Jobs!

After teaching the first sessions of my two fall classes, I can share a major concern of entry-level masters of nursing students: jobs.

At least in the San Francisco Bay Area, hospital-based new graduate orientation programs largely ended with the economic downturn beginning the last quarter of 2008. Although the professional nurse population in America is aging, the recession caused many nurses to postpone or come out of retirement, at a time when hospitals may have to cut back related to dwindling profits, or limited public funds.

With Baby Boomers turning 65 beginning in 2011, including a lot of our current nursing workforce, I wonder about ideas for grant proposals or business plans that might help increase employment opportunities for new graduate nurses. Are nurse managers and health care administrators waiting for health reform to kick in?

Palliative care

I'm well aware there's been some unfortunate press about "death panels" related to health reform proposals. Sigh. One of the most timely business plans my students submitted this summer was to train hospital staff nurses on principles of palliative care, to improve their assessment and care planning skills in this important area. With Baby Boomers starting to turn 65 in 2011, isn't it time we started thinking about financial and quality of care implications of end-of-life conditions?

I would welcome thoughts about this issue.

Vascular Catheter Infections

One of the HACs I reviewed in June referred to prevention of vascular catheter related infections. Over the summer, I had a terrific group of CNL (Clinical Nurse Leader) masters of nursing students. Two of the teams prepared business plans that recommended dedicated teams of nurses to start and manage vascular catheters, on medical-surgical units and in the newborn intensive care units (NICUs).

Other than labor, there were few additional costs other than purchasing a portable sonogram to facilitate line placement. With the increased focus on infection prevention and compliance with patient safety provisions, I wonder how many of you are thinking about approaches to this problem, and would be interested in seeing how a business plan might develop around this topic.

The Summer's Over!

It's time to stop putting things off...the fall semester's starting this week, with another course to teach in financial management. I'll have 25 or so graduate nursing students coming up with creative ideas for business plans and grant proposals.

Until I start seeing some comments, it will take a real leap of faith to start posting regularly. However, I'm determined to see whether nursing and other health care managers are interested in learning and discussing about this topic.

At any rate, I'm back from vacation! Let's see where these ideas take us...

Disaster Management

The Joint Commission Standard EC.4.11 Element of

Performance 4, implemented in 2008, states:

When developing its emergency operations plan, the

[organization] communicates its needs and vulnerabilities

to community emergency response agencies and identifies the

capabilities of its community in meeting their needs.

Let's say your hospital needs resources to put this communication plan in place. However, your hospital is among the half of U.S. hospitals currently losing money. What about applying for grant funding? You may need to write the grant proposal in collaboration with local response agencies, such as the fire and police departments, but the Joint Commission expects you to collaborate with these agencies, anyway.

We can talk more about writing grant proposals, or business plans. I'm interested in your comments and feedback!

HACs and Business Plans

How are the HAC provisions related to costs?

• added treatment costs, for example, the added cost of a pressure ulcer that develops after hip surgery
  
• increased length of stay
  
• potential fines or litigation
  
• potential accreditation, reputation and referral problems

How are the HAC provisions related to revenues?

• Medicare will withhold additional payment for these conditions if they were not present on admission, resulting in lost revenues.

What about quality?

• The Centers for Medicare and Medicaid (CMS) is proposing additions to the current list of HACs:

Surgical Site Infections Following Elective Procedures:

• Total Knee Replacement


• Laparoscopic Gastric Bypass and Gastroenterostomy


• Ligation and Stripping of Varicose Veins

Legionnaires’ Disease

Glycemic Control:

• Diabetic Ketoacidosis


• Nonketotic Hyperosmolar Coma


• Diabetic Coma


• Hypoglycemic Coma

Iatrogenic Pneumothorax

Delirium

Ventilator-Associated Pneumonia (VAP)

Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)

Staphylococcus aureus Septicemia

Clostridium difficile-Associated Disease (CDAD)

How does this relate to writing business plans?

If you're trying to make a business case for your idea, showing that you will improve quality, reduce costs and capture revenue makes your plan convincing. We can use HACs (current and proposed) as examples of ideas for business plans.

Hospital-Acquired Conditions

Last July (2008) Medicare identified 10 categories of Hospital-Acquired Conditions (HACs). HACs present as: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence‑based guidelines.
The 10 categories of HACs include (I’ve omitted subsets of conditions—see the Medicare link for more detail) :
1. Foreign Object Retained After Surgery
2. Air Embolism
3. Blood Incompatibility
4. Stage III and IV Pressure Ulcers
5. Falls and Trauma
6. Manifestations of Poor Glycemic Control
7. Catheter-Associated Urinary Tract Infection (UTI)
8. Vascular Catheter-Associated Infection
9. Surgical Site Infection Following:
o Coronary Artery Bypass Graft (CABG) - Mediastinitis
o Bariatric Surgery
o Orthopedic Procedures
10. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)

Is this new information for you, or are you currently trying to cope with this new ruling and its payment implications, implemented in October 2008?

In the next post, I’ll discuss implications for costs, quality, revenues and business plans.