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Nurses

Feds recommend trio of changes in staffing, hiring and overtime management to facility’s new leadership

Northport VA Medical Center. File photo

A federal investigation into Northport Veterans Affairs Medical Center’s four community living centers has shown a troubling trend of chronic nursing staff shortages and excessive overtime, issues that could have placed patients “at a higher risk for adverse events.”

In one case, federal investigators found a nurse’s assistant worked double shifts for six straight days — more than 96 hours in a single week – while expected to diligently oversee a patient requiring one-on-one care.

As the Northport facility is the only VA Medical Center on Long Island it serves more than 31,000 patients per year and oversees several outpatient clinical sites. Its four nursing homes are located in two buildings, with an approximate capacity of 170 beds.

The Office of Inspector General, a division of U.S. Department of Health & Human Services, charged with independent oversight of Department of Veterans Affairs programs, received several anonymous complaints about the quality of care received at Northport VAMC in 2017 following the deaths of two patients.

In September 2017, the OIG launched a year-long investigation into staffing shortages after receiving two further emails: the first from an employee at Northport VAMC, the second from a liaison to the House Committee on Veterans’ Affairs. The investigation produced a Sept. 18 report (click here to read the full report) that found Northport VAMC’s leadership knew about the staff shortages, forced administrative level nurses to care for patients, and yet still continued to accept new patients despite knowing they wouldn’t have the staff needed to provide the expected level of care.

Federal investigators recognized in August 2017 there was significant turnover in the leadership at the Northport VAMC, affecting key positions such as its director, acting chief of staff and acting nurse executive, who were cited “as catalysts for this change.” Staff members’ remarks indicated it’s given them hope for a better future.

The agency recommended a series of changes for the Northport VAMC pertaining to the nursing staff currently being enacted, and the facility says is bringing immediate tangible results.

Two patient deaths

Anonymous complaints about two patient deaths at the Northport VAMC in 2017 started the series of federal investigations into the facility.

The first death was a male patient in his late 60s who died as a result of choking on his food. Federal inspectors found insufficient evidence the man’s death was due to a lack of nurse oversight, as alleged in the complaints, but did conclude Northport VAMC had ongoing challenges in maintaining basic necessary staffing levels.

“Conditions such as staffing shortages could create an environment where the increased workload assigned to each staff member was such that it became more difficult to remain vigilant,” the report reads.

A forum was held for the Northport VA nursing homes staff to voice their concerns with the facility and its operation while an investigation of the first patient’s death was ongoing.

“Many [staff members] shared a concern about staffing levels being too low,” the report reads.

A second death raised claims of poor quality of care in the Northport vets nursing homes, after a patient in his mid-60s slipped, fell and fractured his hip. He underwent surgery and six days later stopped breathing. Allegations included the VA staff failed to protect the patient from falling and failed to properly provide
one-on-one observation post surgery, neither of which was substantiated by federal investigators.

The investigation into the second death showed the nurse’s assistant caring for him was on her sixth consecutive day of double shifts — 16 hours at a stretch. Investigators again cited “concern that working extra hours with double shifts could lead to staff becoming tired and less vigilant.”

A staff member working double shifts was not common practice, according to Northport VAMC spokesman Levi Spellman, who said union workers are contractually required to have 10 to 12 hours off between nursing shifts.

Closer look at staffing numbers

Records pulled by the federal investigators showed Northport VAMC has been chronically short of nursing staff dating back to at least 2016. Allegations were made that understaffing could lead to a higher rate of “nurse-sensitive outcomes,” such as surgical wounds getting infected, urinary tract infections, ulcers and pneumonia.

Northport’s four nursing homes were found to be short approximately 6.3 full-time employees in 2016 needed to meet VA’s recommended number of nursing hours spent with patients per day. By 2017, the facility’s staffing shortage had more than doubled, with 15.3 additional full-time employees needed. Northport VAMC’s nursing homes were only staffed at 60 to 80 percent of recommended levels over the two years, according to federal investigators.

Northport VAMC’s leadership attempted to tackle the short staffing issue by using “floating” shifts and overtime — sometimes mandatory, according to the federal report. Floating shifts meant staff from other areas of the VAMC were brought in to assist with patients in the nursing homes.

In 2016, Northport VAMC’s nursing home employees put in a  total of 19,991 hours of overtime. It nearly doubled by the end of 2017 as only 107.9 of the facility’s authorized 128 full-time positions were filled, according to Spellman, causing the facility’s overtime costs to skyrocket to nearly $1.5 million.

“Nurse managers had no mechanism to alert them if one of their unit nursing personnel worked excessive OT,” the report reads.

Federal investigators found part of the nursing homes’ staffing issues were due to an inability to hire and retain the members of its nursing staff. Northport VAMC got approval to hire 10 additional registered nurses and 10 nurse assistants as intermittent staff in November 2016, though the team wasn’t assembled until August 2017.

Often the process of hiring new nursing staff was delayed. In one instance, Northport’s leadership said two applicants interviewed and hired in January 2017 were told they would not start working until July.

“This delay in hiring often resulted in the loss of selected applicants who took other jobs,” the report reads.

The leadership of Northport VAMC said the high cost of living on Long Island has also made finding and maintaining a full-time staff difficult.

“Not only does this affect our ability to retain talent, but to recruit it as well,” spokesman Spellman said.

Steps to improvement

The federal investigators made three recommendations to Northport VAMC in order to  ensure it has adequate nursing care for its patients and improve quality of care for residents.

First, that the VAMC’s acting director, Dr. Cathy Cruise, completes a review of the nursing homes to ensure staffing levels align with the needs of its current residents. More staff should be recruited and hired to fill the current vacancies “until optimal staffing is attained,” reads the report.

Spellman said leadership of Northport VAMC, including Cruise, have already started taking action, implementing changes to improve the quality of care and working conditions.

A registered nurse clinical coordination position has been added in order to streamline nursing staff’s efficiency, according to Spellman. At the beginning of 2018, the facility was given approval to hire 2.6 more full-time employees and another 10 staff members were recently approved to bring the total nursing staff to the equivalent 140.6 positions.

“A staffing methodology is in the process of being completed, with additional staff expected,” Spellman said.

The Northport VA has received approval to directly hire its nursing staff and is giving new employees immediate start dates, according to him. It also had plans to expand its nursing floating pool, and to cross train other VAMC nurses in long-term care to continue to grow the available number of staff who can provide residents with care.

Third, Northport’s leadership was also told to improve its management of staff’s overtime hours and make sure of future responsible use of financial resources, citing the $1.5 million in 2017 overtime.

“Federal employees are expected to be good stewards of government funds,” the report reads. “The OIG found a lack of accountability for managing OT expenditures.

Spellman said the nursing homes staff had a total weekly average of 437.3 hours of overtime for the 2018 fiscal year, which ended Sept. 30. This indicates a significant drop from last year, where the total weekly average of overtime exceeded 750 hours.

“All of this is to say that, while the OIG has helped Northport identify areas in which we can improve, we have implemented measures to make those improvements — and we are already seeing results,” Spellman said.

Stony Brook University Hospital nurses and EMS workers held an informational picket May 16. Photo from Anna Maria Amicucci

Some employees at a local hospital are tired of tightening their belts.

Approximately 75 Stony Brook University Hospital nurses and EMS workers represented by the New York State Public Employees Federation held an informational picket and press conference May 16. The goal was to inform the community about a severe long-term shortage of health care workers at the hospital, high medical staff turnover and pay inequity.

EMS workers joined Stony Brook University nurses for an informational picket May 16. Photo from Jason Schmidt

Before the rally, PEF President Wayne Spence said the organization represents more than 2,000 nurses and EMS workers at SBU hospital.

“My members have been very patient in trying to get parity or close to parity with surrounding hospitals,” Spence said.

He said the hospital is a level-one trauma center transporting patients from hospitals where staff members make more than the average SBU worker. Nurses at St. Charles Hospital make at least $3,500 more per year, Southside Hospital in Bay Shore about $9,500 and Huntington roughly $11,000 more, according to Spence.

Even with state benefits, Spence said SBU health care workers’ compensation isn’t equal to surrounding private hospitals. According to the federation president, other institutions compensate employees to go back to school to achieve higher degrees and offer certain days off around holidays. A Stony Brook nurse can work three to five years without having off Christmas Day, he said. Spence said many rely on working overtime to make up the difference in salary and at times they are not able to break for meals, adding that medical staff working without a break can lead to crucial errors, such as making a mistake in medicine dosage. Many long-term employees are asking themselves why they are staying with Stony Brook.

“There was once a time where you stayed with the state system for the state pension,” Spence said. “But guess what? Northwell and other unions have now offered comparable compensation and fringe benefits that can now be comparable to the state. So, the state is not competing anymore.”

“Stony Brook hospital has always been a leader in cutting-edge medicine and research. It is time that it becomes a leader in staff recruitment and retention.”

— Anna Maria Amicucci

Paramedic Jason Schmidt said he independently compared paramedic salaries to other institutions like Northwell Health’s hospitals and found many emergency workers can make as much as $20,000 per year more than SBU workers. While Schmidt said it’s always been known that one can’t get rich working for state institutions, he said with health insurance costs increasing and pay freezes, many of his colleagues are working more than one job. He said he felt it was important for the workers to ban together and picket.

“It’s so frustrating this has been going on for so long,” Schmidt said. “We deserve more.”

Registered Nurse Anna Maria Amicucci said during her 18 years working at SBU she has been through furloughs and hasn’t received a pay increase in four years.

“We’re picketing to bring awareness to our state representatives about the gap in compensation between Stony Brook hospital and neighboring, competing institutions,” Amicucci said.

The nurse said she has seen a steady flow of new hires over the last couple of years receive their training at SBU and then leave for other institutions where they have been offered higher pay. Amicucci said in understaffed units the hospital has been paying more overtime to make up for the shortfall.

Nurses take part in an informational picket at Stony Brook University Hospital May 16. Photo from Renee Golde

“Stony Brook hospital has always been a leader in cutting-edge medicine and research,” she said. “It is time that it becomes a leader in staff recruitment and retention. A critical step in achieving that goal is putting its staff at par with our peers.”

Renee Golde, a registered nurse with the hospital for two-and-a-half years, said after working as an ultrasound technician, she went back to college to become a nurse. She said working for Stony Brook hospital is something she always wanted to do, and she wants to stay and bring about change to keep nurses at the institution. She said she hopes the administration will see that the employees want to stay and are just asking to close the salary gap.

“I stay because I love the people I work with,” Golde said. “I love my patients and I love being a Stony Brook nurse.”

Stony Brook released a statement through Kali Chan, director of medicine media relations at Stony Brook Medicine, when asked about the workers’ concerns

“Stony Brook University Hospital is supportive of our nurses, EMTs and paramedics,” Chan wrote. “We work every day to foster a positive work environment where all employees are valued and respected.”

Huntington Hospital volunteers pose with MD Anderson Cancer Center nurses in Houston. Photos from Meghan Billia

Huntington nurses went to work and rolled up their sleeves to help out the victims of Hurricane Harvey.

Three Huntington Hospital nurses stepped forward to answer a call for aid from MD Anderson Cancer Center in Houston. The Texas hospital had put out a nationwide request for volunteer nurses to provide relief for their own staff members impacted by the storm.

“I got into nursing because I wanted to help people,” Meghan Billia, an oncology nurse at Huntington Hospital, said. “When you hear there’s a greater scale on which you can help people, it feels like something you should do.”

Billia, of Huntington, stepped up for the first time as she knew firsthand the havoc that storm and flooding could wreak on one’s personal life. She had lived on the South Shore of Long Island when Hurricane Sandy hit Oct. 22, 2012.

ER nurse Demetrios Papadopoulos, of Bellmore, traveled to Houston from Sept. 9 to 16 with Billia.

“When I got down there, the first thing I asked was if I could work every day,” he said. “Houston is a lovely city, but I’ll go down another time to see it.”

Papadopoulos said he learned that roughly 70 percent of the employees of MD Anderson had been affected in some way by the storm. To further add to its problem, the Houston hospital had been forced to cancel approximately 300 surgeries scheduled the week that Harvey hit.

Meghan Billia stands with co-worker and friend at MD Anderson. Photos from Meghan Billia

“They were adding on 100 cases a week in order to catch back up,” Papadopoulos said. “In addition to being understaffed, they were overbooked.”

The volunteers were given a one-day crash course on MD Anderson’s computer systems then immediately scheduled to work up to 12-hour shifts. By taking over Houston nurses’ schedules, Huntington Hospital’s staff was providing much-needed time for them to file insurance claims on flooded homes, begin ripping out damaged floors and sheetrock, and grieve the death of loved ones.

“We were covering nurses who were affected by the hurricane personally,” Billia said. “It’s not often you get to go somewhere and help other nurses. You usually go to help the patient. This was helping the staff and giving back to fellow nurses.”

While rolling up their sleeves and putting in long hours at the hospital, the volunteers also said it turned out to be an unexpected learning experience.

“There are parts of MD Anderson that are highly specialized,” Papadopoulos said. “I got to see what they have and what they are capable of. They had a few ideas that I hope to bring back here.

MD Anderson is nationally ranked as the No. 1 hospital for adult cancer treatment by U.S. News & World Report.

Billia said working in oncology she learned about a different style of IV pump and equipment that allows chemotherapy to be administered differently to cancer
patients. She brought a sample product back to Huntington Hospital for staff members to review and discuss.

Both first-time volunteers said they were surprised, and nearly overwhelmed, by the appreciation and gratitude of MD Anderson’s staff. Papadopoulos said Houston staff members attempted to take him out to dinner on his last night in the city, while Billia was given a few small presents for her hard work including a T-shirt.

A third nurse who volunteered, Shaneel Blanchard, could not be reached for comment.

Dr. Gerard Brogan Jr., the executive director of Huntington Hospital, said he fully supported the actions of his employees taking time to volunteer in Texas.

“I’m very proud of our dedicated staff who went down to Houston to help the people
affected by Hurricane Harvey,” Brogan said in a statement. “As a hospital that turned into a community resource during Hurricane Sandy with caregivers who constantly go above and beyond for their patients, it’s not surprising that our staff would feel compelled to help people whenever they can.”

Billia and Papadopoulos said they have both stayed in touch with those they met while volunteering. Papadopoulos hopes to make a trip down once the city has recovered, while Billia is keeping in touch via text messages.

Nurses at Huntington Hospital smile during a shift. Photo from Northwell Health

By Victoria Espinoza

The nurses at Huntington Hospital are standing out for all the right reasons.

The staff recently received its fourth consecutive Magnet Recognition, the highest recognition for nursing excellence, becoming the first hospital staff on Long Island to achieve this success, and only the second in New York State.

In order to achieve Magnet Recognition, a staff must achieve strong patient outcomes, high levels of job satisfaction, low staff turnover rate, increased involvement in decision-making and more. The Magnet Recognition is awarded by the American Nurses Credentialing Center.

Susan Knoepffler, chief nursing officer at Huntington Hospital, said the success comes from the team collaboration constantly taking place within the hospital.

“The nurses here are able to make their own decisions about improving nursing care,” Knoepffler said in a phone interview. “Instead of me always explaining to them how things should be done, I take direction from them on the best way to deliver care.”

The strongest example of this method of practice leading to improved patient care comes in the form of the Nightingale phone, a communication device that helps link patients directly with their nurse.

The invention came from the oncology department, where nurses were trying to figure out how to better manage and monitor their patients’ pain levels. Patients have a phone with a red button that instantly connects them with their nurse, instead of having to call the nurses station or have someone go look for their nurse on the floor. The staff said it has decreased wait time for patients and improved patient pain control to a 90 percent success rate.

“It is absolutely the best practice,” Donna Tanzi, director of nursing education, said in a phone interview. “And it was created at our local community hospital.”

Tanzi said she loves that the nurses at Huntington have the ability to continue to grow on a daily basis and are committed to doing the best thing for their patients.

“They are caring for someone’s family members, and they treat their patients as if they’re their own family members,” she said.

Tanzi added Huntington Hospital has always been an organization focused on serving the community.

Knoepffler said the level of education of the nursing staff is another component that leads to such a high standard of care.

The chief nursing officer said by 2020 it will be an expectation at most hospitals that all nurses have a bachelor of science degree in nursing, and at Huntington 90 percent of the nurses already have a BSN. She also said the nursing staff at Huntington has a higher than average level of certified nurses in the departments they serve, like the emergency department or oncology.

“We have happier and more energized nurses because of their passion to succeed,” Knoepffler said. “We support them to try and get the highest education they can.”

As for the fourth Magnet Recognition, Knoepffler said it is “a distinction like no other,” calling it the gold standard of nursing.

“Health care is changing all the time, and this group is so adaptable, and that translates to a passion to have an impact at the bedside,” Knoepffler said.

At a National Nurses Week celebration last month, local officials and Huntington Hospital staff members gathered to thank the staff for its dedication and to celebrate their award.

“Your clinical excellence and attentive care are what make our physicians confident in Huntington Hospital and want to bring their patients here,” Michael B. Grosso, chief medical officer at Huntington Hospital, said.

“Nurses are the unsung heroes of our health care system,” Legislator William “Doc” Spencer (D-Centerport) said at the event.

Nurses from St. Catherine of Siena Medical Center and St. Charles Hospital have a new contract. File photo by Alex Petroski

The final hurdle was cleared to avoid a work stoppage for nurses at two North Shore hospitals.

Registered nurses from St. Catherine of Siena Medical Center in Smithtown and St. Charles Hospital in Port Jefferson voted overwhelmingly to approve a new contract Nov. 10 — they had been working without a contract since March 2015.

The New York State Nurses Association identified inefficient staffing, health benefits and a pay increase as the key issues they wanted addressed during negotiations, and according to a statement, all three were achieved. Additional nurses will be added to shifts at both hospitals, nurses will receive a three percent pay increase and an increase in health benefits, according to a statement from the union.

After about 18-months of negotiations, the NYSNA and hospital administration from both facilities reached a tentative agreement for a new contract to avoid a work stoppage Nov. 5, and the Nov. 10 vote made it official.

“Nurses at St. Catherine are always willing to stand up for safe patient care.”

— Tammy Miller

“The nurses at St. Charles Hospital are happy to ratify an agreement that protects both nurses and patients,” Tracy Kosciuk, RN and president of the local bargaining unit at St. Charles Hospital, said in a statement. “The issues were so important to our nurses that we took a strike vote that overwhelmingly passed, by a vote of 96 percent, and we were willing to hold a two-day strike. We are grateful to have a union behind us to speak up and educate the community on these important issues, and we look forward to working with the community in the future.”

Kosciuk, who has been at the hospital for nearly three decades, said in a phone interview last week that the tentative agreement was reached in part thanks to a “marathon” negotiating session that spanned from the afternoon Nov. 4 until about 9 a.m. Nov. 5. Nurses at both hospitals, who are among about 40,000 in New York State represented by the NYSNA, had voted to authorize the union to give notice of a strike in October, though that never manifested.

“I’m happy with what we were able to retain in regards to nurse-patient ratio with the intensive care unit,” Kosciuk said. Typically six nurses are staffed for shifts in the ICU, though Lorraine Incarnato, a nurse at St. Catherine’s in the ICU for nearly 30 years, said, during a picket outside of the hospital in April, she frequently worked shifts with five or even four nurses on duty.

“It’s causing a lot of friction between administration and staff,” Incarnato said in April. “When you have staff working always short [staffed], always extra, and then knowing that there’s not the respect factor there, they’re unhappy. Unhappy staff doesn’t keep patients happy. We try to put on a really happy face, because the patients come first.”

Administration members from both hospitals were also glad to avoid a work stoppage.

Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley
Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley

“We are pleased to have reached a fair settlement and I’d like to commend both bargaining teams who worked very hard to reach this agreement,” Executive Vice President and Chief Administrative Officer at St. Charles Jim O’Connor said in a statement prior to the vote. “St. Charles Hospital is proud of our professional nursing staff and the high quality of care they provide to the members of our community.”

Leadership from St. Catherine of Siena expressed a similar sentiment.

“We are pleased to have reached a tentative agreement which is subject to ratification by NYSNA members at our hospital,” St. Catherine’s Executive Vice President and Chief Administrative Officer Paul J. Rowland said in a statement last week.

The more-than-a-year-and-a-half negotiating session featured pickets at both hospitals, with nurses frustrated by inadequate staffing and seeking better health benefits and a pay increase in their next contract.

“All of these issues affect retention and recruitment,” Tammy Miller, a nurse at St. Catherine of Siena, said in a statement in October. “Keeping and attracting experienced nurses are essential to quality care.”

Miller was proud of the efforts put forth by the union and nursing staff since their contract expired.

“Nurses at St. Catherine are always willing to stand up for safe patient care,” she said in a statement after the vote.

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Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley

Members of the New York State Nurses Association had drivers honking their horns near St. Charles Hospital in Port Jefferson on Friday, as picketers called for increased staffing of nurses.

Between 11:30 a.m. to 2 p.m. on April 8, nurses and supporters marched and chanted outside the hospital to spread awareness of their cause. According to the nurses’ association members, some nurses tend to 10 or more patients and those working in St. Charles’ Intensive Care Unit are exceeding what they call a safe limit of one to two patients per nurse.

Increased staffing would help nurses devote more time to their patients, according to group members, which is better for the patient.

Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley
Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley

Nancy Joly, the New York State Nurses Association’s deputy director, said the organization has data showing that when ICU nurses have more than two patients “the chances of death are skyrocketed.”

The picketing comes as the St. Charles nurses’ union is negotiating with the hospital on a new contract, after the previous one expired in March 2015.

According to a statement from the hospital, the facility bases staffing guidelines on various factors, including when nurses call in sick, how much nursing care a patient needs, the number of patients who need care and guidelines set in previous union contracts.

Tracy Kosciuk, a St. Charles nurse of 27 years and president of the state nurses’ association’s executive committee for St. Charles nurses, said when they have too many patients, it’s difficult for nurses to give their “100 percent” and care for each patient, including teaching the patient and their family about their health.

“Unfortunately the mentality … nowadays in the industry is [that] all hospitals are short-staffed,” Kosciuk said. “That’s not acceptable to have that mindset.”

But St. Charles said the nurses and the hospital share the same goal of providing their patients with high-quality care. While the group has a right to picket, according to the hospital statement, it would prefer to discuss the nurses’ contract in a formal meeting.

“St. Charles remains committed to negotiating a fair contract … that supports our caregivers and the communities we serve,” the hospital said. “We will continue to negotiate in good faith with the union.”

Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley
Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley

Stony Brook resident Barbara Cea was among the nurses chanting outside St. Charles and celebrating when drivers honked their horns in solidarity. She has worked at the hospital for the past 32 years.

“They seem to be ignoring our pleas to increase the nurse-to-patient ratio so that we could provide adequate and safe care, which is more and more important,” Cea said. “We have to keep the nurses at the bedside.”

Cea supported the hospital’s statement that it’s trying to establish fair contracts with appropriate staffing guidelines, but said it’s been a slow process.

“Nobody knows when they’re going to end up in the hospital,” Joly said. “A lot of people are worried about their community hospitals being well-staffed. You really need to have good staffing everywhere.”