Following these "experiments," we have always returned to some variety of primary care or augmented primary care (with nurse assistants helping with some physical care).

There is ample research that shows that quality outcomes and nurse:patient rations are strongly correlated. I think the better approach is to create a system that will quantify what a nurse does and seek compensation for it. Nursing will then shift from a cost center to a profit center and the entire balance will change. Ultimately, the patient will benefit by the new incentive to recruit and retain highly skilled nurses.

Re: Nod If You Can Hear Me - Industry News | Healthcare Finance News

jmartindf — Fri, 13 Mar 2009 15:07:00 -0000

Thanks for the info on education and regulation. That's very useful to know. It sounds opposite pharmacy in some ways. From what my wife tells me, pharmacists use to have to go through a full PhD program, before the PharmD program was created to make schooling easier. Now I'm told that only research pharmacists go for the full PhD experience.

I did forget to take note of the super low pay. That has to change too. I'm making a comfortable salary and there's no way I'd be willing to teach at that rate. Economically, we're sending clear signals that people who can either teach or do should do, not teach. That's probably true in the short term, but it doesn't make sense long term. We need more do-ers.

If I ever make it over to Michigan, I'd love to take you out for a beer (I'll probably just drink soda) to pick your brain about nursing. I feel like there should be a good solution but there's so much about the field that I don't know.

Re: Nod If You Can Hear Me - Industry News | Healthcare Finance News

igeekrn — Fri, 13 Mar 2009 14:38:04 -0000

You said- "I'm positive that there are many nurses who graduated 20 or 30 years ago with a humble B.S."

Few nurses that graduated 20 or 30 years ago had a BSN. I'm sure that I could find the statistics if I looked hard enough (simple google search didn't reveal anything useful), but BSN programs really came into prominence in the mid-to-late 1990's as diploma programs were phased out. Prior to the 1990's, the vast majority of nursing programs were hospital-based diploma programs or community college-based associates degree programs. These were primarily designed to produce clinicians who had a certain practical skill set, but only allowed for the development of a minimal theoretical foundation. As the practice of Nursing became more complex and the role more autonomous, the need for a longer formal education period became evident. The need to make the BSN the entry-level degree for Nursing has been evident and proposed for some time, but the shortage has made lawmakers hesitant to do anything that might deepen it. Prior to 2003, there were several states that required it (North Dakota, New Mexico, Montana, and I think New Jersey (not sure of the others)). The increasing complexity of the hospital environment also drove the majority of LPN/LVN's out and into sub-acute settings.

That said, current clinical practitioners with significant experience would almost certainly make excellent clinical instructors, depending on their individual ability to transfer their knowledge in a coherent way. Several of my non-graduate degreed coworkers function in that capacity part-time, and they find it completely managable and extremely rewarding.

Didactic courses, however, require a higher level of training. Most subjects are taught by PhD's, MD's, and PharmD's because they have the necessary understanding of those specialty subjects.

You said-

"I'm fundamentally suspicious of any system that lets the current practitioners dictate what's acceptable for the next generation of practitioners."

Nursing traditionally hasn't had a voice in the development of their professional role and the socialization and training of new members. Often, it has been politicians, influenced by the medical profession and the insurance industry, that have dictated the shape of nursing practice. Nurses are known to be a large but uninvolved body with low rates of membership in state associations and specialty organizations for that very reason.

Nursing needs to take control of its destiny, become more politically adept, and ensure that the needs of patients remain front and center.

you said - "If these are the "standard" they're talking about lowering, I'm all for it. Let's focus on increasing the supply of teachers by getting rid of ridiculous standards that limit the supply of teachers."

I don't see that lowering standards will significantly increase the supply of teachers. The problem isn't unnecessarily high standards, it's unsuitably low pay. Why would a clinician making $28-45 dollars an hour working 36 hours a week agree to work for 18-25 dollars an hour in 4 hour blocks or for $2500 a semester to teach a class part-time. Why would anyone want to leave a 75-120K a year clinical job to work for 40-60K a year as a clinical instructor? Aside from an innate love for teaching, I can't think of any logical reason why.

Nurses are not money grubbing dollar chasers anymore than MD's are. Why do you think the practice of Primary Care is so short of Docs? The pay is poor.

Re: Nod If You Can Hear Me - Industry News | Healthcare Finance News

jmartindf — Fri, 13 Mar 2009 13:07:28 -0000

This phrase from the article caught my eye: "Boards of nursing that approve programs and faculty have to work together to come up with creative initiatives". I'm fundamentally suspicious of any system that lets the current practitioners dictate what's acceptable for the next generation of practitioners. While it sounds good in theory, I'm afraid that in practice it contributes to a very conservative establishment that innovates slowly -- if at all.

Given that I've grown up in a period of very rapid innovation, I distrust anything that hinders innovation.

So, I went a Googling and found this page on the requirements to be a nursing instructor. Quoth the page:

An instructor must have a Master's or higher degree in nursing, education or administration, at least one year's experience teaching or coursework in teaching and at least one year's experience providing direct patient care as an RN with recent (last 5 years) competency. Instructor level approval is required in order to assume full responsibility for a classroom course.

A Master's degree can be a pretty high barrier. I'm positive that there are many nurses who graduated 20 or 30 years ago with a humble B.S. Over the years, they've amassed an incredible amount of experience and wisdom but have never returned to school for a Master's. If these are the "standard" they're talking about lowering, I'm all for it. Let's focus on increasing the supply of teachers by getting rid of ridiculous standards that limit the supply of teachers.

Re: Nursing as a Second Career: Trading One Problem for Another

jmartindf — Thu, 12 Mar 2009 12:35:07 -0000

I'll respond as someone who works in health care IT, but not in the actual delivery of health care. I'd consider myself an educated observer of health care but not really a participant in the health care field. (And my HIT experience is on the billing side, not the clinical side.)

I'll post my economic thoughts since I don't really have any clinical thoughts. I think a lack of true financial incentives are strangling the field. I don't see any viable alternative explanation. You mention several causative factors: underpaid teachers (leading to a lack of teachers), lack of money to expand nursing training, nurses who don't have the influence to change their work environment, and a lack of nurse / physician collaboration. Those are all economic factors that show up when incentives aren't aligned properly.

In her recent State of the State speech, Governor Granholm talked about a waiting list of people who want to become nurses and a shortfall of actual nurses. That's really an amazing statement. Organizations are desperate for nurses. People are eager to become nurses. But nothing's happening. Where's the dam in the river? Why isn't the water flowing downhill here? Why are teachers underpaid even when there's a desperate need for training? Why is there a lack of money to expand training for the very workers that are desperately needed?

The only rational explanation I can see is that health care organizations either don't believe they'll profit from increasing nursing staff or don't believe their allowed to take the actions necessary to properly increase their nursing staff.

Most of the businesses that we're familiar with hire friendly, competent, well trained staff for a very good reason: a customer that feels insulted is likely to leave for a business that makes them feel welcome. Good employees are an asset to these businesses. They serve both to increase customer trafic and to retain customer traffic. This increases profitability. Good employees are good for the bottom line. Bad employees drive customers away and keep customers away. This decreases profitability. Bad employees are bad for the bottom line.

But I don't think this is true in health care. In the U.S., people have a choice of 1-3 health plans offered by their employer. These health plans provide a very limited number of options for outpatient and inpatient clinical care. (Warning: this part is from the patient perspective. It may or may not match reality as seen from the provider's perspective. And, that's kinda the point.) Do you feel insulted by your doctor? You can request another one -- if he has openings. But he's employed by the same organization that hired th first jerk. Do you feel that your nurse is slacking off? Good luck getting another one. Want to move to a different clinic or hospital? Well, you can, if you want to pay for it entirely out of your own pocket.

Patients have very limited choices. This leads to limited (non-existent?) competition and limited incentives for improvements. Sure, health plans compete for members. But they're mostly interested in getting access to premium paying healthy people. Nobody's really competing for patients to walk into their waiting rooms. Few organizations are truly competing to have the best physicians and nurses. Few organizations truly believe that the quality, friendliness, and diligence of their providers drives their bottom line profits.

So much for my view of the profit side of the problem. What about the regulatory side? Here I'll just have to throw out questions. What qualifications are necessary to open a nursing school? What qualifications are necessary to teach nursing? What prerequisites are necessary to enter nursing school? What would prohibit (or discourage) a health care organization from providing training? What would prohibit (or discourage) other organizations from providing training? What existing regulations make it difficult for graduates to find jobs? What existing regulations make it difficult for graduates to learn on the job in a controlled, manageable way? What types of jobs do nurses do that could be done by someone less credentialed and less well trained? How many of those lower skill positions are limited to nurses even when a nurse's qualifications aren't necessary to do the job well?

I don't know nursing well enough to answer those questions myself. But I've read enough about the health care field to believe that those questions have answers and that those answers would reveal a lot about the current nursing shortage. I think the only way that the shortage will truly be alleviated is if organizations clearly profit from better nursing and are free to act in a way that will maximize their profits.

There, Ken. I think I've written something that may anger people just as much as your original post.

Re: Show me the Expert: Balancing Authority and Humility

igeekrn — Thu, 12 Mar 2009 11:47:52 -0000

You make a great point. I can see how being wishy-washy would drive away readers.

It seems the reader has to decide (if the writer has an incomplete or incorrect view) whether they should try to engage and expand the writers' understanding of the subject, or that it would require more effort than it merits.

Re: Show me the Expert: Balancing Authority and Humility

jmartindf — Thu, 12 Mar 2009 09:47:48 -0000

I've struggled with that as well. I usually give in to the temptation to sound authoritative even when I'm sure that I'm not authoritative. I think that's better than sounding so wishy-washy that my opinion isn't even worth reading. But I could be wrong.

Re: Nursing as a Second Career: Trading One Problem for Another

igeekrn — Wed, 11 Mar 2009 22:12:55 -0000

Added a commenting system following @lgpiper 's request. I decided to use Discus because it integrated well with Tumblr (and I already had an account). Suggestions for improvement are welcome.