TAG: "Nursing"

Battling alarm fatigue


UCSF nursing school leads research on rising problem in hospitals.

Hospital room with alarmsTalk about the dangers of multitasking.

“You’re in sterile garb with a patient, and in the next room an alarm goes off. You have to decide if it’s a bed alarm, a ventilator alarm or something else – you need to memorize those sounds and most monitors have multiple sounds. You have to make a decision about whether it’s a technical problem or something more serious, and then you have to decide if and how quickly you need to respond,” says Barbara Drew, R.N., Ph.D., an internationally recognized cardiac monitoring expert who is a professor in the critical care/trauma program at the UC San Francisco School of Nursing and in the Division of Cardiology at the UCSF School of Medicine.

The decision points she describes are disturbingly frequent, especially in intensive care units (ICUs), where nurses might hear over a hundred alarms an hour, many of them false positives.

There is a lot at stake in these complex interactions among people, processes and technology that lead to what has come to be known as alarm fatigue: where clinicians turn down, turn off or tune out the alarms because they are exhausted by their frequency and the number of times they are false. Awareness of the dangers is rising fast around the country.

In one highly publicized case in Pennsylvania, the muting of an alarm cost a teen her life and the surgery center a $6 million malpractice settlement. According to a recent article in the Washington Post, over a three-and-a-half-year period ending June 2012, the Joint Commission had reports of 98 alarm-related incidents, including 80 deaths; in more than 60 percent of the cases, alarms were either inappropriately turned off or were not audible in all areas.

The commission believes the reports, which are voluntary, do not begin to tell the whole story and has established a national patient safety goal on alarms that goes into effect in 2014.

Along with colleagues at UCSF Medical Center and nursing schools that include Johns Hopkins and Yale, Drew is among a small group of nurse scientists conducting research to inform emerging regulations and processes and, ultimately, solve the problem.

At the moment, her collaborative project with GE Healthcare is designed to characterize every piece of clinical information ICU alarms deliver so device manufacturers have the data they need to create better, smarter alarms.

She cautions, however, that the solutions go beyond better technology. “This is a multifactorial problem – technology, nursing practice and systems – and we have to approach it from all of those angles,” says Drew.

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Sleep apnea study uncovers more hidden dangers for women


UCLA researcher: “We now know that sleep apnea is a precursor to bigger health issues.”

Paul Macey, UCLA

Paul Macey, UCLA

There’s more bad news for women with sleep apnea. A new study from the UCLA School of Nursing shows that the body’s autonomic responses — the controls that impact such functions as blood pressure, heart rate and sweating — are weaker in people with obstructive sleep apnea but are even more diminished in women.

Women with obstructive sleep apnea may appear to be healthy — having, for instance, normal resting blood pressure — and their symptoms also tend to be subtler, which often means their sleep problem is missed and they get diagnosed with other conditions.

“We now know that sleep apnea is a precursor to bigger health issues,” said Paul Macey, lead researcher on the study, which appears today (Oct. 23) in the peer-reviewed journal PLOS ONE. “And for women in particular, the results could be deadly.”

Obstructive sleep apnea is a serious disorder that occurs when a person’s breathing is repeatedly interrupted during sleep, sometimes hundreds of times. Each time, the oxygen level in the blood drops, eventually resulting in damage to many cells in the body. The condition affects more that 20 million adults in the U.S. and is associated with a number of serious health consequences and early death. Women are much less likely to be diagnosed than men.

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UC Davis nursing school opens applications for 2014 classes


Generous financial support available.

Deborah Ward, UC Davis

Deborah Ward, UC Davis

Applications are now open for fall 2014 classes in the Master of Science — Leadership and the Doctor of Philosophy Nursing Science and Health Care Leadership Degree Programs offered through the Betty Irene Moore School of Nursing at UC Davis. The school provides generous financial support to all admitted fall 2014 students. This support is offered to committed, creative leaders who share the vision to transform health care through nursing education and research.

“Health care settings desperately need leaders during this time of massive changes,” said Deborah Ward, associate dean for academics. “It is essential for more providers to see where their expertise is needed and to respond. The Betty Irene Moore School of Nursing is your first step in becoming a health care leader.”

Ward said the school seeks a diverse student population with varying backgrounds and work experiences; which is why the school is offering each admitted master’s-degree leadership and doctoral student generous financial support for tuition and fees and additional expenses. This support is made possible by the founding $100 million commitment from the Gordon and Betty Moore Foundation and additional scholarship sources.

Setting this graduate program apart from others, the Nursing Science and Health Care Leadership Degree Programs prepare nurse leaders, researchers and faculty in a unique interdisciplinary and interprofessional environment. As with other graduate groups at UC Davis, this program engages faculty from across the campus with expertise in nursing, medicine, health informatics, nutrition, biostatistics, public health and other fields.

The Doctor of Philosophy program prepares graduates as health-care and health policy leaders and nurse faculty/researchers at the university level. Entering doctoral-degree students receive $45,000 per academic year for four years. This support fully covers fees and tuition with the remainder intended as a stipend to help offset loss of income while concentrating on doctoral studies.

The Master of Science — Leadership program prepares students for health care leadership roles in a variety of organizations and as nurse faculty at the community college and prelicensure education levels. Entering master’s degree students receive a $40,000 scholarship over two years to go toward tuition and fees. Out-of-state and international packages are individually examined and approved.

The general application deadline is Jan. 15, 2014, with acceptances announced in March. All admission slots are expected to fill during this period. Applications submitted from Jan. 15 to May 31, 2014, are reviewed on a space-available basis only.

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UCLA nurse leads volunteers brining health care to Kenya


“Coming from the place, I know how much health care is needed.”

UCLA nurse Millicent Manyore extracts a bacterial infection, known as a "chigger," from a baby's foot at a clinic she helped organize in her homeland of Kenya. (Photo from Medical Missions Kenya)

UCLA nurse Millicent Manyore extracts a bacterial infection, known as a "chigger," from a baby's foot at a clinic she helped organize in her homeland of Kenya.

During her overnight shifts at Ronald Reagan UCLA Medical Center, nurse Millicent Manyore checks patients’ blood pressure nearly 100 times a week.

But in Manyore’s native Kenya and other parts of the developing world, this routine test is virtually unheard of in rural villages and urban slums. So thousands of people with hypertension are never diagnosed or put on the simple medical regimens that can help prevent potentially deadly problems like stroke, heart disease or kidney failure that are linked to high blood pressure.

That’s one of the reasons why Manyore and a team of 14, which included nine people from UCLA, all paid their own way to Kenya to spend more than two weeks working in makeshift clinics in three rural villages and a slum outside Nairobi. Manyore organized the trip through the nonprofit organization she runs, Medical Missions Kenya, which uses volunteers to bring desperately needed basic modern medical care to her home country.

From May 31 to June 13, the group, which was composed of nurses, a pharmacist, a pharmacy student and two doctors, saw more than 850 people. The volunteers checked blood pressure and blood glucose levels, tested for malaria and HIV, taught proper condom usage, treated diseases and dispensed vitamins and medications. About 75 percent of the kids who came in had discolored patches of bald, scaly skin on their scalps — a fungal infection called tinea capitis, easily treatable with antibiotics.

“Coming from the place, I know how much health care is needed,” said Manyore, who grew up in a village of 4,000 in central Kenya.

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UC Health helps ICU nurses bring palliative care to patients


Project aims to improve quality of care for seriously ill patients and their families.

Kathleen Puntillo (left) with UC San Francisco colleague Kathleen Turner

Kathleen Puntillo (left) and Kathleen Turner, UC San Francisco

By Diana Austin

In the six months before we die, more than 15 percent of Americans age 65 and older will spend a week or longer in the intensive care or cardiac care unit. But most of us will not receive the kind of care that studies consistently indicate people want at the end of life: supportive, holistic care that takes into account one’s values, desires and goals and addresses the entire spectrum of health-related needs that a seriously ill person may have.

A new two-year initiative led by UC San Francisco’s Kathleen Puntillo, Wendy Anderson and Steven Pantilat aims to expand access to that kind of care – known as palliative care – in intensive care units across five UC academic health centers, which along with UC’s 17 health professional schools are collectively known as UC Health. Titled IMPACT-ICU: Integrating Multidisciplinary Palliative Care into the ICUs, the project initially aims to help bedside critical care nurses understand how to integrate palliative care into their day-to-day work. The thinking is that while palliative care is a multidisciplinary effort, nurses are the most constant element in a patient’s care and are therefore well suited to becoming leaders in expanding access to this type of care in ICUs.

A new discipline

Palliative care is a relatively new clinical specialty. The National Board for Certification of Hospice and Palliative Nurses began certifying nurses in 1994, and palliative care was recognized by the American Board of Medical Specialties in 2006. Recognition and certification formalize expertise in aspects of care that go beyond treating a patient’s medical condition to include symptom management, psychosocial support, spiritual care, family care and other elements that affect quality of life.

“It’s trying to address all the dimensions that matter to people,” says Pantilat, director of UCSF’s Palliative Care Service. “Even something like pain isn’t just a physiological phenomenon. It’s got social, psychological and emotional implications, maybe even spiritual implications. You can’t just give morphine for that.”

That’s why a palliative care team typically includes physicians, nurses, social workers and chaplains – and, at times, pharmacists, dieticians and occupational therapists – to enhance a patient’s quality of life regardless of prognosis.

Not all ICU patients need that level of expert palliative care, but most would benefit from honest, compassionate conversations about prognosis, goals of treatment, symptom management and other stressors that affect them and their families. Unfortunately, such conversations don’t always happen, says Puntillo, professor emerita at UC San Francisco School of Nursing. The reasons for that failure, she says, include a fragmented health care system that often doesn’t reward talking with patients, misperceptions about what palliative care means – including confusing it with hospice – and lack of palliative care-specific education for clinicians.

While palliative care has begun to gain a foothold in many settings, IMPACT-ICU aims to advance the effort in a unique way with its focus on training bedside ICU nurses.

Birth of IMPACT-ICU

The project grew out of an End-of-Life Care Committee (now the Palliative Care Committee) that Puntillo and several other nurses and physicians from the UCSF medical-surgical ICU formed about 10 years ago. It was a response to nurses voicing concerns about the care dying patients were and weren’t receiving – and the nurses expressing an interest in getting more education about palliative care.

Wendy Anderson, UC San Francisco

Wendy Anderson, UC San Francisco

In response, Puntillo and Anderson, both of whom had taught related communication skills to clinicians, formed an interdisciplinary group that developed a series of workshops. Since 2010, they’ve trained 95 critical care nurses at UCSF Medical Center in palliative care communications. The program has proved so popular that each session has a waiting list within a day of being announced.

Then, last year, the Center for Health Quality and Innovation Quality Enterprise Risk Management – a joint venture of the UC Center for Health Quality and Innovation (CHQI) and the UC Office of Risk Services that provides funding for projects that have the potential to both improve care and reduce risk – put out a request for proposals. Anderson and Puntillo recognized the opportunity to increase patient access to palliative care throughout the UC system by empowering bedside nurses to become more actively engaged in making the important conversations happen.

Terry Leach, executive director of the CHQI, says their proposal was successful because palliative care is good for patients and families, and good communication is one of the pillars of risk reduction. The project received just over $1 million for a two-year rollout that began this summer and continues with workshops for critical care nurses at all five UC medical centers.

Initially, the IMPACT-ICU project is focused on ensuring that bedside nurses have the skills and resources they need to engage in palliative care discussions with families, physicians and other clinicians. Each of the five UC medical centers has identified two ICU sites and two nurse leaders (either nurse practitioners or certified nurse specialists with expertise in palliative care) to implement the program. The nurse leaders attended a three-day training at UCSF that taught them to lead quarterly workshops for other critical care nurses in their medical centers.

The workshops begin by outlining the ICU nurse’s role, rights and responsibilities in discussing prognosis and goals for care with patients and families. “Often, ICU nurses feel like they’re not supposed to participate in those discussions,” says Puntillo. “We give them the background to empower them and to understand that this is part of their nursing practice.”

During the workshops, the nurses also engage in role-playing that helps them practice leading palliative care discussions with families – and facilitating group meetings between nurses, physicians, patients and families.

Another aspect of the workshop focuses on nurses caring for themselves, an often-forgotten component of critical care bedside nursing that can affect quality of care. “These discussions are difficult,” says Janice Noort, a palliative care nurse practitioner and one of the leaders of the IMPACT-ICU project at UC Davis. “[Critical care nurses] are at high risk for burnout and compassion fatigue that comes from working in this life-and-death environment.”

In addition to leading the workshops, the nurse leaders round in the ICUs to provide real-time support to bedside nurses as they’re trying to apply the skills they’ve learned. “[This involves] looking at patients’ symptoms that may be uncontrolled and identifying other patient needs that really haven’t been looked at before,” says Noort.

Reducing costs by improving quality and meeting patient needs

By paying closer attention to patient needs, palliative care has the potential to improve outcomes and reduce costs. Pantilat notes that when a detailed palliative care discussion happens, patients often express a desire for care that is less invasive and more focused on symptom control and quality of life. That kind of care is less costly according to a 2008 study published in the Archives of Internal Medicine, and can free up resources for what patients really want, such as assistance with staying in their homes. Even if only a subset of the estimated 5 million Americans admitted to an ICU annually were to receive palliative care, the savings could be considerable.

That’s partly because the U.S. health care system has evolved to reward more, rather than better, care. Historically, because clinicians have been paid for procedures, not outcomes, Pantilat says aggressive, all-out care tends to be the default, even when patients might not want it and when it’s unlikely to be beneficial. Palliative care providers strive to interrupt that default thinking and step back to find out what’s really important to patients and families.

Both Pantilat and Puntillo stress that this approach is absolutely not about denying any medical care to patients who want and can benefit from it. Unlike hospice, which in the US requires that a patient be within six months of dying and asks patients to forgo aggressive care, palliative care can be given alongside all kinds of care, including curative treatment, and can benefit any patient with a serious, but not necessarily terminal, illness.

As a former practicing nurse and former hospital attorney, Leach has seen the problems that arise when communication about goals and needs doesn’t happen. “When you’ve got a seriously ill patient and their family members, all circuits are firing at a very stressful level,” she says. “When they don’t feel [the specialists] are talking to one another, it can be very frustrating.”

If critical care nurses can have conversations about goals and desires with families of seriously ill patients, it can defuse the situation and lead to happier patients and families. “We see it in patient satisfaction scores,” she says. “When we engage families and patients, we know that their care feels better – and they sue less.”

Why nurses

As the most consistent hospital presence for both patients and families, the bedside nurse is often the most logical choice to initiate palliative care discussions.

“Family members don’t necessarily have adequate opportunities to communicate with physicians, and one physician may not communicate with another team taking care of the same patient,” says Puntillo. “It can be very disjointed.”

On the other hand, a typical ICU patient has two primary nurses that work in 12-hour shifts, so they’re with the patient almost constantly and are privy to interactions and conversations that other members of the care team and family members aren’t. “It’s the nurse practicing shuttle diplomacy,” says Puntillo.

In addition, demand for palliative care services throughout the hospital and beyond is growing, and there aren’t enough palliative care specialists to meet it. Empowering nurses to be more proactive and engaged in discussions about goals of care can potentially change the structure for palliative care in the ICU setting, says Noort.

“There are limitations to the consultative model and a lot of strength to having the main people who are taking care of you [bedside nurses] provide your palliative care,” says Anderson. “What’s unique about [the IMPACT-ICU project] is that it creates a model for providing nurses with palliative care skills and also access to specialist palliative care nurses. At many hospitals, specialist palliative care can only be engaged through physicians. It is very challenging for critical care bedside nurses not to have direct access to palliative care expertise.”

Through the workshops and by placing palliative care nurse leaders directly in the ICU, the project will give bedside nurses both the skills they need and direct access to greater expertise when it’s needed.

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Decade of planning coming to life at Mission Bay hospitals


Innovative design of UCSF’s new medical center includes input from staff and patients.

As summer transitions into fall, construction crews continue to work hard each day bringing the new UCSF Medical Center at Mission Bay to life.

Years of collaborative planning with UCSF staff, patients and families will come to fruition on February 1, 2015, when the 289-bed hospital complex for children, women and cancer patients opens its doors. The project also realizes UCSF’s vision of building one of the world’s most innovative health care centers.

“I am incredibly excited for our team to work in this beautiful space that they have all had the opportunity to create,” said Kim Scurr, executive director of UCSF Benioff Children’s Hospital and hospital operations planning at Mission Bay. “This is the ultimate employee engagement exercise, and I cannot begin to articulate the enthusiasm, pride and vision that every member of our team has for this new hospital. It’s a very emotional experience.”

One of the many members of the UCSF community who has been involved in the planning is Cassandra Robertson, a nurse and patient care manager for the pediatric operating room at UCSF Benioff Children’s Hospital.

According to Robertson, the entire OR was created with staff input, which resulted in a design that will truly serve the people going to work there each day. For example, the ORs are built around a central core where supplies will be stored and readily accessible, so that staff will not have to walk to several places gathering supplies for cases.

Robertson, who has spent her nearly 35-year career at UCSF, described her feelings about what will be the first dedicated children’s hospital in San Francisco in a recent video interview.

“I’m excited as I see the hospital take shape and walk through the space envisioning our team working and caring for patients in a place that was designed just for them,” she said.

“All of my career I’ve taken care of pediatric patients in a hospital that was designed to care for adults, and we’ve certainly made it work,” she added. “But children have special health care needs, and I believe we have captured that within our design of the building and the workflows we have established for Mission Bay.”

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Nursing school addresses nation’s faculty shortage crisis early in its launch


UC Davis postdoctoral fellows preparing for faculty positions.

Michelle Fennessy (left) and Hermine Poghosyan

Michelle Fennessy (left) and Hermine Poghosyan

Two Betty Irene Moore School of Nursing at UC Davis postdoctoral fellows recently received appointments at prestigious nursing colleges, adding their names to a growing list of the school’s postdoctoral alumni tapped to educate the next generation of nurses at colleges and universities nationwide.

Michelle Fennessy was appointed an assistant professor at The Ohio State University College of Nursing. Hermine Poghosyan was appointed assistant professor at University of Massachusetts at Boston College of Nursing and Health Sciences.

Since the school’s 2009 founding, seven of eight postdoctoral alumni earned faculty positions educating new nurses in schools across the country. The accomplishment is significant said Deborah Ward, associate dean for academics, because a key goal for the school is the preparation of nurse educators of the future.

“Our nation needs an enormous number of skilled nurses to care for us, now and in the future,” Ward said. “Educating them — and preparing educators for the next generations — is our work. The development of new nurse faculty is a primary goal of our school.”

Two years before students were ever enrolled, the UC Davis nursing school recruited postdoctoral scholars — recent doctoral graduates — for two-year fellowships that prepare the new researchers for faculty positions. Such postdoctoral programs provide new researchers time to pursue scholarly interests in areas of specialized content.

“These fellowships provide postdoctoral scholars with a variety of options often not available at other schools. As a new nursing school, we’ve only just begun to develop our research programs,” said Jill Joseph, associate dean for research. “Here, they have a unique opportunity to make their experience truly their own. Because of our commitment to interprofessional education and research, our scholars are also exposed to scientists and projects from across campus.”

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For healthier kids, focus on lifestyle changes, not weight loss, study suggests


UCLA findings underscore need to focus on changing diet and increasing exercise.

Christian Roberts, UCLA

Christian Roberts, UCLA

A UCLA School of Nursing study has found that both healthy-weight and obese children who participated in an intensive lifestyle modification program significantly improved their metabolic and cardiovascular health despite little weight loss.

“These findings suggest that short-term lifestyle modifications through changing diet and exercise can have an immediate impact on improving risk factors such as cardiovascular disease and diabetes,” said Christian Roberts, an associate research professor at the UCLA School of Nursing and the study’s lead author. “This work underscores the need to focus on changing lifestyle as opposed to focusing on body weight and weight loss.”

This study is believed to be the first to compare the effects of changing diet and exercise in both normal-weight and obese children. The article is published online in the American Journal of Physiology.

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Professional degree supplement tuition approved


Modest PDST increase included for UC nursing programs.

The University of California Regents today (July 18) approved first-time professional degree supplemental tuition (PDST) for four professional degree programs and a modest PDST increase for students enrolled in UC’s four nursing schools. The fees will affect about 800 professional students systemwide.

The professional degree supplemental tuition (PDST) levels are scheduled to take effect Aug. 1, 2013. Although PDST levels traditionally are set in November for the upcoming academic year, the regents delayed voting in 2012 to allow for further review requested by Gov. Jerry Brown. Of UC’s 57 professional programs with existing PDSTs, now only the four nursing master’s degree programs are recommended for a PDST increase — an increase of $619 per year.

“Professional programs throughout the university submit a comprehensive multi-year plan that includes uses of and justification for PDST revenue, financial aid strategies, and the views of students and faculty,” said UC Provost Aimée Dorr. “We have thoroughly evaluated all requests for PDST increases and believe that what we asked the regents to approve at the July 2012 meeting represents the minimum needed to ensure program quality and continuity.”

In addition to the nursing programs at UC San Francisco, Los Angeles, Davis and Irvine, the four programs that propose to charge PDST for the first time are Games and Playable Media at Santa Cruz; Health Services-Physician Assistant Studies at Davis; Technology and Information Management at Santa Cruz; and Translational Medicine, a joint program to be offered by Berkeley and San Francisco. Three of the four are brand-new programs.

In setting PDST levels, program comparators include both public and private institutions. Of the programs included today, most are below the average cost of their competitors.

The nursing programs have been singled out for a PDST increase because after many years of keeping tuition levels artificially low — at the request of then-Gov. Arnold Schwarzenegger — program quality would be severely jeopardized without at least a minimum increase. Cuts in state and federal funding have taken their toll and the university believes it is essential to offer a high-quality program to benefit students and serve well the needs of the state of California.

Each of the 61 UC professional programs that charge PDST has committed to channeling at least a third of all PDST revenue into student financial aid; many programs anticipate exceeding this percentage. The average is nearly 36 percent.

PDSTs are only for professional degree students, not for academic graduate students.

At UC and other universities, the funding model for professional schools is based on a different model than that for undergraduate education, due both to the nature of the training provided and to policy decisions of prior state governments. Gov. Schwarzenegger, for example, believed that while the state had an obligation to fund undergraduate education, the professional schools should be the responsibility of the individual students.

This model is the standard approach nationally to professional school funding: While citizens and governments accept the role of government in providing access to undergraduate education, there is more of an expectation that students should bear primary responsibility for professional education. The exception, during the Schwarzenegger administration, was the nursing programs. The administration asked UC to expand the nursing program and keep fees artificially low, in exchange for promised state and federal funding that, in fact, did not materialize.

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How privacy laws impact researchers’ abilities to share data


UC Davis nursing doctoral candidate’s published findings identify need for collective policies.

Katherine Kim, UC Davis

Katherine Kim, UC Davis

Betty Irene Moore School of Nursing at UC Davis doctoral candidate Katherine Kim and a team of researchers recommend the development of guidelines that protect patient preferences and privacy while allowing investigators to share data through electronic health records and other databases. The research, “Development of a Privacy and Security Policy Framework for a Multi-state Comparative Effectiveness Research Network,” is published today (July 16) in Medical Care, a national public health journal.

Kim and three co-authors discovered that researchers, who analyze records to translate trends into treatment options, are limited by traditional approaches to sharing data, such as the distribution of data across state lines and institutions. The study compares state laws and regulations as well as institution-specific policies intended to protect privacy and security of health information.

“We found that most state laws focus on consent for gathering the information,” Kim said. “There is much less guidance on sharing data for research purposes.”

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UCLA nursing school, Children’s Hospital LA to collaborate


Partnership to improve kids’ health, advance nursing practice.

An innovative new partnership between the UCLA School of Nursing and Children’s Hospital Los Angeles will bring together nurses working in clinical practice, education and research to improve the health and well-being of children while advancing nursing practice.

“There are so many opportunities with this collaboration that will advance nursing practice by bridging clinical practice and research,” said Courtney H. Lyder, dean of the UCLA School of Nursing. ”And by integrating nursing practice and science, we can improve patient care.”

Under the memorandum signed on July 10, both institutions will encourage the development of a variety of collaborative initiatives, including:

The creation and implementation of an institutional nursing research department at the Children’s Hospital campus to support nurses in designing research, analyzing data and presenting findings.

Joint education efforts to teach the next generation of pediatric nurses, including enhancing the Pediatric Nurse Practitioner Program at the UCLA School of Nursing.

The exchange of scholarly information and materials to keep clinicians and researchers abreast of current findings and best practices.

Attendance at scholarly and technical meetings and at national and international conferences to showcase research results and find new ways to treat and prevent pediatric illnesses.

The organization of joint conferences, symposia and other scientific meetings on subjects of mutual interest.

“Research is a core element of our nursing and patient care mission at Children’s Hospital Los Angeles,” said the hospital’s chief nursing officer and vice president for patient care services Mary Dee Hacker, who noted that the hospital earned Magnet redesignation this year — a status awarded by the American Nurses Credentialing Center (ANCC) to health care facilities that act as a “magnet” in attracting nurses by creating a work environment that rewards them for outstanding clinical practice and collaboration with the rest of the organization.

“The honor served as acknowledgement that our nurses are becoming leaders in research and education,” Hacker said. “We look forward to our new relationship with UCLA and the structure it will provide to enhance our collaborative research projects.”

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The benefits of interprofessional education


UCLA nursing school dean points to better communication.

Courtney Lyder, UCLA

Courtney Lyder, UCLA

By Courtney Lyder

Courtney Lyder is dean of the UCLA School of Nursing, professor of medicine and public health and executive director of the UCLA Health System Patient Safety Institute and assistant director of the UCLA Health System. This column originally appeared on the website Hospital Impact, a blog by and for hospital executives, physicians and other health care thought leaders.

In a recent editorial in The New York Times, Theresa Brown wrote about how clinical hierarchies and the impact of conflict between nurses and physicians can be deadly for a patient. She said, “when doctors and nurses don’t get along, it’s the patient who suffers.”

A lot of studies show that poor communication is linked to adverse patient outcomes. For example, of the 1,243 sentinel events reported to the Joint Commission in 2011, communication problems were identified in 60 percent.

By its very nature, health care is complicated; it is a rapidly changing environment and unpredictable. Professionals from a variety of disciplines can care for a patient during a 24-hour period, which can limit the opportunities for face-to-face communication.

Physicians and nurses are expected to work together, not only practicing side by side, but interacting to achieve a common goal: the health and well-being of the patient. But there are several factors that can make effective communication between nurses and physicians particularly difficult to achieve, including historic tension; conflicting viewpoints based on education, training, communication style; and terminology and existing communication processes that are inefficient at best.

With the focus of health care moving increasingly to the team approach, it becomes even more critical for physicians and nurses to work in collaboration. Higher education institutions including UCLA and the University of Virginia, for example, are working to improve how nurses and physicians work together before they enter the clinical environment.

In the fall of 2008, the UCLA School of Nursing and the David Geffen School of Medicine at UCLA, introduced a pilot program to integrate nursing students (in this case advanced practice students) and third-year medical students. The result was an innovative program that focused on content, such as communication with patients, ethics, behavioral medicine and other psychosocial issues. The idea was to get the two groups working together sooner rather than later so students from both schools could develop team-building skills, increase their awareness of each other’s roles and get used to working together in making decisions to improve patient outcomes.

Our initial results indicated the students found the experience to be of great value. In addition to assisting students with their clinical decision-making skills, the discussions that took place during the course provided an excellent forum in which the nursing and medical students gained a better mutual understanding.

I believe collaborations like this represent the future of medical and nursing education. No two groups of health professionals are more interrelated in practice, and by starting here, we allow them to understand each other and to grow up together as students.

We are now taking the next step by creating assessment tools to evaluate interprofessional competencies not only in the classroom but in clinical practice settings as well. Tools such as an iPad app will allow instruction leaders to assess actual collaborative practices through observations and walk-throughs in clinical settings. Our ultimate goal is to disseminate the tools to a wider community.

Patient safety needs to be our top priority. Successful delivery of health care needs to be interdependent, and respect must be shown for the education and knowledge of each team member. Interprofessional education is an excellent start.

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