Creating Awareness, Protecting Nurses
AnnMarie Papa, DNP, RN
It wasn’t until 2009 that senior hospital administrators really began paying attention to the prevalence of hospital violence, especially that which occurred in the emergency department, says AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, president of the Emergency Nurses Association.
That’s the year ENA researchers published their first survey of emergency nurses’ reports of violent attacks while on the job. The paper was accepted for publication in the Journal of Nursing Administration, which meant that the C-suite who read it would learn some disturbing statistics.
“It was an eye-opener for them,” Papa says. “Once they read this, they said, ‘Wow, this is something we really need to take a look at.’”
Nurses said they were spit on, hit, pushed or shoved, scratched, and kicked in psych units, EDs, waiting rooms, and even in geriatric units.
The perpetrators were usually patients and their family members and visitors.
“Administrators just don’t spend a lot of time down there, and nurses never used to complain; they thought of it as part of their job.” Additionally, some nurses said they didn’t report incidents because of hospital reporting policies that were unclear.
Papa has become a leading voice for this issue, speaking at events internationally and helping format a guideline for hospitals to safeguard their emergency workers.
In 2010, it started to pay off. The Joint Commission published Sentinel Alert #45, Preventing Violence in the Workplace Setting, which called attention to the issue on multiple levels.
Papa says that the past three years have been very rewarding because she feels she’s empowering other ED nurses to speak out, and that has made a big difference. “Yes, we’re here to care for patients, but we also have to care for each other,” she says.
Beyond Emotion: Ethics and Results in Infection Control
Michael Edmond, MD
Back in 2003, Virginia Commonwealth University Medical Center epidemiologist Michael Edmond, MD, realized that the way hospitals try to prevent infections—with active surveillance—just didn’t make any sense.
They were testing so many patients for just one type of infection, Methicillin-resistant Staphylococcus aureus. If the patients were found to be carriers, they would be isolated, with potential for adverse consequences.
“Isolation is not a benign procedure because it increases patients’ risk of falls, pressure sores, and electrolyte disturbances, and we know they get fewer visits from doctors and nurses,” Edmond says. And from an ethical standpoint, he says, “Here’s a group of isolated patients who don’t get any benefit from that, but just bear the burden, because all the benefit accrues to the patients who are not colonized and not isolated.”
Instead of testing for MRSA, hospital staffers at VCU focus on central venous catheter insertion bundles, head-of-bed elevation for mechanically ventilated patients, chlorhexidine baths for patients in the intensive care unit, and simple hand hygiene.
The drop in all hospital-acquired infections for all organisms has been remarkable. “From 2003 to the first half of 2011, we’ve had an 86% reduction in infections in our ICUs, from 21 infections per 1,000 patient days to three. We’ve had an 84% reduction in central line–associated bloodstream infections and a 93% reduction in ventilator-associated pneumonias. One of our ICUs has not had a single ventilator-associated pneumonia case in over three years.”
In all, Edmond says, the hospital has saved $20 million in avoided costs of treating bloodstream infections, ventilator associated pneumonia, and urinary tract infections in the ICU.
Now, Edmond can say with confidence, “it really appears that you don’t have to do active surveillance in order to reduce infections in your hospitals.”
Orchestrating Care, From Ground to Air and Back
Jeanne Yeatman, MBA, BSN
Coping with the emotional connection to patients is one of the biggest challenges nurses who work at Vanderbilt LifeFlight and similar air-medical programs nationwide face, says Vanderbilt LifeFlight Program Director Jeanne Yeatman, MBA, BSN, CEN, EMT. “You are invited into people’s lives at their worst moments, so you become emotionally connected to the patients that you serve,” she explains. “When you see someone with burns over 90% of their body who is talking with you and you know that you are the last person they will talk to, there is no training for that—no book on what to say. That emotional wear and tear is difficult.”
To help her staff of more than 150 professionals cope with the daily rigors of the job, Yeatman has tried to build a level of self-awareness among LifeFlight crew about dealing with the emotion of transporting such high-acuity patients. For example, when a flight crew has performed CPR or there has been a patient death, Yeatman has found chaplain Ray Nell Dyer, MDiv, BCC, from Vanderbilt Children’s Hospital, who is willing to volunteer her time to reach out to that crew and offer emotional support.
Yeatman is also developing programs at LifeFlight to help improve care coordination among flight crews, paramedics, and ED staff. About one year ago, Vanderbilt LifeFlight launched its iFly program, which strives to help paramedics and ED physicians and nurses learn more about care delivery during the “golden hour in trauma,” Yeatman says.