All these nurses writing articles

Nurses General Nursing

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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?

1 hour ago, Asystole RN said:

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::

Please stop with the diatribes. I think that most staff nurses already understand that Joint Commission, as well as other accrediting bodies, are necessary entities that were created for the protection of the unsuspecting public. We understand that they are only enforcing existing policies, regulations, mandates..... We also understand the importance of Joint Commission accreditation in ensuring continuing Medicare reimbursement and the future solvency of our hospitals. What we don't understand is the preoccupation (near obsession) of these agencies with minor concerns such as many have cited. What could possibly be more central to patient safety than adequate caregiver/patient ratios? Or entire units being staffed with new/inexperienced staff nurses without inadequate resources and oversight? The auditors leave and the temporary beefed up staffing as well as everything else, goes back to normal. Having worked all over the country in numerous hospitals as a travel nurse, it's always the same to lesser or greater degrees. I am amazed that some hospitals (with full Joint Commission and DPH accreditation) continue to keep their doors open and I understand why Joint Commission has earned the enmity of many nurses.

1 Votes
20 minutes ago, morelostthanfound said:

Please stop with the diatribes. I think that most staff nurses already understand that Joint Commission, as well as other accrediting bodies, are necessary entities that were created for the protection of the unsuspecting public. We understand that they are only enforcing existing policies, regulations, mandates.....

Have you read the thread?

20 minutes ago, morelostthanfound said:

We also understand the importance of Joint Commission accreditation in ensuring continuing Medicare reimbursement and the future solvency of our hospitals.

I guess not.

20 minutes ago, morelostthanfound said:

What we don't understand is the preoccupation (near obsession) of these agencies with minor concerns such as many have cited.

What would the Fire Marshall care about nurse staffing? What does the Department of Food Safety within the Department of Health care about nurse staffing?

All of those little agencies have tiny scopes that look at hyper specific issues. TJC rolls all of those up into a single audit...which accounts for many of weird items they are looking for.

20 minutes ago, morelostthanfound said:

What could possibly be more central to patient safety than adequate caregiver/patient ratios? Or entire units being staffed with new/inexperienced staff nurses without inadequate resources and oversight?

I agree and I think most people would agree. TJC cites facilities that are not compliant to staffing regulations, where they exist, and I know from personal experience staffing policy, where it exists. TJC enforces regulations and polices set by others.

20 minutes ago, morelostthanfound said:

The auditors leave and the temporary beefed up staffing as well as everything else, goes back to normal.

Are you saying TJC should permanently assign an auditor to each hospital to ensure compliance? I mean they are auditors, not the ethics police. TJC is only so big and if someone wants to game the system there is unfortunately little TJC can do.

20 minutes ago, morelostthanfound said:

Having worked all over the country in numerous hospitals as a travel nurse, it's always the same to lesser or greater degrees. I am amazed that some hospitals (with full Joint Commission and DPH accreditation) continue to keep their doors open and I understand why Joint Commission has earned the enmity of many nurses.

Like I said, nursing tends to hate what it doesn't understand. We can whine or we can try to understand the root cause and actually fix something.

1 Votes
6 minutes ago, Asystole RN said:

Have you read the thread?

I guess not.

What would the Fire Marshall care about nurse staffing? What does the Department of Food Safety within the Department of Health care about nurse staffing?

All of those little agencies have tiny scopes that look at hyper specific issues. TJC rolls all of those up into a single audit...which accounts for many of weird items they are looking for.

I agree and I think most people would agree. TJC cites facilities that are not compliant to staffing regulations, where they exist, and I know from personal experience staffing policy, where it exists. TJC enforces regulations and polices set by others.

Are you saying TJC should permanently assign an auditor to each hospital to ensure compliance? I mean they are auditors, not the ethics police. TJC is only so big and if someone wants to game the system there is unfortunately little TJC can do.

Like I said, nursing tends to hate what it doesn't understand. We can whine or we can try to understand the root cause and actually fix something.

I do understand it but don't agree with your perspective so respectfully, we'll have to 'agree to disagree here'. I, and I think many nurses, see it as the sham that really is and giving the public a false sense of security,

1 Votes

It shocks me on here that many of you think things that I mentioned are hospital policy and not joint commission. I’ve been through surveys, I’ve been through our certifications. I know what is brought to our attention after surveys that we were specifically cited for.

4 hours ago, LovingLife123 said:

It shocks me on here that many of you think things that I mentioned are hospital policy and not joint commission. I’ve been through surveys, I’ve been through our certifications. I know what is brought to our attention after surveys that we were specifically cited for.

Yes. I am not sure how the topic got on OSHA/Fire Marshal and other federal mandates. If you have a hospital wide policy allowing drinks at the nurses station, I would bet money you would be found in violation by TJC during a survey. Someone above even gave an email from OSHA, which from my interpretation meant that this would be perfectly acceptable in their view unless particularly restricted in the hospital's own policies.

I think what people are complaining about is these accrediting bodies are going around to the public saying how they are keeping the PUBLIC safe. But when it comes to big issues that would likely have a much bigger impact on the public's safety, they are completely ignored in favor of finding relatively minor infractions even if they are violations of OSHA/Fire marshal codes.

I think its overall a much easier process for the accrediting body and hospital administrators. Finding minor issues that can be tacked on to the duties of the general staff is much easier than coming in and saying you need to start hiring more staff around here in order to meet our certification guidelines.

1 Votes
4 hours ago, LovingLife123 said:

It shocks me on here that many of you think things that I mentioned are hospital policy and not joint commission. I’ve been through surveys, I’ve been through our certifications. I know what is brought to our attention after surveys that we were specifically cited for.

WADR you just aren't processing what is being said. Yes we know that your facility didn't make up rules involving minutiae such as refrigerator temperatures just to torture you. We are saying a couple of different but relevant things: 1) That these are rules put forth by another regulatory body, and when TJC visits a site they seek to ensure that you are following that basic rule put forth by that body. So then, these rules did not originate with jake-o. 2) Some of the rules allow for interpretation and take the form more of 'facility must have a policy addressing [x, y, z] that meets [x basic standard] and must follow it. And that part is where your facility's interpretations and choices come into play. The food/drink example has been used to clearly outline what we are talking about with regard to rules put forth by other agencies that allow for some interpretation: The (OSHA) rule says only that poop and nachos can't share the same space (as succinctly summarized by another poster). That means that your facility has to decide whether a) the poop (patient samples) must be eliminated from the nacho space (places where food/drink is allowed), or if b) the food/drink must be disallowed so that you can continue to handle poop in common workspaces. [Many hospitals initially went with "b"; I have already given my theories why].

Regardless of your facility's decision, when TJC visits your site they will check whether you have taken steps to follow the basic rule.

43 minutes ago, Jkloo said:

Yes. I am not sure how the topic got on OSHA/Fire Marshal and other federal mandates.

The connection has been described very clearly several times now.

44 minutes ago, Jkloo said:

If you have a hospital wide policy allowing drinks at the nurses station, I would bet money you would be found in violation by TJC during a survey.

Nope. You have to follow the basic rule, which is that food/drink may not be consumed in areas where patients/patient samples are being handled such that they could contaminate the food/drink. So you would only be in violation if you haven't specified where food/drink may be consumed, where patient samples will be handled, and kept the two things in their own distinct areas apart from each other.

If you have your patient's stool sample in a cup at your computer while you're snacking on bon bons, you would be cited. If staff is carrying their personal water bottles around into patient rooms, you would be cited. But if you demonstrate an established process and practice of putting the patient samples in a dedicated place and eating your snacks and drink your water somewhere else, you will not be cited (in general).

46 minutes ago, Jkloo said:

Someone above even gave an email from OSHA, which from my interpretation meant that this would be perfectly acceptable in their view unless particularly restricted in the hospital's own policies.

Yes! The purpose of sharing the letter from OSHA was exactly to demonstrate to people not understanding this that facilities' own interpretations may make things unnecessarily unpleasant! If your facility chooses to satisfy the rule by disallowing you from having food or drink at your nurse's station, that is their fault because the rule does not expressly require that, as proven by the letter from OSHA.

That IS the connection.

1. There is leeway in satisfying many of the rules; there is often more than one way to show that you are accomplishing x, y, z.

2. TJC is going to check to see that, one way or another, you are following the rules of other agencies/regulatory bodies.

3. Your facility can choose an easier or a particularly burdensome way to follow a specific rule from a particular agency/body, but regardless of which they choose, TJC is going to look to see if they are abiding by their own choice/policy.

1 hour ago, Jkloo said:

I think what people are complaining about is these accrediting bodies are going around to the public saying how they are keeping the PUBLIC safe. But when it comes to big issues that would likely have a much bigger impact on the public's safety, they are completely ignored in favor of finding relatively minor infractions even if they are violations of OSHA/Fire marshal codes.

I won't disagree with your basic idea there.

2 Votes
8 hours ago, klone said:

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.

Well, that's their own fault. They could have gone with a useable TLA (Three letter acronym) like CDC, FBI, CIA. Or a pronounceable acronym like NASA, or even NOAA, which can be pronounced like Noah.

But instead they went with some messed up spelling like a parent who names their unique and special daughter Jessieighkah. Name your kid what you want, but don't get tweaked when we get it wrong.

Also, Jayco deserves to be spelled wrong. Those guys are a pain in the ***.

On 12/5/2019 at 10:03 AM, Asystole RN said:

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?

Or not. Pretty sure taping paper on a wall violates something. This subject actually came up yesterday.


Quote

• Infection Prevention has noted certain areas of vulnerabilities that have impacted our surveys in the past.

They are: 1. Tape- tape cannot be used to hang anything on the walls, in the desk areas or to hold equipment together.

http://lsglm700.learnsoft.com/rblearnwbt/The Joint Commission Standards for Infection Prevention 2016 2017.pdf

1 Votes
Specializes in Critical Care.

It’s such ********

“ACTIVATE CODE J. ACTIVATE CODE J”

(okay guys I know we usually aren’t up to standard but make sure we are just until these goons leave!)

2 Votes
Specializes in Surgical Specialty Clinic - Ambulatory Care.
On 12/2/2019 at 1:16 PM, Asystole RN said:

If the hospital is not staffing to their own policy

To me this is the problem. To me the mere fact that the hospital only has to follow their own policy regarding staffing is a problem. The fact that JACHO even mentions shareholders in their mission statement is a problem.
Yes we all complain about keeping up with building codes, but usually hospitals have building management personnel that are responsible for helping us keep hallways clear and temperatures correct. There is no one helping us keep patients safe. Upper management and accreditation boards are touting that they are making things safer through mandatory paperwork that merely provides lip service to the kind of care we should be able to provide once ratios are adequate and administrative creep is put in check.

I am not saying it is upper management’s fault....I realize they a doing their job. What I am saying is that at the point where monies and service collide, we are failing to provide value to those we are serving. And like our government currently, instead of coming up with a plan that makes changes that the public are demanding (good care at a reasonable cost) policy and regulation continue to focus on paperwork as a means to correct the issue. You can keep adding whatever kind of check lists and check boxes to my day that you want, if the impact of all this extra paperwork and policy never impacts care in a manner which gets us to the goal (good care at a reasonable cost) then their is no point. And I would argue that a by product of all this extra work is a false sense that we are making an impact. Because complying with ‘The Joint commission’ and thus facility policy for the very short time JACHO is ‘in the house’ and then returning to survival mode is ineffective. That me filling out additional paperwork only allows the hospital metrics to look like they’ve been met on paper. If healthcare was actually meeting these metrics then the USA healthcare system would NOT look like the over priced piece of crap that it does on the world market.
I don’t blame management, I don’t blame JACHO, but it is obvious to me that this system we have is not working, so no, I don’t have a lot of respect for it. I do blame shareholders for their profit margins when it is obvious the system is not working in favor of those it is suppose to serve. I also blame elected officials for the same reason.

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