Last year one of my patients was on the phone, lamenting about how long he had been in the emergency room. He had already waited several hours to get a CT scan. Medications he was supposed to be given were repeatedly delayed. I heard his voice rise and fall, with each swell more expansive than the one before. When I turned to look at him, he yelled a racial epithet before hurling a desktop computer into the area where doctors and nurses sit. A seasoned nurse ducked. As I pushed an intern and medical student out of the way, he charged at us with a steel tray. Thankfully, no one was injured.

According to the article, a 2022 survey of Emergency Medicine Physicians found that “55 percent said they had been physically assaulted, almost all by patients, with a third of those resulting in injuries. Eighty-five percent had been seriously threatened by patients.” For ER nurses, it is worse: 70% reported physical assaults at work.

This is unconscionable.

The article was written by Emergency Medicine physician and Columbia University professor Dr. Helen Ouyang. She wrote this:

In the E.R., there’s a certain level of resignation that violence is just part of the job, like getting bloodstains on our shoes. We have come to endure racist, sexist and homophobic slurs, choosing silence over confrontation, to fulfill our duty to care for human life. After all, we pledge to hold our patients’ well-being above all else.

Violence should never, ever, ever, ever, ever be “just part of the job.” This is unacceptable. Those of us who have answered the call of healthcare – whether physician, or nurse, or respiratory therapist, or physical therapist, or patient care technician – have sacrificed a great deal to be here. We have given so much of our time, our blood, our sweat, and our tears to care for those who are ill.

No part of this job should include violence directed toward the healthcare team. None.

I understand that sometimes, if not many times, patients are not in their right minds. They may be sick with infection, or organ failure, or substance abuse. That does not excuse violence against us. I always say that patient safety is “number one a.” Staff safety is “one b”: it is co-equal with patient safety.

We can’t easily fix the societal maladies that lead to violence against healthcare workers. At the same time, every healthcare institution must ensure that their staff is safe at work. It is an absolute necessity.

Please make sure you read the article and watch the opinion video accompanying it. It is heart-wrenching.

And I say again: violence should never, ever, ever, ever be “just part of the job.” It is absolutely unacceptable.

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I planned, and then God laughed.

The first flight got delayed initially because the incoming flight was delayed. Then, at the gate, when I still had hope to leave relatively soon, the plane had a maintenance issue and we had to change planes. 

Everyone was frustrated, and I must admit so was I. This whole delay disrupted my entire day, and I was already on a tight schedule because I was flying home the same day. I had to miss some meetings. 

Yet, the reason for the delay was that there was a maintenance issue, and this maintenance issue could place the safety of the passengers and crew at risk. This was a nonstarter. 

Better be late than risk the safety of people on an airline. Better cancel the flight altogether, like for bad weather, than risk loss of life and limb. Better I miss a meeting than never show up to that meeting or go back home ever again. 

Yes, it can frustrate passengers, and the airlines do have an obligation to help their passengers (their clients essentially) when their travel plans get disrupted. Still, safety is absolutely essential and no shortcuts can ever be made. 

Would that Healthcare have the same attitude. The airline industry has some of the best safety records in the world. It may not be as well known that it is much safer to fly than drive. This is because the airline industry never compromises on safety. We need to be the same in Healthcare. 

There are thousands upon thousands of medical errors that occur each and every year. Many of these errors can cause significant harm to patients. And when these errors are examined critically, too often the safety checks that were in place were bypassed in order to save time or assuage an angry or upset patient or family member.

This should never occur. 

Yes, I get very frustrated with the stops and safety checks my EMR places in front of me (that dreaded stop sign in Epic gives me PTSD). And sometimes it doesn’t make sense from a clinical perspective. 

But they are in place for the sake of my patients’ safety. That should make me patient with them. What if that patient who gets harmed by a medical error is my family? What if they are my child? I would be devastated to learn that safety measures were bypassed. 

Yes, flight delays can be terribly frustrating – especially those for maintenance and safety issues (why didn’t they figure them out sooner?). But they are there to make sure we get to our destinations safely. If we die because of a safety issue that was ignored, no vacation or work meetings will occur…permanently. In fact, I was able to write this article because my flight delay gave me time to reflect about this. 

At the same time, every time I travel I pray to the Lord this: “Lord, take me to my destination safely and on time.” Most of the time, it goes without a hitch. However, the “safely” part comes will always come at the expense of the “on time” part. I thank God for that, and we need to be better at it with the patients entrusted to our care. 

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Part of society deems it honorary, while another views it as workhorse. Still another sector, physicians, oftentimes respond to nursing personnel as though they are invisible, inconsequential creatures. The reality is that the expertise, knowledge, training, and intuition that constitute a good nurse, create an absolutely invaluable, supportive role in medicine and in society. This fact is the focus in this essay.

Nursing credentials come in two forms, the LVN and the RN. Both are licensed. Both have the opportunity to engage and join in one or more of several affiliations that support nursing roles and create opportunities for advancing knowledge and certifications in specific nursing specialties. The LVN requires two years of pre-requisites and 3 following semesters of nursing school. The RN requires two years of prerequisites and 4 following semesters of nursing school. Either profession may continue to BSN or MSN status.

The Unique Qualifications of Nursing

The LVN and RN learn and utilize life-preserving and life-saving skills that progress and sharpen with daily use. Each patient interaction requires moment by moment professional medical judgment to exercise consistent patient care that fosters both health and safety, optimally. No patient, case or shift is ever the same. This reality requires the nurse to be vigilant and up to date in the practise of medical knowledge and skills, such as medication administration/knowledge or the knowledge/practical execution of appropriate interventions and/or triage assessment of/for health-compromising insidious symptoms easily misunderstood, ignored or missed.

Professional positions in a society must meet some important needs of the members of that society. Nursing supplies human beings with preventative healthcare, emergent healthcare and supportive healthcare, which is a most basic biological need of humankind. Most lifelong nurses will agree that to enter the nursing profession is indeed a life purpose and calling. Those who do leave the field usually do not do so without much brooding and conflict, as caring for people is usually interwoven into a nurse’s physical and emotional makeup and is very difficult to break from, professionally and personally.

To be successful in the nursing field, the nurse must always be open to learning about the co-disciplines involved in patient care and in cross-training in new specialties. This gives the nurse opportunity for a deeper understanding of patient perspective and experience, provides the mastering of all skills required to care for and treat diverse patient groups/needs and also increases flexibility for advancement in their career.

The resources available for nurses to continue in and to support their professionalism are Continuing Education Credits, medical seminars, and opportunities to educate patients through pop-up clinics/speaking engagements.

As a nurse hones his/her specialties, they are able to have increased autonomy over their schedules, which provides the freedom and time to focus on their own expression and direction of the profession (such as online courses/blogs/teaching materials), which they have personally designed.

Professionalism Is Actually A State of Mind.

Although not every job is a profession, every employee has the capability to be a professional in moral and in integrity.

Nurses are absolutely required to have the highest integrity and moral values and to carry out those characteristics with every patient they encounter, without a trace of judgmentalism.

Not every person faces a job with conviction or investment in the counterparts, but most nurses do, as the counterparts are people and people are why we do what we do.

I enjoy my profession as a nurse because I have had daily opportunities over the past thirty years to love and care for the precious human beings on this planet.

Professional, committed nurses make the medical world go ‘round.

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When the time finally came, I came to the ICU thinking I knew all that there was to know about Critical Care Medicine. I came to the ICU fully confident in my abilities to crush critical illness and save every patient I saw. I came to the ICU roaring like a lion…until I met the ICU nurses.

They whipped me into shape real, real quick. They showed me, in short order, what I didn’t know, and they showed me how to be properly behave in the ICU. I came to the ICU roaring like a lion…and the ICU nurses left me meowing like a kitten. And that experience taught me very early on to NEVER cross an ICU nurse.

The nurses in the ICU are among the best nurses around. They are highly skilled, highly educated, highly motivated to do what is right for the patient, and they do not back down easily. They will keep fighting for the patient with all their might, all their passion, and all their soul. I am not saying that other nurses do not do this. I am saying that ICU nurses do this par excellence.

I was witness to their selfless care during the COVID-19 pandemic. They spent hours at the bedside of countless very, very sick people with COVID-19. They gave them everything they had, and if the patient was not going to make it, they made absolutely sure the patient did not die alone, holding their hand in the room while the family was mourning on an iPad or cell phone.

They are such an important component of the care of the patient in the ICU. I was – and continue to be – in awe of their excellent patient care, and I am grateful to be their partner in the ICU.

As I said before, when I first came to the ICU, they whipped me into shape real, real quick. I learned to NEVER cross an ICU nurse, and their tough love made me a much better critical care doctor. I am forever better because of those ICU nurses with whom I worked my very first month in the ICU as a doctor. And to them – along with every other ICU nurse – I am forever grateful.

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In the very beginning, I must admit, there was a small bit of a thrill inside me: “I’m joining the war against SARS CoV-2…I’m part of the fight in this global pandemic.” People all across the world stood up to thank us, whether banging pots and pans from their windows, or sending us cards, posters, and treats. While we are not in it for the praise, the praise was nice nonetheless.

Almost two years into this pandemic, I must say that thrill is gone.

In my entire career, I have never experienced the scale of death and destruction by one condition. I was in practice during the 2009 H1N1 pandemic; I have worked many bad influenza seasons. All of those pale in comparison to the SARS CoV-2 pandemic. It has been horrific.

There are scenes in my head that can never be unseen. Patient after patient after patient has died – many times alone in the ICU with their families screaming in anguish on an iPad. We are exhausted, physically, mentally, and emotionally.

We had thought that, with the advent of vaccines, it would be the beginning of the end. Indeed, tens of millions of us have gotten vaccinated, and in the beginning of the summer of 2021, it seemed like it was over.

But there were also tens of millions of us who didn’t want to get vaccinated, even though the vaccines are incredibly safe, incredibly effective, widely available, and free of charge to boot. And when Delta hit our shores, the anguish started all over again.

Hospitals and ICUs were, once again, overwhelmed with COVID-19 patients. Once again, tents were erected outside of Emergency Rooms. Once again, resources were running thin. In one of my hospitals, we came dangerously close to running out of ventilators. In some parts of our country, fellow colleagues had to choose which patient would live or die. I never though it would be like this – again – in the summer of 2021. But, it was, and we are exhausted.

And now, way more than before, the patients coming in with COVID-19 – the overwhelming majority of whom are not vaccinated – are younger. And, they are dying.

What’s more, many of them are angry and belligerent towards us. What did we do? Why are you taking our your frustrations out on us? We are angry, too, but we would never take it out on our patients, who come to us seeking our help to relieve their suffering. It’s been a terrible road, and we are exhausted.

And, like I said, the virus is not yet done with us. I genuinely fear this winter, where we may very well have “Revenge of the Flu” along with a steady stream of new COVID-19 patients. It may very well get worse before it gets better. But, we don’t have much left to give. We are done with this virus, and we are exhausted.

And so, as we soldier on, all I can say is, “Thank You.”

From the very bottom of my heart and soul, I say “Thank You.” Thank you, my sisters and brothers on the front lines, for all you have done. Thank you, my sisters and brothers, for your fatigue. Thank you, my sisters and brothers, for your exhaustion. Thank you, my sisters and brothers, for your exasperation.

This pandemic has tested us to our very cores, and I pray that we will come out of it much better caregivers and much better people, our emotional scars notwithstanding.

If I said “Thank You,” my sisters and brothers, for eternity it would not be enough. But still, let me say, one more time, “Thank You.” You are all so special to me, and you will always be in my heart and my prayers.

The post Sisters And Brothers On The Front Lines appeared first on Medika Life.

Arena Analytics offers a solution

Date of Release: Sept. 15, 2020

BALTIMORE/PRNewswire/ — Even before the COVID-19 pandemic hit this continent, healthcare workers across the U.S. were struggling with stressful, exhausting, and untenable conditions. Whether as a result of increasing administrative demands as a result of changing insurance requirements, increasing acuity of walk-in patients, or the shortages of skilled nurses and medical professionals pushing staff into longer shifts and over-time – healthcare workers at hospitals and post-acute/long-term care communities have long had among the toughest jobs in America. And, as recent events have revealed, these jobs have only gotten harder.

Arena Analytics recently examined a wide range of peer-reviewed journals for research related to these workforce issues and the impact on quality of care. The results raise questions for our society to consider – what can we do to ensure that those we rely upon to care for us, are being supported in this essential, important work?

“Researchers consistently found significant correlations between decreased quality of patient care and staff struggling with burn-out and ‘new hire’ turnover,” says Myra Norton, Arena’s President & COO. “We knew this from the experiences of our partner healthcare employer organizations, but researchers across the country have aggregated abundant evidence that the impact is real and widespread.”

As one example, data collected from 268 nursing units at over 100 hospitals found that “instability in the nursing workforce implies adverse impacts on the continuity and quality of patient care.”They found that low levels of turnover were associated with fewer patient falls and fewer medication errors. The authors recommended that nursing unit turnover be managed within appropriate levels as a critical step in delivering high–quality patient care. ¹

In one of the largest studies on this topic, involving over 95,000 registered nurses taking the Multi-State Nursing Care and Patient Safety survey, high levels of burnout and job dissatisfaction among hospital nurses were associated with lower patient satisfaction, which signals problems with quality of care.

Michael Rosenbaum, Arena’s Founder and CEO, sees multiple means of addressing the conditions which give rise to worker burn-out, fatigue, and dis-engagement. But once multiple operational processes are in place, the most effective way to  bring these changes to bear at scale requires making changes at the source – by implementing a data-informed, bias-free process of optimizing the hiring of people who will work well within existing teams and remain committed to the organization’s mission.

“We help organizations move away from guesswork and unconscious hiring biases to a more objective approach informed by data, advanced analytics, and machine learning. We’re excited to provide value to mission-driven, people-centered organizations who share our vision of hiring for outcomes, and matching people to meaningful careers.”

Across the 1,100 healthcare facilities implementing Arena’s technology, all have experienced reduced ‘new hire’ turnover rates, averaging a 21% reduction within 12 months of deployment. 

About Arena (https://www.arena.io/) applies predictive analytics and machine learning to solve talent acquisition challenges. Learning algorithms analyze a large amount of data to predict with high levels of accuracy the likelihood of different outcomes occurring, such as someone leaving, being engaged, having excellent attendance, and more. By revealing each individual’s likely outcomes in specific positions, departments, and locations, Arena is transforming the labor market from one based on perception and unconscious bias, to one based on outcomes. Arena is currently growing dramatically within the healthcare industry and expanding its offerings to other people­-intensive industries. For more information contact info@arena.io

SOURCE Arena

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