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Nurses key to making healthcare better


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Rebecca Hendren for HealthLeaders Media, December 27, 2011

Nurses made a strong showing in this year's HealthLeaders 20, our annual profile of individuals who are making a difference in healthcare. Four nurses were featured this year, all people who are changing healthcare for the better, and all operating in very different arenas that showcase the many ways nurses make a difference across healthcare.

The public figure
AnnMarie Papa, DNP, RN, is president of the Emergency Nurses Association and has achieved national prominence for her efforts to call attention to the prevalence of hospital violence, especially violence in hospital emergency departments.

Nurses and other healthcare staff are so used to violence from patients and family members that many consider it simply one of the hazards of the job. Healthcare leadership, however, was largely unaware of the scale of the problem until Papa and the ENA shone a light on the statistics and started talking about ways to reduce violence.

ENA published a seminal study in 2009 that revealed one in four nurses in EDs or trauma centers had experienced physical violence more than 20 times in the past three years, and almost one in five had experienced verbal abuse more than 200 times during the same period. Suddenly the topic was on everyone's lips, The Joint Commission published a sentinel event alert, and healthcare facilities started looking at ways to reduce the risk. Many hospitals now have zero tolerance policies and the ENA offers a toolkit for hospital administrators to evaluate the safety of their EDs and trauma centers.

The hospital leader
Robert Donaldson, NPC, is clinical director of emergency medicine at Ellenville Regional Hospital in Ellenville, NY. He is a nurse practitioner and is also president of the hospital's medical staff, sharing ED leadership responsibilities with a medical director.

Under Donaldson's expert leadership, the 25-bed critical access hospital has gone from 8,000 patients a year to 13,000. And it's done so with a staff made up of nurse practitioners and physician assistants.

"We are admitting patients, making money for the hospital, and the hospital is in the black year after year ...The hospital has received an award for its emergency department for patient care. What does that say?" says Donaldson.

In addition to his ED leadership, Donaldson was elected medical staff president and is demonstrating how successful organizations can be when caregivers collaborate and respect is high. The small hospital in the Catskill Mountains is proving to be a model other organizations want to look at more closely.

The care coordinator
Jeanne Yeatman, MBA, BSN, CEN, EMT, developed a program to improve care coordination among flight crews, paramedics, and emergency department staff in the Vanderbilt LifeFlight system in Nashville, TN. She launched the iFly program to help paramedics, ED physicians, and ED nurses learn more about care delivery during the "golden hour in trauma." The program brings caregivers along to shadow and learn the process, which ultimately improves patient care.

Yeatman also spends a lot of time talking about compassion fatigue, which plagues healthcare workers and is a major cause of burnout and leaving the healthcare profession. She recognizes the emotional strain on the more than 150 professionals who average more than 3,000 trips annually and to help them cope with the daily rigors of the job, she builds self awareness about the acuity of patients that LifeFlight transports.

The quality improvement specialist
Diane Whitworth, RN, CWOCN, is a wound ostomy and continence nurse-and a nurse safety scholar-in-residence-at St. Mary's Hospital in Richmond, VA. She has become a champion in the nationwide effort to prevent hospital-acquired pressure ulcers and has overseen her hospital's dramatic quality improvement efforts.

Pressure ulcers are the second most common patient safety incident with a development rate of 36.05 incidents out of every 1,000 hospitalizations. In addition, healthcare-acquired pressure ulcer (HAPU) cost the healthcare system roughly $2.6 billion to treat, according to HealthGrades Seventh Annual Patient Safety in American Hospitals Study, which was released in March 2010.

Whitworth says over the years she started seeing more and more pressure ulcers in patients, which drove her to work toward reducing the rates. In the back of her mind, she often thought of her grandfather, who in his 80s, fell and fractured his hip and developed a pressure ulcer on his foot. He ended up having to have his foot amputated. "At the time it was an acceptable practice," she says. "Even being in healthcare, I thought, 'Well, that is one of the hazards of falling and breaking a hip.'"

In 2006, some areas of St. Mary's were showing healthcare-acquired pressure ulcer (HAPU) rates of 20%, at a time when the national average was only 5-6%. Whitworth and the hospital realized it had a tremendous opportunity to improve patient care. Now, after a culture changes regarding pressure ulcers, the hospital's rate is around 0.5%.

Read more about the incredible nurses making a different in the full HealthLeaders 20 list.

Source: HealthLeaders Media