All these nurses writing articles

[KalipsoRed21]

To you advanced degree nurses that like writing all the articles on here, I have a request for an article.

I want to know if accrediting agencies actually help healthcare facilities. For example JACHO: “OurMission: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. “

Do all the JACHO nit picky crazy regulations actually help quality or has it gotten to the point that accreditation organizations gotten over zealous with regulation and box checking that patient care is actually worsening even though charting and other administrative measures are showing high marks

Are we being nit picked apart about measures that have minimal effect while unquantifiable direct care measures, due to the inability to consistently be able to quantify and identify them, being ignored and not valued solely because there is no way to measure for them or just the face that they are not on the ‘list’ of things to monitor?

I feel like healthcare is becoming the ‘wanna be’ field. Where we are more often posers for good care through over charting but actual care and facility staff sanity has gone by the wayside. I don’t like my profession...I don’t respect it because we have lost focus due to reimbursement and over regulation. I don’t feel like I can advocate for the good in my career, because while I know TONS of nurses, CNAs, MDs, NPs, etc that care greatly about patients, all of us are stuck doing a *** job because of over regulation and reimbursement strategies. I am all for hospitals making money, and I like rules, but are we over doing it to the point that we are not obtaining the obvious goal of taking good care of people as the minimum standard?

[JKL33]

On 12/3/2019 at 3:14 PM, LovingLife123 said:

You are missing my point. You can be a JHACO advocate all you want, and as I stated, they do serve a purpose.

I don't believe s/he is advocating for JCAHO/TJC. It's more a matter of being better informed. We only make things worse when we misdirect our dissatisfaction.

On 12/3/2019 at 3:14 PM, LovingLife123 said:

Should I have charted I educated my GCS of 6 on the importance of physical therapy while she was in V-Tach, or while I was placing an OG for vomiting? Or while we discussed terminally weaning or trach and pegging?

It is directly within your facility's powers and capabilities to mitigate your charting burden. Just like it was never true that staff members could not have water in the nurse's station, there are a lot of other "JCAHO" things that are simply not true and don't involve JCAHO. And occasionally you can actually gain back some ground if you know what you're talking about, just like some places got their water back after pressing the issue. It's all such ridiculousness, but you definitely won't get anywhere if you accept the idea that everything is because jake-o.

On 12/3/2019 at 3:14 PM, LovingLife123 said:

Should I have charted I educated my GCS of 6 on the importance of physical therapy while she was in V-Tach, or while I was placing an OG for vomiting? Or while we discussed terminally weaning or trach and pegging?

Of course not, and JCAHO doesn't say that you have to. Apparently someone in your facility has said that you must do it anyway.

That's exactly the kind of thing the poster is talking about, and s/he gave a direct example.

[Asystole RN]

20 hours ago, LovingLife123 said:

We got our accreditation to be a Comprehensive Stroke Center a whole back. We were certified by JHACO so yes, many of these things are coming from them.

You are missing my point. You can be a JHACO advocate all you want, and as I stated, they do serve a purpose. But they don’t focus on the big things. It’s the small, minute things. They don’t at all see we just cracked a chest open at bedside, or I was involved in a bedside laparotomy. That my whole day was simply keeping my patient alive and the other happy at the same time with ice and pain meds. So then I get to stay until 2100 charting things 3 times so I’m compliant. I’m late getting home to my family and frankly, it’s burning nurses out.
The focus should be on the safety of the hospital and not our charting. And my charting is pretty darn good. I’m pretty quick and accurate. But I was at work until 2030 last night finishing up plans of care on a new admit and my dying terminal wean because she was a stroke and the chart will “fail” if I don’t chart my plan of care and education. Should I have charted I educated my GCS of 6 on the importance of physical therapy while she was in V-Tach, or while I was placing an OG for vomiting? Or while we discussed terminally weaning or trach and pegging?

I personally don't care about the Joint Commission but complaining about items that are either matters of facility policy or legal requirements determined by other agencies like the Department of Health is misguided.

[Asystole RN]

6 hours ago, hherrn said:

I agree with your sentiment 100%. It is a simple mathematical fact: If my time is completely full, and a task is added, a task of equal size will need to be subtracted. My tasks fall into two categories; patient care and charting. If a charting task is added, that time has to come from somewhere. If I don't want to get dinged, that time comes from PT care.

No PT has ever benefited from me asking a bizarre selection of inane questions, or me charting response to an icepack. They have suffered if I have to use my limited time doing that, rather than help them download Goodrx on their phone so they can afford the medication and actually be compliant.

But- much of what you cited is not from regulatory agencies, but straight from hospital policy as hospital staff misinterpret those regulations. These are unusually mid-level admin who walk around with clipboards, none of whom do bedside care.

Take for example water at the nursing station- This is neither a threat to PTs or staff. And, I challenge anybody to find a regulation anywhere that prohibits it.

Do you transport, label, or do anything involving lab stuff at the nursing station?

Most of the time the prohibition comes from a contamination concern, this is a public statement from OSHA.

"OSHA does not have a general prohibition against the consumption of beverages at hospital nursing stations. However, OSHA's bloodborne pathogens standard prohibits the consumption of food and drink in areas in which work involving exposure or potential exposure to blood or other potentially infectious material takes place, or where the potential for contamination of work surfaces exists [29 CFR 1910.1030(d)(2)(ix)]. Also, under 29 CFR 1910.141(g)(2), employees shall not be allowed to consume food or beverages in any area exposed to a toxic material. While you state that beverages at the nursing station might have a lid or cover, the container may also become contaminated, resulting in unsuspected contamination of the hands.

The employer must evaluate the workplace to determine in which locations food or beverages may potentially become contaminated and must prohibit employees from eating or drinking in those areas. An employer may determine that a particular nurse's station or other location is separated from work areas subject to contamination and therefore is so situated that it is not reasonable under the circumstances to anticipate that occupational exposure through the contamination of food and beverages or their containers is likely. The employer may allow employees to consume food and beverages in that area, although no OSHA standard specifically requires that an employer permit this. OSHA standards set minimum safety and health requirements and do not prohibit employers from adopting more stringent requirements.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at http://www.osha.gov. If you have any further questions, please feel free to contact the Office of Health Enforcement at 202-693-2190."

[klone, MSN, RN]

On 12/2/2019 at 12:46 PM, ThePrincessBride said:

They don't advocate for nurses or providers.

That's not their job. Their job is to be the eyes and ears of the state Medicaid program, making sure hospitals are following the laws that Medicaid and other governmental agencies have set forth in order to get government funding to stay in business.

[klone, MSN, RN]

For G-d's sake people. It's not JACHO or JAHCO or JHACO. Their FORMER name was JCAHO. Now it's just Joint Commission, or TJC.

[anchorRN, BSN, MSN, RN, APRN]

Let's not forget that a hospital must pay The Joint Commission to come in and do a survey. It's not a freebie. I think that speaks volumes about TJC to be honest. Don't want to play by their rules? Fine. They'll just take away your Medicare/Medicaid reimbursement and good luck keeping the doors open if that happens. TJC is nothing but a stain on the healthcare system. I know for a fact the hospital I work for keeps a stash of "good records" for the surveyors to look at (although supposedly its random, yeah right). I have been an RN for 16 years now and I could not imagine a more horrible job than working in the compliance department of a hospital. What a nightmare.

[Guest219794]

17 hours ago, Asystole RN said:

Do you transport, label, or do anything involving lab stuff at the nursing station?

Most of the time the prohibition comes from a contamination concern, this is a public statement from OSHA.

"OSHA does not have a general prohibition against the consumption of beverages at hospital nursing stations. However, OSHA's bloodborne pathogens standard prohibits the consumption of food and drink in areas in which work involving exposure or potential exposure to blood or other potentially infectious material takes place, or where the potential for contamination of work surfaces exists [29 CFR 1910.1030(d)(2)(ix)]. Also, under 29 CFR 1910.141(g)(2), employees shall not be allowed to consume food or beverages in any area exposed to a toxic material. While you state that beverages at the nursing station might have a lid or cover, the container may also become contaminated, resulting in unsuspected contamination of the hands.

The employer must evaluate the workplace to determine in which locations food or beverages may potentially become contaminated and must prohibit employees from eating or drinking in those areas. An employer may determine that a particular nurse's station or other location is separated from work areas subject to contamination and therefore is so situated that it is not reasonable under the circumstances to anticipate that occupational exposure through the contamination of food and beverages or their containers is likely. The employer may allow employees to consume food and beverages in that area, although no OSHA standard specifically requires that an employer permit this. OSHA standards set minimum safety and health requirements and do not prohibit employers from adopting more stringent requirements.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at http://www.osha.gov. If you have any further questions, please feel free to contact the Office of Health Enforcement at 202-693-2190."

No. Our nursing station is essentially a row of charting stations that face the PT rooms. We frequently eat and drink at those stations. Bringing over a bit of C-diff would be bad form. Labelling a specimen other than in the PTs room would be bad practice.

"employees shall not be allowed to consume food or beverages in any area exposed to a toxic material".

A good, common sense rule that applies to multiple industries and professions.

In other words, if there is both poop and nachos in the same area, one of them is in the wrong place.

[JKL33]

4 hours ago, hherrn said:

We frequently eat and drink at those stations. Bringing over a bit of C-diff would be bad form. Labelling a specimen other than in the PTs room would be bad practice.

Yes, but that realization has evolved over time and processes have changed (all for the better). It did use to be common to bring specimens to where the labels were, which used to be one central location. So there was a time where food/drink and patient samples were being handled in the same general area.

4 hours ago, hherrn said:

In other words, if there is both poop and nachos in the same area, one of them is in the wrong place. 

Correct, and I'm sure most all would agree. But, given that, what happened first is that places chose to make it about the nachos (water) instead of the other fun things that shouldn't have been in the nurse's station/common work area. [Forget the labeling errors that happened directly due to that old process]. Why? Because they wanted their three birds with one stone: Stay in line with OSHA and eliminate the possibility that a member of the general public will see a nurse "sucking on" a water bottle [to use their actual mean and disparaging words] and refuse to give in to requests from low-level workers. This is such a perfect, classic example of why a nurse would want to understand what is and what isn't jake-o (along with what the actual rule is) because you then have the opportunity to brainstorm solutions that will satisfy the actual rule, such as developing a process where patient samples aren't brought into the common work area any more (which satisfies OSHA and is very helpful in moving toward better processes that reduce labeling errors).

The evolution of this food/drink/lab samples issue has become the classic, prime example of purposeful misrepresentation. OSHA said food/drink must not be consumed where there are known contaminants like these. That morphed into: Jake-o says you cannot have water at the nurse's station, because we just don't want you to. Purposeful, useful misrepresentation.

[Asystole RN]

10 hours ago, anchorRN said:

Let's not forget that a hospital must pay The Joint Commission to come in and do a survey. It's not a freebie. I think that speaks volumes about TJC to be honest. Don't want to play by their rules? Fine. They'll just take away your Medicare/Medicaid reimbursement and good luck keeping the doors open if that happens. TJC is nothing but a stain on the healthcare system. I know for a fact the hospital I work for keeps a stash of "good records" for the surveyors to look at (although supposedly its random, yeah right). I have been an RN for 16 years now and I could not imagine a more horrible job than working in the compliance department of a hospital. What a nightmare.

The Joint Commission is non-profit and most states do not require the Joint Commission, they just require accreditation by an accrediting body. Not all facilities opt for the Joint Commission either.

[Asystole RN]

4 hours ago, hherrn said:

No. Our nursing station is essentially a row of charting stations that face the PT rooms. We frequently eat and drink at those stations. Bringing over a bit of C-diff would be bad form. Labelling a specimen other than in the PTs room would be bad practice.

"employees shall not be allowed to consume food or beverages in any area exposed to a toxic material".

A good, common sense rule that applies to multiple industries and professions.

In other words, if there is both poop and nachos in the same area, one of them is in the wrong place.

That's great, then you just have the minor and entirely internal step of designating that nursing station a contamination free work area where beverages are allowed. Literally 1 sentence in a policy, hell 1 sentence on a piece of paper taped to the wall and you are Joint Commission citation free.

See how easy that was?

[Asystole RN]

I think this thread highlights the #1 issue in nursing right now.

::Begin Rant::

We as a profession will automatically assume malice or incompetence to anything we don't like and spend vast amounts of energy complaining about something without spending even the most modest amount of energy researching the root cause. We as a profession wonder why others don't take nursing seriously, why we are constantly dismissed and undervalued.

We don't like the things the Joint Commission is doing so they must be either incompetent at best or evil at worst. Who cares about researching why they look at things like food and drink in nurses stations or temperature logs. "I am angry the Joint Commission cited me on not charting in 87 places for a single item," but lets ignore the fact that it is entirely internal policy driving those 87 charting locations.

You can see this in the sheer hatred for any kind of leadership, if they are not providing direct bedside care then they are essentially useless, greedy, and possibly the devil. Lets not take a minute to consider that someone has to negotiate the tier rates on a GPO contract, contract compliance rates, or ensure regulatory compliance and applications are filled for licensing. Who cares about filing mandatory reports to the state and federal government?

You see this with staffing. We are short staffed so our leadership must be corrupt, greedy, and evil. Who cares about things like fixed versus variable costs? Who cares about cost containment strategies enacted on a federal level in the 1980's that were directly aimed at increasing the nurse to patient ratio through reimbursement manipulation with the MS-DRG labor base rate? Who cares about the many, many, many articles, publications, and government presentations that explicitly said they were going to help control healthcare costs by controlling nursing labor costs? No one ever asks why physicians and LIPs are reimbursed but nursing is rolled into the base labor rate. Lets just complain about our middle management instead of addressing the root cause that incentivizes high ratios.

Who cares about what is actually causing our issue so as long as we can easily whine about something that is easily digestible and comfortable to us? If we are to be taken seriously as a profession we must start asking why things are the way they are...

::End Rant::

[anchorRN, BSN, MSN, RN, APRN]

1 hour ago, Asystole RN said:

The Joint Commission is non-profit and most states do not require the Joint Commission, they just require accreditation by an accrediting body. Not all facilities opt for the Joint Commission either.

When I was in the Navy and stationed at the Naval Hospital in San Diego we were not required to be accredited by an accrediting agency since we only accepted TriCare. But they opted to get that TJC accreditation because there is a stigma attached to hospitals that do not have it. And I assure you that hospitals do, in fact, pay out of their own pockets to have the surveys completed. It’s all about getting that little gold TJC seal to put on their advertising publications. What a joke.