The National Labor Relations Board claims that Holy Family Hospital of Methuen, Massachusetts, part of Steward Health Care System, fired Mary Ramirez for her activity leading a union organizing effort. Ramirez, 61, has 40 years of nursing experience, 18 of them at Holy Family. NLRB also said that nurses at Holy Family weren’t allowed to wear buttons showing support for Ramirez.

Through a spokesperson, Steward has denied the allegations, claiming that Ramirez was fired for a variety of performance issues that were reported to management by a fellow nurse. The hospital claimed that Ramirez intentionally changed a doctor’s order, made an intentional medication error, and didn’t enter a morphine dose in a patient’s record. (Ramirez doesn’t deny that she administered a drug intravenously rather than injecting it, but said it wasn’t an intentional error. She also noted that the patient wasn’t harmed in any way.)

The hospital also said that the Board of Registration put Ramirez on probation for two year for diverting patient medication for her own use. Ramirez didn’t deny the allegation, but again pointed out that no patients were harmed by her actions.

Ramirez maintains that her union activity was the real (and improper) reason for her firing. She’s seeking reinstatement to her position and back pay.

Between 2000 and 2010, the number of doctors hospitals employ has increased by 32% — up to 212,000 physicians, according to the latest edition of AHA Hospital Statistics.

Of those, 27.5% are covered by either a group or individual contract, 17.3% are directly employed by the hospitals — the rest, more than half, of all hospital doctors, aren’t employed or under contract.

The report also looks at many other vital areas, including hiring patterns for registered nurses, how hospitals apportion revenue, and various community health measurements.

An agreement was reached with 1,300 nurses at St. Luke’s-Roosevelt Hospital Center in Manhattan, while negotiations are still taking place with 4,000 nurses at Mount Sinai in Manhattan and Montefiore Medical Center in the Bronx, according to the New York State Nurses Association.

The strike was threatened largely because nurses were being asked to begin paying for a portion of their health benefits.

The deal is said to call for a four-year contract. If the contract is signed, nurses will receive $1500 at the time of the signing, additional annual bonuses and a salary increase totaling 8% over the next three years. The deal does require nurses to pay a portion of their health plan premiums.

Mount Sinai nurses appear to be approaching an agreement as well. However, talks with Montefiore Medical Center’s nurses are stalled over staffing levels, according to sources familiar with the negotiations.

A large part of that growth is driven by health care’s increasing reliance on IT — and the people who design and maintain IT systems. Electronic health records play a huge part in that — physician adoption of EHRs has roughly doubled in the past two years.

Along with installing and maintaining EHR systems, hospitals and practices adopting EHRs are creating a larger need for skilled people who can train medical professionals on those systems.

According to a recent survey by The Medicus Firm, national physician search firm, doctors with more than 16 years of experience (after their medical training) get much lower interest from recruiters and hiring managers than their younger peers.

Nearly 29% of candidates with 16 or more years of experience reported a zero response rate on applications to hospitals and direct employers. Just over 8% of candidates with 1-15 years of experience reported a zero response rate.

Even when they do get a response, it’s less enthusiastic. Oder doctors reported they only received an average of 2.12 job offers in a two year period, while younger doctors received an average of 7.88 offers. Both groups applied for approximately the same number of jobs.

http://healthexecnews.com./where-are-the-docs

That’s the warning from a recent Joint Commission Sentinel Event Alert (downloadable pdf).

While fatigue certainly is never the only cause of adverse events, it’s a leading factor in many of them, as demonstrated by numerous studies.  Besides increasing the risk to patients, the Alert noted that it puts health care workers’ own safety in jeopardy as well.

In response, the Joint Commission made the following nine recommendations regarding the prevention and management of fatigue as well as creating a safety culture for all health care organizations:

1. Assess your organization for fatigue-related risks. This includes an assessment of off-shift hours and consecutive shift work and a review of staffing and other relevant policies to ensure they address extended work shifts and hours.

2. Since patient hand-offs are a time of high-risk – especially for fatigued staff – assess your organization’s hand-off processes and procedures to ensure that they adequately protect patients.

3. Invite staff input into designing work schedules to minimize the potential for fatigue.

4. Create and implement a fatigue management plan that includes scientific strategies for fighting fatigue. These strategies can include: engaging in conversations with others (not just listening and nodding); doing something that involves physical action (even if it is just stretching); strategic caffeine consumption (don’t use caffeine when you’re already alert and avoid caffeine near bedtime); taking short naps (less than 45 minutes).

5. Educate staff about sleep hygiene and the effects of fatigue on patient safety. Sleep hygiene includes getting enough sleep and taking naps, practicing good sleep habits (for example, engaging in a relaxing pre-sleep routine, such as yoga or reading), and avoiding food, alcohol or stimulants (such as caffeine) that can impact sleep.

6. Provide opportunities for staff to express concerns about fatigue. Support staff when appropriate concerns about fatigue are raised and take action to address those concerns.

7. Encourage teamwork as a strategy to support staff who work extended work shifts or hours and to protect patients from potential harm.20 For example, use a system of independent second checks for critical tasks or complex patients.

8. Consider fatigue as a potentially contributing factor when reviewing all adverse events.

9. If current policy allows for sleep breaks, assess the environment provided for sleep breaks to ensure that it fully protects sleep. Fully protecting sleep requires the provision of basic measures to ensure good quality sleep, including providing uninterrupted coverage of all responsibilities (including carrying pagers and phones, and coverage of both admissions and all continuing care by another provider), and providing a cool, dark, quiet, comfortable room, and, if necessary, use of eye mask and ear plugs.

• Most organizations (82.3%) reported that all of their medical directors have contracts. Of those contracts, the majority, (72.9%) are for just one year — the fourth year in a row that number has increased.

• Wages are 3.9% higher on average for independently contracted medical directors to account for foregone taxes, benefits and insurance payments.

• The number of organizations offering performance bonuses to medical directors was up 4.3percentage points from 2010, to 26.9%.

Median hourly rates increased by an average 3.0% from 2010 to 2011.

The data is intended to help health care organizations make compensation decisions and learn more about current market trends. For more detail, visit IHS’ survey page.

More young people are entering the profession thanks to a efforts to make nursing a more appealing career option. According to a new study published in Health Affairs, there’s been an 62% increase in the amount of people aged 23-26 who started careers in the field between 2002-2009.

Now, the number of registered nurses is expected to keep pace with population growth through 2030. Previously, the number of nurses was expected to decline over the next 20 years.

The problem isn’t totally resolved though. Several independent reports suggest that key specialties, most notably geriatrics, may not have adequate numbers of well-trained nurses to meet patient needs.

To keep the workforce growing, experts recommended finding ways to make nursing a more mobile career. Right now, more than 52% of nurses work within 40 miles of where they went to high school. In the long-term, that could create regional pockets where there aren’t enough nurses to fill the required positions. To meet long-term needs of those areas, the researchers recommended:

• Expanding the number of educational programs in under-served areas, such as off-campus “registered nurse to bachelor’s degree in nursing” programs or increased use of distance learning
• Targeting educational support such as scholarships and loan forgiveness programs to local students, to encourage them to not only be nurses but also to serve their local area
• Urging state and university leaders to review admission policies for nursing programs and the financial aid they offer, and
• Funding programs and policies such as the National Health Services Corps that offer financial incentives to attract nurses to under-served areas.

A pathologist was awarded $7.6 million from a federal jury in her suit alleging racial and gender discrimination by her employer.

Dr. Vivian Renta was a senior attending physician with the Cook County (Illinois) pathology department in early 2003 when she filed a charge of discrimination with the Equal Employment Opportunity Commission. In the complaint, she claimed that she had suffered harassment and been paid less than her professional peers. Renta claimed the cause for the treatment was that she was a woman and Puerto Rican.

Three months after she filed the complaint, she was suspended from her job, and in September 2004 she was terminated. She had worked for the county for nine years.

Among other things, Renta claimed she was retaliated against because she tried to expose various incidents of misdiagnosis, negligence and other wrong-doing that put patient care and safety at risk. For its part, the hospital argued that Renta herself had misdiagnosed several patients and had demonstrated a pattern of not following protocols. Renta’s lawyer provided proof that her error rate was actually better than the national average.

The federal jury hearing the case agreed with Renta, and awarded her $4 million for pain and suffering and $3.2 million in lost wages and benefits. The jury specifically requested that the pathology chairman be ordered to pay Renta an additional $400,000. Note: The jury verdict isn’t final. The judge can reduce the award for pain and suffering to just $300,000.

Few would argue that’s not a significant benefit. But many experts are concerned that the growing use of the devices is increasing certain risks as well. For starters, if doctors and other health care pros get too used to staring at a device for information, they may pay less attention to the patient in front of them.

And that assumes employees are using the devices strictly for work purposes. But some employees are inevitably tempted to access email, Facebook and other decidedly non-work-appropriate uses. And while that may seem like something only a rare few would stoop to doing, research shows quite the opposite. In fact, in one survey, 55% of technicians who monitor bypass machines said they had talked on their cellphones during surgeries, and half said they had texted during surgery.

To keep the benefits of mobile devices without creating a potentially risky for patients, hospitals and practices using the devices need to write — and thoroughly train employees on — a policy that covers all aspects of the use of tablets, cell phones, etc. The policy should cover both employer-issued and private devices brought to work, as well as when/how it’s appropriate to use them on the job.