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All these nurses writing articles

Nurses   (1,729 Views 46 Comments)
by KalipsoRed21 KalipsoRed21, BSN (Member) Member Nurse

KalipsoRed21 is a BSN and specializes in Currently: Home Health.

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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?

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RosesrReder has 15 years experience.

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You’re an excellent writer yourself. You should do an article!

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Jedrnurse has 25 years experience as a BSN, RN and specializes in school nurse.

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Well, these commissions and accreditation bodies need to justify their existence. So they pick an "urgent" cause du jour and focus on that like it's emergent. Then they move on to the next one. That way there's always something for them to be needed for...

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morelostthanfound has 27 years experience as a BSN and specializes in CVOR, General/Trauma Surgery.

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This is a pet peeve of mine and I've long maintained that the JCAHO is a complete joke.  What could be more central to improving our nation's health care and protecting the public than strictly enforcing hospitals' nurse/patient ratios?  Or what about ensuring that nurses have readily available the necessary resources to deliver quality health care?  Nope, their (JCAHO pencil pushers) major concerns are refrigerator temperature logs and restraint order documentation.  Really??  They turn a blind eye to glaring and unsafe care ratios and chronic/dangerous understaffing to focus on these trivial issues. JCAHO certification, like Magnet designation, is a scam.

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Asystole RN is a BSN, RN and specializes in Vascular Access, Infusion Therapy.

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10 minutes ago, morelostthanfound said:

This is a pet peeve of mine and I've long maintained that the JCAHO is a complete joke.  What could be more central to improving our nation's health care and protecting the public than strictly enforcing hospitals' nurse/patient ratios?  Or what about ensuring that nurses have readily available the necessary resources to deliver quality health care?  Nope, their (JCAHO pencil pushers) major concerns are refrigerator temperature logs and restraint order documentation.  Really??  They turn a blind eye to glaring and unsafe care ratios and chronic/dangerous understaffing to focus on these trivial issues. JCAHO certification, like Magnet designation, is a scam.

To be fair, The Joint Commission is focused on many different things, not just patient care. Most of the items nurses complain about like temperature logs, equipment in the hallways, etc are regulatory requirements from government bodies like the Fire Marshall, Department of Health, etc. 

The Joint Commission's first and primary goals are generally focused on the basic legal requirements that a hospital has to maintain, like temperature logs. Then they move onto other matters concerning patient care. 

Under staffing is an understandable concern but was a core goal of the MS-DRG development plan in the 1980's as a cost-containment intervention. CMS is attempting to control healthcare cost by increase the patient-to-nurse ratio through the DRG base labor rate or as it is better know, the bed fee. There are many articles on it. If you want to change staffing start looking to CMS. 

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Asystole RN is a BSN, RN and specializes in Vascular Access, Infusion Therapy.

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I would also add that in many states they require healthcare facilities to be accredited by an acceptable accrediting agency in order to receive Medicaid funding or sometimes even just licensing. Joint Commission audits will often also replace or augment Department of Health audits. 

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morelostthanfound has 27 years experience as a BSN and specializes in CVOR, General/Trauma Surgery.

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I won't disagree that a hospital's temperature logs, clutter in the hallways, restraint documentation....aren't important.  My contention rather, is that among all of the other areas of concern, staffing and patient care ratios, (which factor very prominently in the delivery of a safe health care experience) are never scrutinized.  Therefore, JCAHO's mission statement, as stated by the OP, becomes somewhat disingenuous and hollow don't you think?

Edited by morelostthanfound

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Asystole RN is a BSN, RN and specializes in Vascular Access, Infusion Therapy.

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2 hours ago, morelostthanfound said:

I won't disagree that a hospital's temperature logs, clutter in the hallways, restraint documentation....aren't important.  My contention rather, is that among all of the other areas of concern, staffing and patient care ratios, (which factor very prominently in the delivery of a safe health care experience) are never scrutinized.  Therefore, JCAHO's mission statement, as stated by the OP, becomes somewhat disingenuous and hollow don't you think?

I have worked in facilities where The Joint Commission questioned staffing, in particular it was an outpatient infusion unit where there was one nurse giving blood and the policy cited 2 to be present at all times. 

The Joint Commission will review a hospital and it's compliance to regulatory requirements and compliance to policy. If the hospital is not staffing to their own policy or violating a regulation in those states that have staffing requirements then they will be cited. They also have staffing standards where the hospital is expected to conduct routine staffing assessments and have action plans to address staffing issues, here is an article about it and what it interesting to me is that the Joint Commission has some of the strongest language I have seen from a major organization about staffing. https://www.jointcommission.org/assets/1/18/health_care_at_the_crossroads.pdf 

If you are expecting The Joint Commission to come in like the Hulk and bust down the doors of Congress and CMS to get them to federally mandate staffing ratios or reverse their very intentional interventions to decrease staffing then you will be disappointed. 

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Hoosier_RN has 20 years experience as a MSN and specializes in LTC, home health, hospice, ICU, ER, dialysis.

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8 hours ago, Jedrnurse said:

Well, these commissions and accreditation bodies need to justify their existence. So they pick an "urgent" cause du jour and focus on that like it's emergent. Then they move on to the next one. That way there's always something for them to be needed for...

I've said this for years...

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ThePrincessBride has 4 years experience as a BSN and specializes in Med-Surg, NICU.

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I have sat with a surveyor and the level of nit-picking was ridiculous.

And let's be honest....they care more about charting /paper work than actual patient care. They don't mandate safe ratios at all. They don't advocate for nurses or providers. 

They are a pain in the butt.

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brandy1017 is a ASN, RN and specializes in Critical Care.

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12 hours ago, Asystole RN said:

To be fair, The Joint Commission is focused on many different things, not just patient care. Most of the items nurses complain about like temperature logs, equipment in the hallways, etc are regulatory requirements from government bodies like the Fire Marshall, Department of Health, etc. 

The Joint Commission's first and primary goals are generally focused on the basic legal requirements that a hospital has to maintain, like temperature logs. Then they move onto other matters concerning patient care. 

Under staffing is an understandable concern but was a core goal of the MS-DRG development plan in the 1980's as a cost-containment intervention. CMS is attempting to control healthcare cost by increase the patient-to-nurse ratio through the DRG base labor rate or as it is better know, the bed fee. There are many articles on it. If you want to change staffing start looking to CMS. 

 

These changes were not done with the intent to increase staffing ratios.  They were to cut the over inflated price of hospital stays.  Greedy corporate healthcare execs used this as an excuse to cut staffing ratios to get their big bonuses and promotions!

I agree the govt will not voluntarily intervene because they don't want to spend the money.  I believe the answer is to get the National Nurses United across the country and get staffing ratios like CA was able to achieve with their help!

 

Edited by brandy1017

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brandy1017 is a ASN, RN and specializes in Critical Care.

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As an aside, was the Texas hospital ever fined for the substandard, inadequate and unsafe working conditions the nurses faced with the Ebola patient that resulted in two of the nurses contracting Ebola!

They had no real protection, flimsy gowns where their skin was exposed, no hazmat respirators like should have been the case.  Then they were blamed for contracting the disease.  It just disgusts me the way healthcare is run today!

 

Edited by brandy1017

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