Meaningful use (MU), in a health information technology (HIT) context, defines the use of electronic health records (EHR) and related technology within a healthcare organization. Achieving meaningful use also helps determine whether an organization will receive payments from the federal government under either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program.

Although roughly half of physicians in a recent survey said they planned to apply to the Meaningful Use incentive program in 2011, few would have qualified for payments because their electronic health record systems would not have met enough of the Stage 1 core requirements, according to a study published this week in Health Affairs.

Of nearly 4,000 physicians responding to the survey, conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics, 51 percent said they intended to apply for the incentive payments. Only 11 percent, however, had an EHR system installed that would have met 10 out of 15 requirements for the Stage 1′s core objectives.

The Washington Post: Supreme Court To Hear Arguments On Timing Of Health-Care Ruling
The Supreme Court begins its constitutional review of the health-care overhaul law Monday with a fundamental question: Is the court barred from making such a decision at this time? The justices will hear 90 minutes of argument about whether an obscure 19th-century law — the Anti-Injunction Act — means that the court cannot pass judgment on the law until its key provisions go into effect in 2014. It is the rare issue on which both sides agree: the Obama administration lawyers and those representing the states and private organization challenging the new law argue that the Supreme Court should decide the constitutional question now (Barnes, 3/25).

The New York Times: Health Act Arguments Open With Obstacle From 1867
The Supreme Court on Monday starts three days of hearings on the constitutionality of the 2010 health care overhaul law, an epic clash that could recast the very structure of American government. But it begins with a 90-minute argument on what a lawyer in the case has called “the most boring jurisdictional stuff one can imagine.” The main event — arguments over the constitutionality of the law’s requirement that most Americans obtain insurance or pay a penalty — will not come until Tuesday (Liptak, 3/26).

Stateline: Supreme Court Hears First Issue: Jurisdiction
If the Medicaid portion of the health law is upheld, the work of expanding Medicaid access will be squarely on states’ shoulders, although the initial financial burden will be primarily on Washington. States have already been laying the groundwork for the Medicaid expansion, because waiting until the court decides would mean missing the law’s deadlines. For the same reason, most states have been developing so-called health insurance exchanges, the law’s central mechanism for extending health care access to millions of uninsured Americans (Vestal, 3/26).

Fox News: First Round Of Supreme Court Health Care Hearings Not About Health Care
For all the anticipation leading up to this week’s historic arguments, Monday morning’s opener at the Supreme Court isn’t about the law itself. It’s about the rules of the game. The day may prove disappointing to anyone looking for a vigorous constitutional argument or a hint of how the justices will ultimately rule on the merits of the dispute. Still, the fate of the case rests on this opening round (Ross, 3/26).

Bloomberg: Court Opens Health-Care Debate With Law That Might Derail Case
The U.S. Supreme Court opens today its historic review of President Barack Obama’s health- care law, three days of arguments that might result in the president’s premier legislative achievement being found unconstitutional in the middle of his re-election campaign. The court will determine the fate of a measure designed to extend insurance to about 32 million people and revamp an industry that accounts for 18 percent of the U.S. economy. The six hours of planned debate is the most on a case in 44 years (Stohr, 3/26).

NewsHour: Health Care Reform Heads To The Supreme Court: A Guide To Day 1
Between Monday and Wednesday, the justices will consider several issues, including whether it’s constitutional for the federal government to force Americans either to buy health insurance or pay a fine. … What can we expect on the first day of arguments in this historic case? (Kane, 3/26).

Summaries courtesy of  Kaiser Health News’ Daily Report

Photos by Getty Images and Associated Press

 Yet even if the president prevails, he faces another daunting challenge: implementing the law in a seamless, timely manner. The Centers for Medicare & Medicaid Services is charged with making the health law work, drafting regulations, setting up new programs and providing oversight. But for years Congress has undermined the agency’s leadership and potential effectiveness, raising questions about its capabilities and resources even as the health law ramps up its responsibilities.

For starters: consider the revolving door leadership at CMS.

Since its creation in 1977 as the Health Care Financing Administration, the agency has had 29 administrators in 35 years – an average tenure of just 14 months. The longest-serving administrator held the job for four years and five months. The shortest: two months.

The most recent CMS administrator, Dr. Donald Berwick, resigned in December after 16 months. His replacement, Marilyn Tavenner, currently holds the title of acting administrator. That’s hardly uncommon.

Acting administrators have run the agency 20 percent of the time. And the trend appears to be increasing: the Senate hasn’t confirmed a full-time CMS administrator since 2006, when Mark McClellan resigned midway through the second Bush administration.

“Imagine if somebody went two years without a Secretary of Defense,” Thomas A. Scully, who was CMS administrator under President George W. Bush, told the journal Health Affairs in April 2010.

For decades, government and private researchers have pointed to a widening gap between the agency’s responsibilities and resources. As the largest purchaser of health care in the world, with a budget of $820 billion, CMS pays for the care of one in three Americans, and interacts daily with thousands of hospitals, doctors and other providers.

4,900 vs. 62,000 Employees

The number of Medicare and Medicaid beneficiaries has soared since the programs started in 1966, with tens of millions of Baby Boomers and uninsured expected to swell the rolls even more in coming years. Yet today the agency has the same number of employees it had during the during the Carter administration – about 4,900.

By comparison, the Social Security Administration, with a smaller budget, has 62,000 employees. Even including work that CMS outsources to private contractors – bill-paying, coverage decisions and quality oversight – the agency operates with about half as many employees as Social Security.

The shortages have hurt the agency’s ability to implement crucial reforms, ensure adequate oversight of hospitals and other providers and find ways to stem spiraling medical costs, researchers say. For years, CMS executives weren’t even sure if they could consider cost as part of their coverage decisions, paying high-quality and low-quality providers the same amount.

In 1999, a bipartisan group of former administrators and health policy experts wrote an open letter to Congress decrying “the mismatch” between the agency’s resources and its “mammoth assignment.”

Three years later, the nonprofit National Academy of Social Insurance wrote, “This mismatch has grown worse in recent years as CMS’ responsibilities have increased dramatically.”

“Really, when you consider what they have to work with, they do a fairly remarkable job,” adds Robert A. Berenson, a former CMS administrator, and now a health researcher at the Urban Institute. “Assuring adequate staff at CMS has not been a priority for Congress even though it might more than pay for itself in more efficient programs.”

‘What’s Missing Is … A Consolidated Strategic Vision’

Berwick, a physician and national expert on health quality, said he was “impressed and gratified” by the way senior staff rallied around his calls to implement the sprawling health law. But much of staff time is taken up writing rules and regulations.

Career executives “perform these core components well,” said Berwick. “What’s missing is a kind of coherence and consolidated strategic vision of where to head next.”

In recent years, Congress has added more programs and complex legislation to the agency’s plate, including overseeing a 2003 prescription drug benefit for seniors, ensuring patient privacy, helping to weed out waste and fraud and developing a system for grading hospitals and nursing homes.

The Obama administration’s nearly two-year-old health law adds yet more duties: helping to oversee insurance exchanges in 50 states, operating a program to spur ways of delivering care more efficiently, and guiding big expansions of Medicare and Medicaid, the agency’s core programs.

CMS will be expected to do so even as “frequent changes” at the top “have inhibited the implementation of long-term Medicare initiatives or the pursuit of a consistent management strategy,” according to a 2000 study by the U.S. General Accounting Office.

For years, the agency was criticized for focusing more on getting checks out to hospitals and doctors than ensuring quality or finding ways to trim health spending. Part of that had to do with Medicare’s unique history. For the first 11 years of its existence, the program was housed in the Social Security Administration, which issues monthly income support checks to retired Americans.

But even after the Medicare and Medicaid programs were put under one roof in 1977, the agency continued to struggle, facing criticism from Congress and medical providers. “It’’s almost paradoxical the extent to which Medicare is so important and valued in the lives of so many families and communities, and the overwhelming communication the people running the program get is hostility,” said Bruce Vladeck, an administrator in the Clinton administration.

Not Just A Check-Writing Agency

Gail Wilensky, who ran the agency for two years under President George H.W. Bush, said CMS has evolved into a much more sophisticated operation. “It’s not just a check-writing agency anymore,” she said. But the turnover at the top sends the wrong message to employees, who respond by being “more inward and protective.”

The CMS administrator’s position is a political appointment requiring Senate confirmation. Berwick’s name surfaced as a potential CMS leader shortly after Obama’s election. A pediatrician by training, Berwick gradually shifted his focus to quality improvement, steering the nationally recognized Institute for Healthcare Improvement, a nonprofit based near Boston.

The Obama administration waited to submit his name for the CMS position until April 2010, one month after it won passage of the Affordable Care Act. By then, Republicans were openly attacking the legislation as unduly burdensome and costly. Berwick never did get a Senate hearing and was appointed by the president during the congressional recess that July.

The recess appointment avoided what many predicted would be a losing battle with Senate Republicans. Some of them accused Berwick of promoting rationing, based on favorable comments he had made in the past about the British National Health System. Sen. Pat Roberts, R-Kan., said Berwick’s focus on cutting costs would lead to a rural health system consisting “of a Band-Aid and a bed pan.”

In an interview, Berwick said Republicans “twisted and distorted” his words and used the agency as “a political football. It’s a game to them,” he said. Berwick added that the churn in administrators “demoralizes and confuses” senior staff and hurts the agency’s ability to develop a consistent long-term vision. “What happens, I think, when you have a lot of turnover is senior staff loses its confidence and is less willing to take risks.”

Wilensky said she was “especially frustrated” with what happened to Berwick. “I like Don Berwick. I don’t always agree with him but I have a lot of respect for what he has done and for his passion for the great issues he takes on.”

Berwick had little choice except to resign. His acting term was set to expire at the end of 2011 and 42 Republican senators had already announced their intentions to block his confirmation as a full-time administrator. The administration nominated Tavenner, a former Virginia health official and executive with the for-profit Hospital Corporation of America, just days later.

Several prominent Republicans, including Republican House Majority leader, Eric Cantor, said Tavenner was “eminently qualified” to run the agency. But months later Tavenner still hasn’t gotten a hearing and, with the heated politics of an election year, some wonder if she will.

By Gilbert M. Gaul Kaiser Health News

This story was produced in collaboration with The Washington Post

Jacob Edwards flips through a manual on skin conditions, diagnosing a rash that looks like chicken pox. Jessica O’Babatunde consults her supervisor on treating an adolescent’s obesity, which is literally off-the-charts. And Julie Krueger peppers 3-year-old Daphauni with questions at her physical: How do you spell your name? What did you eat for breakfast? What’s your favorite vegetable? (Cheese.)

They are primary-care residents at Children’s National Medical Center. A third of their class has more than $200,000 each in student loan debt. At the end of residency, they can stay in primary care and earn $29.58 an hour. Or they can specialize and make $74.45. Over a lifetime, a medical student who specializes can expect to earn $3.5 million more.

The Obama administration — and, arguably, the American health-care system — desperately needs them to choose primary care.

Decades of research have confirmed that more specialists leads to more specialty care, which leads to a more expensive system. Now, with the passage of the Affordable Care Act, tens of millions of previously uninsured Americans will be looking for a primary-care doctor. It is no exaggeration to say that the success of the health-care law rests on young doctors choosing to do something that is not in their economic self-interest.

The surprise of the health-care overhaul, at least thus far, is that so many young doctors are cooperating. The number of American medical students matching into primary care residencies jumped 20 percent between 2009 and 2011, according to the Association of American Medical Colleges.

“Regardless of what people think about the health reform legislation, or what side of the aisle people are on, the debate shone a significant light on the importance of primary care,” says Glen Stream, president of the American Academy of Family Physicians. “There was more attention paid to the importance of primary care, the cost-effectiveness of it and that we’re facing a worsening shortage.”

That worsening shortage, he says, has to do with the economics, with nearly every incentive working against going into primary care.

“No matter what speciality you’re going into, your medical education costs the same,” Stream says. “Think about a medical student who is sort of interested in primary care and has got $250,000 in debt. People are often driven by financial incentives, and you basically get the outcome that you incent. Health-care workforce is not different from any other sector in that regard.”

As with speciality doctors, specialty residents bring a hospital more lucrative business. A radiologist will earn a hospital $193 in Medicare reimbursements every hour, a primary-care doctor brings in $101, according to an analysis done for a congressional watchdog agency.

“What hospitals build, in terms of their residency training, has a lot to do with what business they’ll bring in,” says Robert Phillips, director of the Robert Graham Center, which studies health-care workforce issues. “If they have a choice between funding a primary-care residency or one in cardiology, the cardiology residency will make them a lot more money. It’s a perfect storm that aligns the incentives against everything other than primary care.”

Huge projected shortfall

The greatest threat to the health-care overhaul might not be the Supreme Court, which is scheduled to hear challenges to the law next month. Or the shifting alliances of an election year. In the end, it’s more likely to be a lack of medical providers. If the law succeeds in extending health insurance to 32 million more Americans, there won’t be enough doctors to see them. In fact, the anticipated shortfall of primary-care providers, by 2015, is staggering: 29,800.

The Obama administration’s options to address that threat are limited. It does have Medicare, which covers the lion’s share of the cost of training medical residents: In 2009, it spent $9.5 billion on residents’ stipends, teaching physicians’ salaries and related expenses. But when Congress passed the balanced budget amendment in 1996, it cappedthe number of residencies that Medicare can fund. Since then, hospitals’ slots have been tethered to 1996 levels.The health overhaul, some hoped, would address that issue. But with the health insurance expansion’s $971 billionprice tag — and the Obama administration goal to keep the law’s cost under $1 trillion — funds for more slots didn’t turn up.In the context of a $1 trillion overhaul, the White House’s main effort on this front seems modest: a $167 million sliver of the $15 billion Prevention and Public Health Fund created as part of the health-care law.“It’s good,” Stream says, “but it’s also a drop in the bucket.”

Last summer the White House launched the Primary Care Residency Expansion at 82 hospitals across the country, with two strings attached: The programs must train residents dedicated to primary care, and the residents must work in underserved areas.

Medical students see good reasons not to sign up, as primary-care doctors often find themselves at the bottom of the pecking order. Research published last month in the journal Family Medicine found that medical students, even those planning to pursue careers in primary care, viewed the work lives of primary-care doctors more negatively than those of other doctors.

“The income gap that stratifies much of society often stratifies the physician community as well,” a 2009 report on primary care from the Robert Graham Center concluded. “The ‘heart hospital’ side of a medical campus may have fountains and artwork, while the mental image of the primary-care offices is a necessarily full waiting room of a practice where physicians see 40 or more patients a day.”

Those differences help explain the country’s primary-care doctor shortage. They also make an impression on medical students like Reem Nubani, a 30-year-old student at Southern Illinois University interviewing for residency slots.

“It has this connotation that you don’t make much money or you’re not as smart,” says Nubani, who is considering primary care. “Sometimes I feel like it may be even harder in primary care because you still have to know a little bit about everything.”

When the White House launched its residency program, it wasn’t sure medical students would show up. In fact, they snapped up all 172 slots funded in its first year. “The thing we were really thrilled about is that all the positions were filled,” said Kathleen Klink of the Health Resources and Services Administration.

Children’s National Medical Center in the District is among 82 hospitals that were funded. Children’s grant is among the largest, at $3.8 million, and doubled the hospital’s community health residency to 24 students. Some of those new doctors are assigned to the Children’s community clinic on Martin Luther King Jr. Avenue SE, about two miles from the Capitol, where Congress passed the health-care overhaul in 2010.The clinic’s patients are arguably among those who will benefit most from the law’s primary-care expansion. In 1993, the federal government declared the surrounding neighborhood, east of the Anacostia river, a health professional shortage area and, to this day, it has too few doctors to serve its residents.

The doctor shortage correlates with striking disparities between the health of its residents and those who live across the river. Ward 8 residents are eight times more likely to die of heart disease than residents of Washington’s tony upper Northwest neighborhoods in Ward 3, according to a 2008 Rand Corp. analysis. In Ward 8, 33.3 percent of adults are obese, compared with 9.3 percent in Ward 3.The primary-care focus of the Children’s community clinic has attracted students such as Jacob Edwards, 34, who grew up in a low-income, predominantly African American neighborhood in Atlanta. Health-care specialists were hard to come by, he said. Edwards had asthma as a child and remembers his mother driving him 20 miles to see his doctor. “Especially in larger cities, you have higher rates of asthma and an inequality of medicine based on what community you come from,” he says. “I wanted to help bridge that gap.”At Children’s, the care Edwards provides goes well behind medicine. “You end up referring patients to get assistance with basic needs, housing and basic bill paying,” Edwards says.The health-care law bolstered Edwards’s confidence in his decision to join the front line of public health.

For “pediatricians,” he says, “I think there will definitely be a demand and a need for an increasing workforce.”

Familiar hopes

Atul Grover entertained such hopes nearly two decades ago as a young medical student who had watched President Bill Clinton and lawmakers battle over national health-care legislation.

Health management organizations — which emphasized primary care as a way to limit the use of expensive specialists — were booming. So were primary-care residencies: 40 percent of medical students pursued them in 1997, an all-time high.

“There was a very clear signal,” says Grover, who completed a primary-care residency at the University of California at San Francisco. “If you want to be employed, you need to go into primary care. If you want to drive a cab, take something in anesthesiology.”

Phillips, of the Robert Graham Center, graduated around the same time and remembers the era similarly. “There was this groundswell of energy that primary care would be the centerpiece for an effective health-care system,” he said. “We were obviously a bit naive and optimistic.”

The Clinton health-care plan failed. Consumers revolted against HMOs’ limited networks, and the insurance plans rapidly lost market share. As for family doctors? They now earn $150,000 less, on average, than anesthesiologists, according to the American Medical Group Association.

“In the early 1990s, there was a lot of potential,” Phillips says. “By time I was in residency, that was already waning.”

These days, Phillips, Grover and others say the current primary-care craze could end much the same way. The Prevention Fund’s residency financing runs out in 2015, and administration officials say there are no plans to extend the program.

“What I worry about is young physicians being told for a couple of years that this is totally worth it, and then it doesn’t pan out and then they get discouraged,” Grover says. “Unfortunately, I think we are moving in that direction.”

Article By Sarah Kliff for Washington Post

Kliff wrote this article with the assistance of the Dennis A. Hunt Fund for Health Journalism, which is administered by the California Endowment Health Journalism Fellowships, a program of the University of Southern California’s Annenberg School for Communication and Journalism.

An increasing number of nurses are setting their sites specifically on attaining a CNIO position, Hodges told Healthcare IT News in an exclusive interview.

“This is something that has become a passion for many people who went into nursing but also love IT,” she said. “They can see how this role can impact care, especially with the evolving new role of accountable care organizations.”

“Nurses can see the need for an executive nurse focused on nursing needs and nursing practice, so that when health IT solutions are crafted for an organization, they will work for the nurses,” Hodges said.

If the CNIO title follows the course of the CMIO title, it might take some time to become accepted. According to Hodges, the title of chief medical information officer was ten years in the making. It wasn’t readily accepted at first.

Currently, academic institutions and large integrated health systems are the main organizations hiring such a position. A CNIO at a large system can expect to make from $200,000 to $250,000 in base pay annually, she said.

Nurses pursuing this position need a master’s degree in nursing informatics and in some cases a Phd, Hodges said. There are a number of good schools offering highly regarded programs, including the University of Maryland, Vanderbilt and Duke.

“The education programs that exist in nursing informatics need to evolve,” she said. “There is a lot of interest right now, and they are beginning to see traction in terms of more people.”

Hodges will be co-presenting a session titled “The Emerging Role of the Chief Nursing Information Officer: What is the Current State” at the Nursing Informatics Symposium at HIMSS12 on Feb. 20 in Las Vegas.

Article origination by Diana Manos at HealthcareIT News

The study is part of the RN Work Project, a 10-year longitudinal study of newly licensed RNs (NLRNs) that began in 2006 and is funded by the Robert Wood Johnson Foundation. The overtime study drew on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas.

Past research has demonstrated that fatigue caused by long hours without sufficient rest between shifts can lead to mistakes that imperil both patients and nurses.

“The purpose of capping mandatory overtime is to make hospitals safer for patients and nurses,” study investigator Carol Brewer, RN, PhD, FAAN, professor at the University of Buffalo School of Nursing, said in a news release. “Nurses routinely work long shifts, often as long as 12 hours straight. These laws were intended to prevent hospitals from piling mandatory overtime on top of such shifts, a practice that research shows can increase the likelihood of mistakes. The laws seem to be accomplishing their objective.”

According to the study, in 2010, 16 states had rules restricting mandatory overtime hours for nurses: Arkansas, California, Connecticut, Illinois, Maryland, Minnesota, Missouri, New Jersey, New Hampshire, New York, Oregon, Pennsylvania, Rhode Island, Texas, Washington and West Virginia. At issue in the study was the extent to which those laws or regulations had actually affected the workplace. Researchers examined NLRNs’ self-reported mandatory and voluntary overtime hours, as well as their total work hours.

They found that in the states with rules governing mandatory overtime, NLRNs were 59% less likely to work mandatory overtime than their colleagues in unregulated states. (Not all states with overtime rules prohibit mandatory overtime, with some simply limiting total work hours.) Overall, 11.6% of nurses said they worked mandatory overtime in a typical work week, averaging 6.1 hours.

In the states regulating overtime, NLRNs worked an average of 50 fewer minutes per week than their colleagues in states without overtime regulations.

Researchers anticipated that caps on mandatory overtime might lead to increased voluntary overtime, thus defeating the purpose of the restrictions to some degree. But the data demonstrated no relationship between mandatory and voluntary overtime hours. Nevertheless, more than 50% of NLRNs reported working voluntary overtime in a typical workweek.

“While safety is the principal objective of caps on mandatory overtime, the laws probably also have a positive effect on nurse retention,” said study investigator Christine Koyner, RN, PhD, FAAN, professor at the New York University College of Nursing. “Nurses have lives and families outside the workplace just like everybody else, and they probably prefer to have a schedule they can rely on. One way to make their jobs and lives more manageable is to avoid mandatory overtime, which should lead to nurses staying in their jobs, and indeed in the profession longer.”

“The states developed caps on mandatory overtime with safety issues in mind, reasoning that fewer mandatory overtime hours would translate into fewer hours,” said study investigator Sung-Heui Bae, RN, PhD, MPH, assistant professor at the University of Buffalo School of Nursing. “What we learned in this study is that it’s working. The tool is effective. Other states with similar objectives can follow suit and expect similar results.”

RN Work Project

According to RWJF, the RN Work Project (www.rnworkproject.org) is the only multi-state, longitudinal study of new nurses’ turnover rates, intentions and attitudes — including intent, satisfaction, organizational commitment and preferences about work. To date, researchers have learned that more RNs work in hospitals than any other settings early in their careers, with 88.3% working in hospitals six to 18 months after licensure and 78.8% working in hospitals 31 to 54 months after receiving their license.

The study has also revealed that 18.1% of new nurses leave their first employer within a year of starting a job, and 26.2% leave within two years. Nine in 10 of those who leave remain in nursing.

Subsequent studies will determine why nurses stay in or leave their jobs, what influences their first job choice, how the job settings they work in vary over time and whether they move in and out of nursing.

The study appears in an online edition of Nursing Outlook and is available as a PDF at http://www.rnworkproject.org.

Original Article by Nurses.com News .

Wilhelmina Roney prepares a treatment for patient Frank Ratino at Barnes-Jewish Hospital in St. Louis, which offers a program to help nurses fight compassion fatigue. Photo by Tim Mudrovic

With the help of an innovative program offered by the hospital, Ms. Roney says she’s learned how to handle an occupational hazard she wasn’t prepared for: compassion fatigue.

The Barnes-Jewish program is one of a growing number of efforts by hospitals and nursing groups to help combat the constant assault on nurse’s psyches. In addition to meditation and stress-reduction workshops, such programs include discussions about difficult patient situations, support groups, and staff retreats focused on the emotional aspects of care giving.

Compassion fatigue is a combination of secondary traumatic stress from witnessing the suffering of others and burnout. It can lead nurses to feel sadness and despair that impair their health and well-being. Hospitals are tackling the problem amid a worsening shortage of nurses and concerns that patients may suffer. Compassion fatigue can reduce nurses’ empathy and lead them to dread or even avoid certain patients, raising the risk of substandard care.

Nurses who avoid patients “don’t form the relationship necessary to truly understand the patient, identify their problems early, and adapt therapies to their needs,” says Patricia Potter, a nurse researcher and director of research for patient-care services at Barnes-Jewish. Nurses can also become rude and cynical, which can discourage patients from asking them for help, she says, adding less observant nurses may be more error-prone.

Compassion fatigue has been linked to decreased productivity, more sick days and higher turnover among cancer-care providers. A 2008 study led by the University of Nevada, Reno’s nursing school found that about 12% of registered nurses in the U.S. weren’t working. Of those, more than 27% cited burnout or stressful work environments. High turnover and the subsequent increased workload on remaining nurses can result in higher death rates and reduced patient safety, studies show.

“Recognizing, managing and relieving these issues are critical for nurses and their employers,” as well as for patients, says Holly Carpenter, a senior staff specialist at the Center for Occupational and Environmental Health of the American Nurses Association in Silver Spring, Md.

Compassion fatigue was identified as a special problem for nurses in the early 1990s. The ANA’s Healthy Nurse program sponsored its first workshop on the issue at its annual conference last year, with another planned for this year, and it offers special resources on its website. The New York State Nurses Association conducted its first compassion-fatigue workshop at a hospital last year and is urging hospitals and nursing schools in the state to offer such programs.

Concerned about turnover in the oncology unit and evidence of stress among nurses, three Barnes-Jewish nurse managers approached Dr. Potter and the head of the hospital’s patient and family counseling program, Theresa Deshields, for help in 2009. The problem was especially acute for those caring daily for very ill patients whose survival was in doubt. The nurses seemed susceptible to emotional and physical stress and as a result, sometimes disengaged from their patients.

A survey of 150 staffers found that compassion-fatigue symptoms were high enough to warrant intervention.

The hospital turned to Eric Gentry, a Sarasota, Fla., psychotherapist who specializes in teaching stress-management techniques to disaster responders and emergency physicians. A pilot program he created for 14 nurses was promising enough for the hospital to fund development of the compassion fatigue course, now open to all staffers at the hospital, from physicians to housekeepers.

The course includes a checklist of symptoms to watch out for, and offers “antidotes” to compassion fatigue, such as creating a support network. Participants are taught the importance of focusing on “intentionality”—the caring intention that brought them to the health care field in the first place—while accepting their own limits in doing only the best they can on any given day.

The course also teaches physical, stress-relieving exercises. Dr. Gentry says that in anxious or stressful environments, people often react by keeping their bodies tightly clenched all day in anticipation of danger. Relaxing the pelvic floor—the area under and around the pelvis—has been shown to release tension and help control anxiety, he says.

“Being a caregiver is difficult and full of challenges, and that isn’t going to change,” says Dr. Potter. But nurses, she says, can be taught to “self-regulate their stress and restore the energy they need to provide the best patient care.”

Ms. Roney, the cancer-unit nurse, says she first learned about the course after asking a supervisor if there was any way to help with low morale on her unit, including her own. She found herself discouraged when patients or families weren’t satisfied with her care or had a negative outlook.

A particularly draining experience came when a patient in his 40s demanded to know how she felt about caring for cancer patients and if she liked her job. She said she loved it and tried to keep the conversation positive, but he declared, “Well, I’m dying,” despite a likelihood that treatment could extend his life.

“Trying to be compassionate with someone like that is much more difficult” than with some other patients who remain upbeat, even while undergoing chemotherapy, she says.

Jamie Bugg, a 32-year-old nurse at the oncology center, says some of the training felt awkward, such as a session in which participants team up and look into each other’s eyes silently for a minute, and then say positive things about what they observed about each other during the exercise.

Still, Ms. Bugg says she hopes all of her colleagues take the compassion-fatigue course.

“There is a daily toll when you see so many sad aspects of things and people at the end of life, knowing how sick they are and knowing this could be their last holiday,” she says. “We need better ways of coping than internalizing everything.”

____________________________________

Nursing’s Emotional Toll

Compassion fatigue, a combination of secondary traumatic stress and burnout from increasing demands of nursing, can include these symptoms:

Work Related

• Avoidance or dread of working with certain patients
• Reduced ability to feel empathy towards patients or families
• Frequent use of sick days
• Lack of joyfulness

Physical

• Headaches
• Upset stomach, digestive problems
• Muscle tension
• Insomnia, too much sleep
• Fatigue
• Chest pain/pressure, palpitations, tachycardia (elevated heart rate)

Emotional

• Mood swings
• Restlessness
• Irritability
• Oversensitivity
• Anxiety
• Excessive use of nicotine, alcohol, illicit drugs
• Depression
• Anger and resentment
• Loss of objectivity
• Memory issues
• Poor concentration, focus and judgment

 Source: American Nurses Association

Article source by Laura Landro at the Wall Street Journal

The AACN Practice Alert describes family members, friends and other supporters as “partners in care” and outlines administrative and practical considerations for nurses to implement less-restrictive access to the bedside in the ICU.

Although official hospital policies often limit visiting hours in ICUs, most nurses in adult critical care units generally permit unrestricted family visitation, according to the AACN. “This inconsistency contributes to conflict among staff and confuses families,” according to an AACN news release.

Hospitals may limit visiting hours under the assumption that family visitation causes stress for the patient, interferes with the provision of care, is mentally exhausting to patients and families or contributes to increased infections.

“These assumptions are not substantiated by evidence,” according to the AACN. “Instead, evidence suggests that unrestricted presence and participation of a support person … improves communication, facilitates a better understanding of the patient, advances patient- and family-centered care and improves staff satisfaction.”

The AACN Practice Alert calls for nurses to remain accountable for ensuring the safety and well-being of the patient, noting they may choose to limit visitation when doing so is in the patient’s best interest.

The AACN advocates the following guidelines for healthcare facilities relating to visitation rights:

• Establish policies and procedures that support unrestricted visitation in ICUs — ones that allow for the patient’s unrestricted contact with a desired support person while protecting the privacy of other patients and the safety of patients and staff. Policies should support a patient’s right to identify individuals the patient views as “family” and chooses to be partners in care, without discrimination.
• Provide leadership and support for senior administrators to change restrictive visiting policies and practices, including updating materials to communicate more flexible policies to patients, families and communities and educate them about the policies’ benefits.
• Welcome a patient’s “partners in care” 24 hours a day, based on patient preference.
• Allow children to visit when supervised by an adult family member.

According to the AACN and based on available evidence, the goals of policies relating to family visitation within the adult ICU are to:

• Facilitate unrestricted access of hospitalized patients to a chosen support person such as a family member, friend or a trusted individual who is integral to the provision of emotional and social support 24 hours a day according to patient preference, unless the support person infringes on the rights of others, affects safety and/or is medically or therapeutically contraindicated.
• Ensure that the facility and/or unit has an approved practice document — a policy procedure or standard of care — for allowing the patient’s designated support person, who may or may not be the patient’s surrogate decision-maker or legally authorized representative, to be at the bedside during the course of the patient’s stay in accordance with the patient’s wishes.
• Evaluate policies to ensure that they prohibit discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation and/or gender identity or expression.
• Confirm there is an approved written practice document for limiting visitors whose presence infringes on the rights of others, affects safety and/or is medically or therapeutically contraindicated to support staff in negotiating visiting privileges.

Article courtesy of News at Nurses.com