Connecting Safety and Health for Black Nurses
Assessments of workplace health and safety are linked to Black nurses’ personal health evaluations.
A new study finds that for Black nurses, assessments of workplace health and safety are closely linked to their personal health evaluations, underscoring the need for healthy work environments (HWEs) to support these healthcare professionals.
“Original Research: Exploring Black Nurses’ Perceptions of Workplace Safety and Personal Health,” in AJN: American Journal of Nursing, analyzed data from 1,143 nurses who identified as Black or African American in the American Nurses Association’s HealthyNurse Survey from May 2017 through December 2019.
While 68% to 88% of Black nurses felt valued and supported in ways that created safety, about one-quarter experienced verbal or nonverbal aggression or threats in the past year from peers (29%), patients (27%) or leaders (23%).
About half felt obligated to work when ill or injured and skip breaks to complete tasks. In addition, 28% said they were assigned higher workloads than they were comfortable with, and 30.5 % perceived their health as fair or poor.
“It was disturbing to learn that such a high proportion of Black nurses, who work to improve the health of all patients, were often suffering themselves,” the study notes, adding that employees who feel safe at work are more likely to rate their health as good to excellent.
“Thus, in light of the many known disparities compromising the health of Black people, it is crucial that organizations and leaders work to support Black nurses’ well-being by improving their work environment.”
AACN supports hospitals and nurses with resources to help achieve and maintain HWEs:
- The HWE webpage describes the six evidence-based standards for healthy and effective work environments.
- The AACN Healthy Work Environment Assessment Tool (HWEAT) can provide valuable feedback from nurses and healthcare team members regarding HWE efforts.
- The webinar “Creating and Sustaining Healthy Work Environments (HWEs)” explores the HWE standards and discusses how to evaluate your unit using the HWEAT.
AHA Stresses Team Approach to Manage Poststroke
Teamwork is critically important to identify and manage poststroke complications.
To reduce and manage complications from strokes occurring during hospitalization, the American Heart Association (AHA) urges hospitals to form interdisciplinary teams with specialized education on stroke care and to implement effective, evidenced-based strategies to improve patient outcomes.
“Addressing Systemic Complications of Acute Stroke: A Scientific Statement From the American Heart Association,” in Stroke, details primary poststroke complications, including stroke-associated pneumonia, venous thromboembolism, dysphagia, acute kidney injury and various other respiratory, gastrointestinal and renal complications. The AHA statement identifies knowledge gaps and offers cohesive clinical care recommendations based on existing evidence and expert opinions.
Critically important to identify and manage poststroke complications is teamwork from physicians, nurses, rehabilitation specialists and other medical professionals with experience in stroke care and rehabilitation.
“Formation of such teams is necessary to bridge knowledge gaps and fragmentation of care and to inform real-life practice,” the statement notes. “These endeavors should be coupled with implementation strategies that facilitate their uptake in diverse clinical settings.”
Management of post-stroke complications also requires coordinated efforts by healthcare professionals after hospital discharge. But real-world clinical gaps make it challenging to access timely care, particularly for survivors with lasting disabilities. “Further research is needed to develop efficient models for care transitions, taking into consideration patient needs, social contexts, and their unique vulnerabilities.”
A related study in JAMA Neurology examined the treatment of 19,433 patients with acute ischemic stroke who were potentially eligible for intravenous thrombolysis. Findings show that prehospital management in a mobile stroke unit (MSU) compared with standard EMS management resulted in significantly lower levels of global disability at hospital discharge.
Patients treated in MSUs are more likely to receive intravenous thrombolysis quickly and ambulate independently at discharge, the study adds, underscoring the importance of policy efforts to expand access to prehospital MSU management.
Preceptor Competency Model Aims to Set Standards
The study developed a consensus model of required preceptor competencies.
A model for developing preceptors clarifies the knowledge and skills to perform all aspects of the role. A mixed-method approach was used to develop a consensus on the required competencies.
“National Preceptor Competency Consensus Study,” in JONA: The Journal of Nursing Administration, notes that a multistage process helped identify and refine 66 preceptor competencies across seven role domains. “The evidence provided from this National Preceptor Competency Consensus Study provides the foundation for understanding the complexity of the preceptor role and provides a nationally derived consensus model of preceptor competence that can be used to select, develop, assess, evaluate, and support preceptors,” the study notes.
The model uses the domains of role model, teacher/coach, facilitator, protector, socialization agent, leader/influencer and evaluator, listing the consensus competencies for each one. “These competencies represent the foundational knowledge and skills on which preceptor education and training can and should be developed and on which preceptor performance can be assessed and evaluated.”
The research team’s next target is development of a preceptor assessment tool based on the competencies for screening, self-assessment, initial and ongoing assessment, and evaluation. “The team is using the consensus role domain definitions, essential attributes, core competencies, and role domain competencies to develop an evidence-based, valid, and reliable tool for preceptor assessment and to create a national repository of data.”
In addition, AACN’s Fundamental Skills for Preceptors, an online continuing education course, includes preceptor/orientee scenarios, standard-setting content, practical applications and video content. The course focuses on skills needed to help orient nurses who are new to a unit, organization or specialty and enhance their onboarding process by “providing constructive feedback, supporting emotional well-being in stressful situations, and evaluating when orientees are ready to transition to independent practice.”
New Nurse Orientation Checklist Builds Skills Progressively
Each phase leads to higher-order decision making as the nurses build their experience.
A health system developed a checklist for transitioning new graduate nurses to clinical practice with three phases of orientation, with tasks, skills and competencies at each level.
“New Nurse Orientation,” in American Nurse, notes that tools for hospital nurse educators and preceptors emphasize clear orientation language and goals that new nurses achieve gradually. “The Phases of Orientation checklist helps ensure the effective and progressive orientation of goals and skills,” the article adds. “Written in simple language, the checklist helps to ease new nurse graduates into practice and also provides new preceptors with clear orientation goals and objectives.”
Developed by St. Joseph’s Health and in use at University Medical Center in Paterson/Wayne, New Jersey, the checklist helps prepare new nurses to function independently on an expected timetable, and it reduces inconsistencies in the process. The checklist remains visible for both educators and nurses to reduce anxiety and clarify the reasons behind the questions.
Each phase includes critical-thinking questions and leads to higher-order decision making as the nurses build their experience. Using the checklist system, “nurses move from lower-level thinking skills (knowledge and comprehension) through mid-level skills (application and analysis) to higher-level thinking skills (synthesis and evaluation).”
Using the checklist, teams can hold meetings with nurses, preceptors, educators and managers with defined expectations that focus on current clinical skill sets and progress toward the next goal. The article notes that “when the new nurse recognizes where they’re struggling, the educator can plan additional opportunities to help them reach their clinical goals,” adding that the system “creates an environment that supports new nurses.”
AACN resources include the New Nurse Orientation Pathway, which can be personalized while maintaining educational requirements, and the Competence Framework & Toolkit for Progressive and Critical Care webpage. The AACN Knowledge Assessment Tool helps identify educational needs for nurses new to ICU or PCU patient care.
Guiding Safe Medication Transitions for Seniors
A standardized medication discharge plan lists guiding principles in five categories.
To improve medication safety for older adults discharging from the hospital, a study introduces a standardized medication discharge plan (MDP) that uses consensus-based principles to enhance communication between healthcare providers and patients.
“Promoting Medication Safety for Older Adults Upon Hospital Discharge: Guiding Principles for a Medication Discharge Plan,” in British Journal of Clinical Pharmacology, establishes 26 guiding principles, prioritizing 17 for a short-version MDP. The study describes the principles, outlines patient-selection criteria and recommends the MDP format and mode of transmission.
Conducted in Quebec, Canada, the study used a modified Delphi approach, involving four rounds of online questionnaires to gain consensus on guiding principles from 16 participants, including physicians, a hospital-based geriatrician, pharmacists and a specialized nurse practitioner – plus one patient, one caregiver and one researcher.
The MDP lists guiding principles in five categories:
- Care during hospitalization: Gather information on medications received and completed in the hospital.
- General medication information: Consider medication selection, administration, changes and cessation.
- Plain-language summary: Clearly explain relevant medication changes and monitoring.
- Communication with patients and professionals: Provide education and ensure the patient or caregiver’s spoken language is understood; list contact details for the patient, hospital and family physician.
When prioritizing patients for an MDP, consider nonmedication factors such as concurrent medical conditions and neurocognitive disorders, as well as medication-related issues such as adverse drug reactions and high-risk polypharmacy. Give priority to patients who meet both criteria.
The study notes that previous efforts to standardize MDPs were inadequate, often concentrating on information transfer rather than clinical content or patient selection, and not addressing the complexities of senior care.
“To our knowledge, this study is the first to establish a consensus-based standardized MDP for hospitalized older adults to optimize medication safety during transitions of care,” the study adds.
Telehealth Initiatives Bring Cost Savings, Higher Satisfaction
The benefits of inpatient virtual care include regained bedside hours for nurses.
Bedside telehealth initiatives and advanced technology in patients’ rooms are associated with an effective return on investment (ROI) by reducing staffing costs and hospital-acquired conditions (HACs), and regaining bedside hours for nurses.
“Modernizing Acute Care: The Economic Impact of Bedside Telehealth,” in Healthcare IT News, notes that research on technology trends for inpatient care shows the potential for long-range cost savings, and also increased employee and patient satisfaction. “As care continues to evolve, organizations that have embraced virtual engagement and AI at the bedside will have the infrastructure and experience necessary to seamlessly incorporate new technologies and care models, ensuring they remain at the forefront of healthcare innovation,” the article adds.
The first area the article lists for ROI benefits is resource cost reduction, which could be achieved through reducing the administrative burden on nurses and freeing them up for higher-level tasks. With more time spent on their preferred tasks, nurses report higher job satisfaction, which leads to lower turnover and greater cost savings.
Costs related to HACs could be reduced through expanded telehealth thanks to enhanced monitoring abilities and compliance with best practices. “Health systems reported reductions in catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), pressure injuries and patient falls.”
A related resource, “AACN Tele-critical Care Nursing Consensus Statement,” offers hospital leaders and nurses recommendations and a framework to explore practice changes based on new applications of telemedicine. Real-world examples through clinical vignettes explain how to implement the recommendations.
Swing-Shift Relief
When a cardiothoracic ICU in New York added a new swing-shift RN role, they experienced a more than 50% reduction in nurse turnover in less than two years. Developed as part of an AACN Clinical Scene Investigator (CSI) Academy project, this new position ensured break coverage and assistance with patient transfers and admissions, and helped improve the health of their work environment.