Articles of Interest
NATHO goes to Washington this November … for Staffing Industry Analysts’ 14th annual Healthcare Staffing Summit, November 8-10, 2016, at the Marriott Marquis in Washington, DC.
Staffing Industry Analysts describes the Healthcare Staffing Summit as “a dynamic industry event that brings together CEOs, owners, and top-level executives of healthcare staffing firms to generate insights, strategies, and a best practices approach to the ever-changing demands of this diverse segment. The summit delivers opportunities for driving growth through expert speakers, thought leadership, valuable networking, and educational sessions.”
This year’s keynote speakers are Governor Howard Dean, M.D.; Stephen Dwyer, General Counsel, American Staffing Association; Tony Gregoire, Director of Research, The Americas, Staffing Industry Analysts; Ralph Henderson, President, Professional Services and Staffing, AMN Healthcare; Governor Michael Leavitt, Founder and Chairman, Leavitt & Partners; Dr. David Michaels, Assistant Secretary, OSHA, US Department of Labor; John Ratliff, Managing Director, STS Capital Partners; and Dr. David Weil, Administrator, Wage, and Hour Division, US Department of Labor.
On top of all of that greatness, NATHO will host a reception at the conference on Wednesday, November 9th, from 5:30-6:30 p.m. in the Mezzanine Foyer. We really hope you'll join us and invite you to please RSVP to firstname.lastname@example.org by November 2nd.
Click here to learn more, see the agenda, or to register for the 2016 Healthcare Staffing Summit.
Job Order Index (May 1, 2017-September 25, 2017)
It’s essential for travel healthcare staffing companies to remain tax compliant, and an important part of achieving that that is staying up to date on current rules, regulations, and industry news.
To help your company achieve its compliance goals, NATHO will offer a free webinar “Travel Healthcare — Tax Compliance Update” on Thursday, December 8, at 3:30 p.m. Eastern.
The webinar will be hosted by two very knowledgeable sources: the travel tax guru himself, Joseph Smith of TravelTax.com, and Michael Healey, Vice President-Tax at AMN Healthcare.
NATHO is relaunching its quarterly newsletter in October 2016. The following is a note about the reinvigorated newsletter from current NATHO Board President, Gene Scott.
Welcome back to our newly formatted and revamped quarterly newsletter. We hope that you will find it informative, interesting and fun. It is the goal of NATHO to keep you up to date on the happenings in our industry. To that end, we hope that you will enjoy the segments that are included here each quarter.
This is your association and, therefore, your communication. We invite you to give us feedback on what you like and don’t like. We also look forward to your ideas on what you would like to see included in the future. Each of you brings a wealth of knowledge and experience to share. Please do so.
By Jackie Larson, President, Avantas
Growing shortages of healthcare professionals, and particularly registered nurses, are now being felt throughout our nation’s hospitals and health systems, threatening not only staff morale but also patient satisfaction and care quality. Without adequate staff, healthcare providers must optimize the workforce they already have. Predictive analytics is one of the most important — and underutilized — methods to assure that hospital shifts and healthcare enterprises have the right nurses in the right places at the right times.
Predictive analytics is a technology-enabled solution that is relatively unknown among nurse managers, who struggle each day to cover nursing shifts and provide the highest quality of care for patients. A survey of nurse managers, including chief nursing officers, directors of nursing and vice presidents of nursing, by AMN Healthcare and Avantas, found that 80% of nurse managers are unaware of available technology that can accurately forecast patient demand and staffing needs. Nearly 90% said that such technology would be helpful in the daily scheduling and staffing of nurses.
Survey: Problems Hurt Staff Morale, Impact Care Quality
The survey, Predictive Analytics in Healthcare 2016: Optimizing Nursing Staffing in an Era of Workforce Shortages, included a questionnaire completed by 85 nurse managers and interviews with 35 nurse managers, registered nurses and finance managers. It was released at the 2016 Healthcare Workforce Summit in San Diego in October.
The survey found that nearly 94% of nurse managers say that understaffing caused by scheduling and staffing problems hurts staff morale. Nearly 70% say they are very concerned about the impact on patient satisfaction, and more than half say they are very concerned about the effect on quality of care.
Said one Registered Nurse interviewed as part of the survey, “I feel like my patients are getting the short end of the stick, but I always try to give my all no matter what…” A nurse manager added, “Morale is affected adversely any time there are not sufficient staff to take care of patient needs.”
However, nurse managers are not using advanced methods to solve these problems: 24% use paper-based scheduling and staffing tools, 19% use simple digital spreadsheets, and 23% don’t use any scheduling tools at all. The apparent reason is that a large majority of nurse managers do not know about the availability of advanced scheduling tools that can manage and solve scheduling and staffing problems up to 120 days in the future.
While some healthcare enterprises engage in long-range workforce planning, this survey shows that most actions taken are short-term, reactive responses to immediate scheduling and staffing problems. Since these problems are prevalent at most patient care facilities, it can be surmised that the usual responses are not broadly successful.
Balancing Staffing Needs, Budget Concerns and Patient Care
The survey also included interviews with nurse managers, registered nurses and finance managers on scheduling and staffing problems. Many of these interviews reiterated the problems that registered nurses, nurse managers and finance managers face daily in balancing staffing needs and budget concerns.
Said one nurse manager, “When staffing is low, staff doesn’t have faith that it will ever get better. They don’t feel like anyone cares how hard they work, and I see how this impacts patient care.”
A Registered Nurse concurred, adding, “When we are understaffed, patients do not get the quality care they deserve. Nurses rarely have time to really connect with patients on a human level, because they have so many patients, tasks, and charting.”
Finance managers also share the frustrations of staffing problems, with one respondent stating, “It’s very difficult to maintain budgeted productivity levels when there aren’t sufficient people to staff the shifts.”
Predictive Analytics Offer New Approach
Predictive analytics is already used successfully for resource management in industries such as manufacturing, transportation and financial services. The same approach can be applied to healthcare scheduling and staffing through the analysis of “big data” about patient census, public health threats, business information about the enterprise, and other material.
In the predictive analytics processes developed by Avantas, staffing data are first processed with standard algorithms, then forecasting models are created and validated, allowing workforce projections up to 120 days prior to the shift. The forecast is updated weekly, and by 30 days in advance of the shift, the forecast of staffing need is 97% accurate. The analytics are then applied to workforce scheduling and staffing through advanced labor management strategies such as an open-shift management process that allows hospitals and other healthcare organizations to fill 75% of open shift hours more than two weeks ahead of the shift.
Healthcare enterprises that have adopted predictive analytics combined with advanced labor management strategies have realized outcomes that include reductions in agency nursing, increased staff satisfaction scores, improved nurse retention, reductions in open shift incentives and bonus pay, and significant annual savings in labor spending. Avantas sees clients routinely saving 4% to 7% of labor budgets, which is considerable since labor typically represents over half the annual costs for healthcare organizations. Predictive analytics can transform scheduling and staffing from guesswork to science -- and staff, patients and healthcare organizations reap the rewards.
Click here to request the full survey.
The modest use of supplemental (temporary or contract) nurses is a cost-efficient strategy during temporary periods of patient census swings or short-term shortages of permanent nurses at large U.S. medical centers, according to a new study led by researchers at the University of Rochester School of Nursing. The study also found that the hourly personnel costs for supplemental nurses efficiently offset the overtime costs of permanent nurses.
This study is the first to use longitudinal hospital unit-level data to investigate the cost and cost efficiency of using supplemental nurses.
"Prior research has shown that temporary and contract nurses are just as qualified-through education and experience-as permanent nurses," said Richard Wahlquist, president and chief executive officer of the American Staffing Association. "This study shows that supplemental nurses offer the strategic flexibility that hospitals need to augment their workforces during peak times, and to address any interim labor shortages related to leave coverage, vacancies, and expansion of services." "This study shows that supplemental nurses offer the strategic flexibility that hospitals need to augment their workforces during peak times, and to address any interim labor shortages related to leave coverage, vacancies, and expansion of services."
Published in the April-June issue of the Journal of Nursing Care Quality, the study, "Cost Outcomes of Supplemental Nurse Staffing in a Large Medical Center: A Method for Quantifying Supplemental Nurse Cost Efficiency," analyzed hospital nursing personnel cost data collected from a large medical center in upstate New York between July 2003 and December 2006. The data included all patient stays (465, 936) in 19 varied adult patient care units.
According to the study's findings
"In addition to not being cost-effective, overtime hours performed by permanent nurses may equate to poor nurse and patient satisfaction," said researcher Linda H. Aiken, Ph.D., RN, FAAN, FRCN, with the Center for Health Outcomes and Policy Research, University Pennsylvania. "Extensive research indicates that overtime work is connected to nurse burnout, turnover, and poor patient outcomes. The use of supplemental nurses can alleviate these risks."
To access the report, visit bit.ly/1aISZ07.
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About the American Staffing Association
The American Staffing Association is the voice of the U.S. staffing, recruiting, and workforce solutions industry. ASA and its affiliated chapters advance the interests of the industry across all sectors through advocacy, research, education, and the promotion of high standards of legal, ethical, and professional practices. For more information about ASA, visit americanstaffing.net.
Overall patient satisfaction with care and evaluations of quality of nurse communications are not affected by the employment of supplemental (temporary or contract) nurses, according to a new, first-of-its-kind study led by researchers at the University of Pennsylvania School of Nursing. Satisfaction levels are assessed according to how patients would rate their hospital experiences or whether they would recommend their particular hospitals to loved ones.
“Patient satisfaction is a valid and vital component of quality of care,” said researcher Linda H. Aiken, Ph.D., RN, FAAN, FRCN, with the Center for Health Outcomes and Policy Research, University Pennsylvania. “This groundbreaking study helps debunk the myth that the use of supplemental nurses negatively impacts patient quality of care or satisfaction.”
Published in the March issue of the Journal of Nursing Administration, the study, “Hospital Employment of Supplemental Registered Nurses and Patients’ Satisfaction of Care,” analyzed cross-sectional data from registered nurses in 427 hospitals in four states that were linked to American Hospital Association data and patient data from the Hospital Consumer Assessment of Healthcare Providers and Systems survey developed by the U.S. Centers for Medicare and Medicaid Services.
“This study confirms that the use of supplemental nurses is a sound strategy for medical institutions to employ to maintain appropriate nurse to patient staffing levels and ensure high levels of patient satisfaction and patient care,” said Richard Wahlquist, ASA president and chief executive officer.
To access the report, visit bit.ly/18hlznu.
The ultimate objective for any healthcare staffing firm should be to provide a framework of quality, safety, benchmarking, and performance improvement. To that end, The Joint Commission’s vision statement is a great standard for firms to follow: “All people always experience the safest, highest quality, best-value health care across all settings.”
But how do you achieve — and maintain — the critical operational aspects of your healthcare staffing firm on that level, especially with the other responsibilities of your business?
While there is no magic formula for success, NATHO membership and Joint Commission Certification are integral steps your company can take to strengthen operational processes, brand, and reputation for quality and value within the industry.
These 10 tips are essential building blocks to provide quality and value to your firm’s client hospitals.
Your company’s conduct — and client perception of it — is everything when trying to attract business. Attaining Joint Commission certification and becoming a NATHO member, which is known for promoting ethical practices in healthcare staffing is essential. Aligning yourself with industry leaders synonymous with quality and integrity is imperative for your operations and reputation.
The most crucial step to providing value to hospitals is employing top- quality healthcare providers who’ll represent your firm well and ensure clinical quality. At a minimum, travelers should be stringently reviewed by: resume, background, references, skills, licensure/certification, health requirements, education. Emphasize the importance of credentialing — which protects patients and hospitals — including checks of OIG, NPDB, state boards, formal education verification and work history verification.
Good healthcare staffing firms know their job isn’t done when a traveler arrives on assignment. It’s important to ask: What resources and support can you provide your travelers to help maintain clinical competency? One great approach is to employ internal clinical staff and supervisors, making them available as a resource for your travelers and clients. Besides being advantageous for travelers and cementing your firm as one that will always support and assist, hospitals will greatly appreciate that your firm possesses clinical experts. Conducting ongoing performance evaluations is another surefire way to measure and maintain quality.
Providing travelers with proper training and continued resources can have a big impact in the reduction of sentinel events and other negative outcomes. Consider offering online modules and testing regarding HIPAA, OSHA, workplace safety/violence/harassment, Joint Commission requirements, clinical concerns, and other important categories that can ensure quality and maintain ethical performance.
Compliance is important to your clients. Maintain updated policies and procedures on a company-wide level to reflect revised federal and state laws, regulatory agency requirements, and Joint Commission standards.
When entering into a contract with a client hospital performing due diligence is key to eliminating risk while also building optimum relationships with your clients. Be sure to educate yourself on key terms and stay abreast of industry trends. Protect yourself by reviewing contracts carefully to eliminate the possibility of your firm accepting undue risk.
It’s just as essential for your firm to be HIPAA-compliant as it is for your travelers. Offer training and maintain stringent standards for internal access to individual information and protection of sensitive information, whether it is medical or personal identification.
In addition to fostering improved patient outcomes, utilizing a contingent workforce has been shown to save hospitals money in the long run, by limiting expenses such as overtime and turnover costs. But what makes your firm stand out? Quality is an excellent differentiating value, and one to which hospitals will respond.
Know exactly where your firm stands—and why—when making important decisions regarding initiatives, policies, and scope. Use key performance indicators across departments and positions to track and report productivity. Metrics keep a firm focused, can provide evidence of value, and protect financial viability.
Regularly examine your firm’s operations. A thorough checklist is a helpful way to maintain your firm’s quality standards and strategic follow-through. Joint Commission standards provide a rigorous framework that helps you measure and improve your internal procedures and processes. This gives you confidence that you’re following the best industry practices available.
Quality and safety are paramount for healthcare staffing firms based on who we ultimately serve — patients who have entrusted their care to our clients. Our work comes with a great responsibility and accountability towards the delivery of outstanding healthcare in our communities nationwide.
As you take heed of these 10 tips, think about how you can integrate them into your culture with ongoing training not only of your temporary talent, but also your internal staff. Everyone agrees quality and safety are important, but to effectively uphold these areas you need to make an investment in relevant and ongoing training of your staff. This is especially critical now in a time when there are many changes taking place based on healthcare reform. Take advantage of all of the industry resources possible. Be informed of the regulations and dynamics in our industry and schedule regular sessions to educate your staff and hold them accountable to your standards on consistent basis. This investment is a key part of the service we offer to our clients.
NATHO and The Joint Commission are two valuable resources that can help you meet these challenges. NATHO provides a wonderful forum for networking with industry colleagues, many of whom have great expertise. They are willing to share this in order to continually improve the service we collectively provide. NATHO also offers educational webinars and other resources to help you stay informed and on top of compliance and contractual issues. The Joint Commission offers an extremely effective way to objectively and regularly assess your firm’s overall compliance with quality and safety standards. Throughout the certification process, The Joint Commission works collaboratively with your firm in order to help it implement best practices and rise to its highest potential.
Finally, ask your key stakeholders (internal employees, talent, and clients) for feedback. Anonymous surveys that can assess your Net Promoter Score can be a wonderful tool to measure your progress and help you determine specifically where to focus performance improvement initiatives.
www.jointcommission.org/HCS | www.natho.org
Cynthia Kinnas, founding board member and current president of NATHO, Executive Vice President of Randstad Healthcare.
NATHO is a non-profit association of travel healthcare organizations, founded in 2008 to promote ethical business practices in the travel healthcare industry, setting the gold standard for conduct that is aligned among member agencies on behalf of travel healthcare candidates and clients.
Benefits of joining NATHO:
Sarah Wengert, healthcare staffing industry expert with Medical Solutions, the nation’s third-largest travel nurse staffing agency, and an industry leader in quality.
Michele Sacco, Executive Director, Health Care Staffing Services Certification at the Joint Commission.
The Joint Commission’s Health Care Staffing Services (HCSS) Certification Program provides an independent, comprehensive evaluation of a staffing firm’s process to provide qualified and competent staffing services.
Benefits of achieving Health Care Staffing Services Certification:
The Joint Commission is an independent, not-for-profit organization that accredits and certifies more than 20,500 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.
Job Integration Factors As Predictors of Travel Nurse Job Performance, A Mixed-Methods Study
Philadelphia, PA- Carol A. Tuttas, PhD, RN authored a study published in the Journal of Nursing Care Quality titled, “Job Integration Factors As Predictors of Travel Nurse Job Performance, A Mixed-Methods Study”. In addition to being published for a third time in this particular journal, Dr. Tuttas was asked to create a video abstract of her study to bring attention to the importance of the topic being researched.
Dr. Tuttas has had extensive experience working with travel nurses. Travel nurses and their work environment are underrepresented in academic studies, despite their contributions to the safety and well-being of patients every day. Dr. Tuttas had a rare opportunity to conduct a mixed-methods study that involved a sampling of full-time travel nurses. In this study, the relationships between onboarding (orientation and integration) and job performance were explored. One unique feature of this study was the use of web-based focus group interviews with travel nurses who might otherwise be excluded from the study due to their geographic dispersion. The results of the study can inform nurse managers preparing to receive travel nurses. Application of the knowledge yielded in this study can lead to onboarding frameworks that more effectively meet travel nurses’ needs and facilitate optimal job performance in the best interest of patient safety and satisfaction.
Dr. Tuttas says of her accomplishment that “It was rewarding to create an opportunity for travel nurses to participate in a study about them. It is an honor to have my study published in the Journal of Nursing Care Quality, the journal in which my first manuscript was published in 2002!”
Dr. Franklin A. Shaffer, CEO of CGFNS International, Inc., lauded Dr. Tuttas’s work as a significant contribution to the literature on nursing practice. He remarked on its potential in shedding light on strengthening the onboarding experience of foreign-educated nurses in the United States to achieve better patient safety outcomes.
About CGFNS International, Inc.
CGFNS International, Inc. is a non-profit and immigration neutral organization whose mission is to serve the global community through programs and services that verify and promote the knowledge-based practice competency of health care professionals. Please visit our website for additional information at www.cgfns.org.
By Steve Wehn, Vice President, NATHO and Vice President, AMN Government and Community Relations
Executive summary on why to oppose this ballot initiative:
In my role at AMN Healthcare, I continually monitor the regulatory environment for any issues or legislation that may impact our business, clients, clinicians and/or physicians. An important matter has come before us that I want to bring to your attention if you are not already aware. Especially if you currently do business or plan to do business in California. Last month it was announced that the anti-MICRA ballot measure had officially qualified for the November 2014 California ballot.
A broad and bipartisan coalition of doctors, community health centers, hospitals, local governments, public safety, business and labor unions has formed to fight this November 2014 ballot proposition drafted by trial lawyers out to profit from medical lawsuits. If passed, this ballot measure will increase health care costs, threaten the privacy of personal prescription drug information, and will jeopardize people’s ability to see their trusted doctors.
The measure’s main provision will quadruple the non-economic damages cap on California’s successful Medical Injury Compensation Reform Act (MICRA), the law that governs legal proceedings if someone is injured in a medical procedure. This single change will triple trial lawyers’ legal fees in the non-economic damages portion of medical lawsuits filed against doctors and hospitals. (Note: Under MICRA, economic damages for past and future lost wages, past and future medical costs, and punitive damages are unlimited.) If trial lawyers get their way, medical lawsuits and payouts will skyrocket. Someone will have to pay those costs. And that someone includes providers, consumers, businesses and taxpayers.
The measure contains two other unrelated provisions dealing with drug testing and prescription drug databases which were intentionally included by the backers in an attempt to mislead voters by taking the focus off the lawsuit provisions. The prescription drug database poses serious privacy risks for California patients. And the drug testing provision was included for political, not policy reasons. In fact, one of the main supporters of the proposition admitted to the Los Angeles Times that the drug rules are in the initiative because they poll well, calling these provisions “the ultimate sweetener.”
Here’s more information why the MICRA ballot measure should be defeated:
Costly for Consumers
According to a study by California’s former Legislative Analyst, the new lawsuits and massive payouts under this proposition will increase health care costs across all sectors by $9.9 billion annually. That amounts to more than $1,000 a year in higher health costs for the average California family. And California’s current independent Legislative Analyst’s Office (LAO) warns the proposition could increase state and local government medical liability and health care costs by “hundreds of millions of dollars annually,” placing the burden of this additional cost on all taxpayers.
Threatens People’s Personal Privacy
This measure forces doctors and pharmacists to use a massive statewide database filled with Californians’ personal medical prescription information. A mandate government will find impossible to implement, and a database with no increased security standards to protect people’s personal prescription information from hacking and theft – none.
Jeopardizes People’s Access to their Trusted Doctors
If California’s medical liability cap goes up, people could lose access to their trusted doctors. . Many doctors will be forced to leave California to practice in states where medical liability insurance is more affordable. Respected community clinics, warn that specialists like OB-GYNs will have no choice but to reduce or eliminate vital services, especially for women and families in underserved areas.
Additional Problems for Physicians
California’s Controlled Substance Utilization Review and Evaluation System (“CURES”) Database Problems Could Jeopardize Patient Access to Needed Medications
The new mandate that providers check CURES before prescribing or dispensing Schedule II or III controlled substances takes effect the day after the November 2014 election – an impossible implementation timeline given the current state of CURES which today lacks important functionality. Without an upgraded CURES database, prescribing health care providers and pharmacists would be legally required to use a database that has, in practice, not been available. According to a recent review of the CURES database and the provisions in the ballot measure, “providers would face the choice of denying treatment to their patients or violating the stated terms of the initiative.”
Provisions Impose a Presumption of Professional Negligence
This ballot measure also flips on its head “innocent until proven guilty,” and instead institutes a presumption of professional negligence in any action against a health care provider arising from:
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