Yesterday, two my of roommates, both members of the New York State Nurses Association (NYSNA) received a mailer from that union. It's basically a four page pamphlet, listing hospital closings and layoffs in the NYC area. Consolidated like that, it is kind of jarring: in NYC and Long Island alone, there have been three hospital closings and six hospitals which have laid off more than 50 people in the past year alone. The mailer also says that according to an American Hospital Association survey, 50% of hospitals were considering staff cutbacks to deal with "financial stress" as of October 2008. The mailer includes two index card size postcards you can punch out, sign, and send to your state senator or assemblymember to urge them to oppose the $1.3 billion in healthcare budget cuts proposed by Governor Paterson. The NYSNA is not the only one organizing around the budget cuts; SEIU 1199 and the Greater New York Hospital Association launched a million dollar campaign against them earlier this year.
Presumably, the mailer went out prior to the HHC cuts. Interestingly, some of the responses I've read posted to articles about the HHC cuts discussed how difficult it already was for nurses to get a job in NYC even before those cuts were announced.
Friday, March 27, 2009
Monday, March 23, 2009
nyc hospital corporation announces cuts
Last Thursday the NYC Hospitals corporation announced that it was cutting 400 jobs and closing several facilities in an effort to close its budget gap or over $300 million. The "400 jobs" figure came from freezing 200 unfilled positions and laying off an additional 200 workers. The layoffs were expected to affect clerical, physician, nursing, and support staff. Unions affected included New York State Nursing Association, Union 1199, and DC 37, which has thus far been the most vocal in fighting off the layoffs. The facilities HHC anticipates closing include: three school based, one adolescent, and one adult mental health programs, four community clinics, three satellite pharmacies, two HIV case management centers, and a directly observed therapy program for TB. The announced cuts were expected to save about $100 million, but the anticipated shortfall is over $300 million and expected to grow. The City of New York provides about $500 million to fund the HHC, the State about $50million. The President of the HHC has called on the state to use some of it $10 billion in federal stimulus money close the gap.
Interestingly, these cuts come in the context of a capital expansion program for HHC. Among the projects is remodeling and expanding a long-term nursing care facility on the LES. The list, however, is long , and in the context of the current economic climate, it's hard not to second guess the desicion to lay off staff when so many projects are proceeding. However, until we kno what the next round of cuts will look like, it's too soon to judge.
Interestingly, these cuts come in the context of a capital expansion program for HHC. Among the projects is remodeling and expanding a long-term nursing care facility on the LES. The list, however, is long , and in the context of the current economic climate, it's hard not to second guess the desicion to lay off staff when so many projects are proceeding. However, until we kno what the next round of cuts will look like, it's too soon to judge.
Wednesday, March 18, 2009
terrific blog
For those of you who read this because you are considering becoming a nurse practitioner, make sure you read the great blog newFNP by a recently-graduated family nurse practitioner who works at an urban clinic. It's great.
RWJF announces another round of nurse-led innovation
Last week the Robert Wood Johnson Foundation announced this year's participants in its fascinating TCAB program. TCAB (Transforming Care at the Bedside) emphasizes developing nurse-lead patient safety innovations, such as falls prevention programs, or the use of white boards for patient goals. The rationale is that "nurses and other frontline staff are uniquely capable of identifying and implementing process improvements that could result in safer, more reliable care." I like it. :) Sixteen hospitals have been selected to participate, meaning that for the next year med/surg nurses at those hospitals on certain units will be developing, implementing, and testing new patient safety measures with RWJ's support.
Although no local hospitals are participating this year, North Shore Long Island Jewish, the hospital network behemoth, has participated in the past. One of their innovations was "rapid response" teams, an idea gaining popularity in hospitals across the country. The idea behind rapid response teams is to take serious, but pre-critical (ie, they're not coding yet), patient conditions and address them as quickly as possible. At Long Island, the rapid response team yielded a lower number of actual codes, and the hospital reported an improvement in "early assessment" skills. Another innocation was a standardized assessment tool that facilitated clearer physician/nurse communication when a patient's condition is worsening.
The RWJF is incredibly active in supporting nursing in the United States. Last month it created a coalition with the AARP's affiliated charity, the AARP Foundation, to address the nursing shortage, which is projected to worsen over the next several years as more and more nurses retire. The coalition, which includes health care providers, consumer organizations, and businesses, will also seek funding to improve nurse education, job satisfaction, and retention. The RWJF has worked with the AARP and the Department of Labor to address the nursing shortage in the past, and even offers $10,000 scholarships for student nurses, especially those from groups that are underrepresented in nursing or from disadvantaged backgrounds.
Although no local hospitals are participating this year, North Shore Long Island Jewish, the hospital network behemoth, has participated in the past. One of their innovations was "rapid response" teams, an idea gaining popularity in hospitals across the country. The idea behind rapid response teams is to take serious, but pre-critical (ie, they're not coding yet), patient conditions and address them as quickly as possible. At Long Island, the rapid response team yielded a lower number of actual codes, and the hospital reported an improvement in "early assessment" skills. Another innocation was a standardized assessment tool that facilitated clearer physician/nurse communication when a patient's condition is worsening.
The RWJF is incredibly active in supporting nursing in the United States. Last month it created a coalition with the AARP's affiliated charity, the AARP Foundation, to address the nursing shortage, which is projected to worsen over the next several years as more and more nurses retire. The coalition, which includes health care providers, consumer organizations, and businesses, will also seek funding to improve nurse education, job satisfaction, and retention. The RWJF has worked with the AARP and the Department of Labor to address the nursing shortage in the past, and even offers $10,000 scholarships for student nurses, especially those from groups that are underrepresented in nursing or from disadvantaged backgrounds.
Wednesday, March 11, 2009
hospital error reporting
Sorry to have been off the grid for so long; but I'm back now. :)
Interesting article in Monday's NYT about the rate at which NYC hospitals are reporting errors. There are apparently huge disparities between comparable institutions, and some of the city's most prestigious hospitals are implicated in poor reporting. New York-Presbyterian, a combination of Columbia-Presbyterian and the former New York Hospital, which now goes by Weill Cornell Medical Center, reported only 20 adverse incidents per 10,000 discharges. Another "comparable institution", which the article did not name, reported 166 adverse incidents per 10,000 discharges. Of the hospitals owned and operated by the city, Bellevue, generally regarded as the most prestigious, is on a list of the 12 lowest reporters released by the city comptroller. Others included on that list are Lenox Hill and Mt. Sinai. The assumption is that these low reporting rates are the result of poor reporting rather than excellent care.
I wish this article was more explicit about to whom these errors should have been reported. The analysis that discovered these disparities was the city comptroller's office, but it seems unlikely, albeit possible, that hospitals are expected to routinely report adverse events to that office. The comptroller's website says nothing about hospitals, although it does include in its list of activities "audits of New York City agencies."
The point of raising this issue is that I wonder if there is a disparity between what hospitals report out and what they monitor internally. I bet there is, due to mostly to two factors: the hospitals' self-interest, and differing definitions of "adverse event". For example, a nurse friend of mine who works in one of the hospitals named in the study accidentally gave a medication intranasally instead of by injection. The patient was fine; the reason the route had been changed was because the intranasal med seemed to have no effect. But she still had to fill out an incident report, etc. because the hospital considered it an adverse event. I doubt errors of this nature were reported to whatever body this is by any hospital, but it was monitored internally by her institution. That is, just because an incident was not reported to an external body does not mean it went unnoticed. I would be curious to know how the external body to which hospitals are supposed to report adverse events defines "adverse event", but I can't find out because I don't know what that external body is If its definition is grave (ie, it's only an adverse event if it results in death or disability) that would mean these hospitals are concealing major errors and underreporting is really a cause for concern. If its definition is more trivial, the underreporting of adverse events is less of a worry, although it obviously shouldn't be tolerated.
Interesting article in Monday's NYT about the rate at which NYC hospitals are reporting errors. There are apparently huge disparities between comparable institutions, and some of the city's most prestigious hospitals are implicated in poor reporting. New York-Presbyterian, a combination of Columbia-Presbyterian and the former New York Hospital, which now goes by Weill Cornell Medical Center, reported only 20 adverse incidents per 10,000 discharges. Another "comparable institution", which the article did not name, reported 166 adverse incidents per 10,000 discharges. Of the hospitals owned and operated by the city, Bellevue, generally regarded as the most prestigious, is on a list of the 12 lowest reporters released by the city comptroller. Others included on that list are Lenox Hill and Mt. Sinai. The assumption is that these low reporting rates are the result of poor reporting rather than excellent care.
I wish this article was more explicit about to whom these errors should have been reported. The analysis that discovered these disparities was the city comptroller's office, but it seems unlikely, albeit possible, that hospitals are expected to routinely report adverse events to that office. The comptroller's website says nothing about hospitals, although it does include in its list of activities "audits of New York City agencies."
The point of raising this issue is that I wonder if there is a disparity between what hospitals report out and what they monitor internally. I bet there is, due to mostly to two factors: the hospitals' self-interest, and differing definitions of "adverse event". For example, a nurse friend of mine who works in one of the hospitals named in the study accidentally gave a medication intranasally instead of by injection. The patient was fine; the reason the route had been changed was because the intranasal med seemed to have no effect. But she still had to fill out an incident report, etc. because the hospital considered it an adverse event. I doubt errors of this nature were reported to whatever body this is by any hospital, but it was monitored internally by her institution. That is, just because an incident was not reported to an external body does not mean it went unnoticed. I would be curious to know how the external body to which hospitals are supposed to report adverse events defines "adverse event", but I can't find out because I don't know what that external body is If its definition is grave (ie, it's only an adverse event if it results in death or disability) that would mean these hospitals are concealing major errors and underreporting is really a cause for concern. If its definition is more trivial, the underreporting of adverse events is less of a worry, although it obviously shouldn't be tolerated.
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