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From Dr. Allen: These two studies confirm yet again, what every long term care administrator knows intuitively:  high staff turnover is typically linked to poorer care…..


Posted in NewsLong-Term CareResearch


Two studies examining the relationship between turnover of nursing staff and quality problems in nursing homes have found adverse outcomes. This comes at a time of greater demand for care by the growing numbers of elderly Americans.

The studies, both published in December, were based on data from the 2004 National Nursing Home Survey, which generated a sample of 1,174 nursing homes representing more than 16,000 nursing homes in the United States. These data were linked by facility to quality outcomes from contemporaneous databases used to monitor standards of nursing home care. The linkages were to Quality Indicators from Nursing Home Compare and to data on deficiencies of care from the Online Survey, Certification and Reporting (OSCAR).

Staff turnover is of concern for nursing homes, as high turnover has been associated with increased adverse outcomes. These studies suggest that preventing staff turnover should be given greater emphasis.

In the first study, “Are Nursing Home Survey Deficiencies Higher in Facilities with Greater Staff Turnover,” published in the Journal of the American Medical Directors Association, Nancy B. Lerner, DNP, RN, BSN, an assistant professor at the University of Maryland School of Nursing (UMSON), and colleagues including UMSON professor Alison M. Trinkoff, ScD, MPH, RN, FAAN, found that turnover for both licensed nurses and certified nursing assistants (CNAs) was associated with quality problems as measured by deficiencies considered to be closely related to nursing care (quality of care, qualify of life, and resident behavior deficiencies reported by OSCAR).

In the second study, “Turnover Staffing, Skill Mix, and Resident Outcomes in a National Sample of U.S. Nursing Homes,” published in the Journal of Nursing Administration, Trinkoff and colleagues found that adverse resident outcomes such as pressure ulcers and pain are related to high turnover among CNAs. The study, even after controlling for factors including skill mix, bed size, and ownership, found nursing homes with high CNA turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections.

 “Changes are needed to improve the retention of care providers and reduce staff vacancies in nursing homes to ensure high quality of care for older Americans,” Lerner states. Further the study by Lerner and colleagues suggests the need for continued research using deficiencies as a measure of quality in addition to the quality indicators used by others.


Lerner N, et al. Are Nursing Home Survey Deficiencies Higher in Facilities with Greater Staff Turnover. Journal of the American Medical Directors Association.

Trinkoff AM, et al. Turnover, staffing, skill mix and resident outcomes in a national sample of US nursing homes. Journal of Nursing Administration, 43(12),630-636. 2013.

Source: University of Maryland School of Nursing


To think about: nursing home residents themselves or their representative may be entitled to lab results directly to themselves, if they have a computer, or to their representative.  Yet another step toward all patient information being available to the “patient”……..

Wall Street Journal

HHS Says Labs Must Give Patients Access to Test Results

New Federal Rule Seeks to Give Patients More Control of Their Own Health


Melinda Beck

Feb. 3, 2014 1:05 p.m. ET

Clinical laboratories must give patients access to their own lab-test results upon request, without going through the physician who ordered them, according to a new federal rule announced Monday by the Department of Health and Human Services.

The rule, first proposed in 2011, is part of an Obama administration effort to give patients more control over their own health information.

"Information like lab results can empower patients to track their health progress, make decisions with their health-care professionals and adhere to important treatment plans," said HHS Secretary Kathleen Sebelius.

The final rule amends two existing federal laws, the Health Insurance Portability and Accountability Act, known as HIPAA, and the Clinical Laboratory Improvement Amendments, or CLIA, which regulates most of the clinical testing labs in the U.S.

Patient advocacy groups had also pushed for the change.

"A number of patients are getting increasingly active in managing their own health care, and having a gatekeeper between them and their data is just baffling," said Deven McGraw, director of the Health Privacy Project at the nonprofit Center for Democracy & Technology.

Studies show that between 7% and 26% of abnormal lab results are not communicated to patients in a timely manner. “I don’t think it’s intentional—doctor’s offices get busy,” Ms. McGraw said. “But patients may assume their test results are normal if they don’t hear, and that’s not always the case.”

Physician groups including the American Medical Association and the American Academy of Family Physicians had expressed concern that patients might overreact to results without a doctor’s interpretation, and urged that the data carry a disclaimer.

The final rule didn’t include such a notice, but said doctors could still proactively report the results to patients and would likely receive them before patients do, since the law gives labs 30 days to comply with a patient request.

Seven states and the District of Columbia already require labs to give patients their data directly. Thirteen states expressly prohibit it; seven allow it only with the health-care provider’s permission; and 23 states have no policy on it, according to HHS. The new rule supersedes all those state laws.

HHS estimates that 22,861 labs don’t have procedures in place to give patients direct access to their data, and that developing them will cost those labs $2 million to $10 million combined. HHS estimates the affected labs will receive between 175,646 and 3.5 million patient requests a year.

Reid Blackwelder, president of the American Academy of Family Physicians, called the new rule a “safety net—so that patients know you can get your lab results from another avenue. But it does not remove the responsibility of the provider to make sure we communicate what the results mean for you.”

Quest said more than one million Americans have signed up for its Gazelle app, which sends test results to their smartphones in states that already permit it. The data is typically sent three days after the request is received, Quest said, giving physicians time to contact patients first. 


Take a look at our new companion site for nurses! The same quality CEUs that you are taking are now available for your nursing staff!

Something for every health care facility to know…………


North Carolina is excited to be a partner in the CDC’s Get Smart About Antibiotics Campaign and we would like to share some of that excitement with you — one of the projects this year is the Get Smart About Antibiotics Week (GSW) which will be celebrated November 18 – 24. 

We hope you will be able to use some of the information available at to promote Get Smart About Antibiotics to your group and others as appropriate – activities include:

CDC is planning activities designed to raise the profile of appropriate antibiotic use and resistance. Some planned activities include:

  • ·         Participating in CDC Public Health Grand Rounds on Tuesday, November 19; 1:00-2:00 p.m. EST and Get Smart Twitter Chat – Friday, November 22; 1:00-2:00 p.m. EST
  • Promoting the release of new “Principles of Judicious Antibiotic Prescribing” for pediatric upper respiratory infection in the academic journal, Pediatrics that is planned for publication on Monday, November 18th.


If you would like further information on the Get Smart Campaign the website is

or GWS the following website is available  the GSW website  

We look forward in the future to sharing more information about the Get Smart About Antibiotics Campaign with you.

Constance (Connie) D. Jones, RN, CIC

NC Department of Health and Human Services

Healthcare - Associated Infections Prevention Program Coordinator

Communicable Disease Branch

225 N. McDowell St.

Raleigh, NC 27603

Mobile Phone – (919) 410-2201

Summary of State CRE Reporting Requirements

CDC Features - Antibiotic Resistance Threats in the US

CDC sets threat levels for drug-resistant 'superbugs'


Nurse Practitioners Seek Right To Treat Patients on Their Own Health Professionals in Five States Fight to Shed Doctors’ Oversight

From the Wall Street Journal

by Melinda Beck

Nurse practitioners in five states are fighting for the right to treat patients without oversight from doctors, as they can in many parts of the country.

The battle is particularly pitched in California, where a bill that would let some nurse practitioners do their work independently passed a key legislative committee this week. California doctors strenuously oppose the idea, arguing that it could jeopardize patient safety.


Other nonphysician health professionals around the country also are lobbying to expand their roles, citing the shortage of doctors in some areas and the expected onslaught of millions of patients newly insured under the Affordable Care Act next year.

NPs, as nurse practitioners are known, say they are particularly positioned to fill such gaps. Unlike physician assistants, who are licensed to practice under a doctor’s supervision, NPs—who have more training and education than registered nurses—can serve as patients’ primary health providers. NPs are trained to examine, diagnose and treat patients, manage acute and chronic illnesses and can prescribe medications, including controlled substances, in all 50 states.

But states vary widely on how much physician oversight NPs must have. In 17 states and the District of Columbia, NPs can set up practices and treat patients autonomously. Twelve states require them to be supervised, to varying degrees, by a physician or other health authority.

In the remaining 21 states, NPs must have a “collaborative” agreement with a physician. Those can vary widely, from stipulating what percentage of patient charts a doctor might review to which tests NPs can order. Tay Kopanos, a vice president at the American Association of Nurse Practitioners, likens the situation to driver’s licenses: “In some states, you have a full license. In others, someone can dictate the routes you have to take.”

In California, the bill that would let NPs practice autonomously passed the state Senate in May. Advocates say the state needs their skills, because only 16 of the state’s 58 counties have sufficient primary-care doctors, according to federal surveys.

But the California Medical Association, representing some 37,000 doctors, has spent more than $1 million to defeat the bill, arguing that allowing NPs to open practices without physician oversight would “ultimately harm patients and decrease quality of care.”

On Tuesday, a key committee in the Assembly, or lower house, passed an amended version of the bill that would allow NPs to operate independently only in a hospital, clinic or other group setting and eliminate a pathway to autonomous practice after 6,000 hours of supervised work.

As a result, the national nurse-practitioner group withdrew its backing of the bill, although state NPs still support it, and the California Medical Association still opposes it. The standoff sets the stage for more bitter fights in coming weeks.

Proposed legislation that would grant NPs full practice authority also is pending in Pennsylvania, Michigan and Massachusetts, while a bill in New Jersey would give NPs autonomy after two years of collaboration with a physician or other advanced-practice nurse.

Weighing predictions that the U.S. could be short of 65,800 primary-care physicians by 2025, both the National Governors Association and the Institute of Medicine have urged state legislatures to loosen laws restricting NP practices.

Doctors increasingly are delegating duties to nonphysicians and setting up team approaches to patient care. But the American Medical Association and other physicians groups say it is critical that a medical doctor remain at the helm of such teams.

Noting that NPs receive, on average, five to seven years of education and 5,350 hours of clinical trainingcompared with 11 years and 21,700 hours for most doctors, the American Academy of Family Physicians issued a report last year stating that “substituting NPs for doctors cannot be the answer.…We must not compromise quality for any American and we don’t have to.”

NP advocates say studies have found that both MDs and NPs deliver safe and high-quality care. States that require greater doctor supervision of NPs don’t have better patient safety records, Ms. Kopanos said, and in those that grant NPs more independence, more NPs are working in rural and underserved areas.

As for patients, a survey of 2,053 Americans, published in June in the journal Health Affairs, found that about half would rather have a physician as their primary-care provider, but nearly 60% said they would prefer to see a nurse practitioner or physician assistant today than wait a day to see a doctor.

New Tack in Preventing Hospital Infections

(note: requires sign in, but if you are already a WSJ subscriber, this proves an interesting article)

For nursing facilities with known rates of MRSA, this approach could be considered by the infection control committee……