Chronic underfunding and understaffing has left the state Board of Nursing unable to carry out its mission as a watchdog.
The New Jersey Board of Nursing is broken, and the next governor will have to fix it.
Watch the 10/05/17 NJTV News Segment
On July 31st, a press conference was held by Senator Loretta Weinberg and Senator Bob Gordon at the New Jersey Statehouse regarding Board of Nursing vacancies and the lack of leadership creating a license certification backlog for over 4,000 nursing professionals.
The Press Conference called on Governor Chris Christie to fill six Nursing Board vacancies on the 13-member board. The NJ Board of Nursing regulates the state’s nursing profession. The state nursing board is understaffed and underfunded resulting in unacceptable delays in licensing and certification for thousands of people who are trained and ready to begin working.
(Pictured Above) JNESO’s former Executive Director, Virginia Treacy at the microphone for the July 31st Press Event at the NJ Statehouse with Senator Gordon (left) and Senator Weinberg (right).
Hosted at the Rutgers Labor Education Center; this event brought together nurses, law enforcement and policy advocates to address the increasing OPIOID epidemic in New Jersey.
This forum covered topics such as: what is driving the epidemic, barriers to treatment, legislative actions and next steps for the future.
Johanna Shaheed, RN, at St. Michael’s Medical Center in Newark and Kelly Bratcher, RN, at Lehigh Valley Health Network –Pocono provided insight from the healthcare provider’s role.
Also, at our Leadership Training and Education Day, April 4th & 5th, JNESO Nurses and Technical employees received Continuing Education Credits (CEUs) on various topics including, The Opioid Crisis and the Healthcare Provider’s Role. Nurses and licensed technical employees must attain 30 credits of continuing education every two years to keep their licenses active.
JNESO plans additional events and forums to cover this increasing public health crisis.
Patient Safety Awareness is sponsored by the The National Patient Safety Foundation: a nonprofit organization dedicated to creating a world where patients and those who care for them are free from harm.
A leader in advocating for patient safety since 1997, the National Patient Safety Foundation takes a collaborative approach partnering with patients and families, the health care community and key stakeholders to advance patient safety and health care workforce safety while disseminating strategies to prevent harm.
The organization offers membership, certification, educational programs, and a wide range of resources. NPSF is the founding organization of the United for Safety Patient Campaign and Patient Safety Awareness Week.
To learn more about the National Patient Safety Foundation and all that we do and have to offer health care professionals, patients, and families, and health care leaders, please visit www.NPSF.org for more information.
Watch the Ask Me 3 Video
The United in Patient Safety campaign culminates each year with Patient Safety Awareness Week, designed to mark a dedicated time and a platform to increase awareness about patient safety among health professionals and the public. This year, patient safety week is March 12-18, 2017.
From: Mountain Grove News Journal
(BPT) – Radiation — it’s not something most people think about very often, and when they do, their thoughts usually turn to radiation’s effects as they are portrayed in the movies. These being namely that exposure to radiation will either turn them into a hideous monster or a superhero.
The truth is, however, that while radiation is great fuel for any Hollywood script, it’s more than sci-fi fodder. It’s part of your real world. And while it is not something to be feared – as it is in the movies – it is something you should be aware of. To that end, here are five things you may not know about radiation.
* You are exposed to radiation every day. One-third U.S. population lives in a “nuclear shadow” area, meaning they live within 50 miles of a U.S. nuclear power plant. Many people are also exposed to radiation every day through their work as dental assistants, medical practitioners, radiology technicians, chiropractors, etc.
* Radiation can come from man-made, terrestrial or cosmic sources. Not all radiation comes from man-made technology. Naturally occurring radiation is present in Earth’s crust as well as in the floors and walls of our homes, schools and places of work. It is even found in the food we eat and drink, and the air we breathe. Our own bodies — muscle, bones and tissue — contain naturally occurring radioactive elements as well.
* Radiation comes in multiple forms. Non-ionizing radiation, like that found in microwaves, radio waves and visible or infrared light, is largely harmless due to its low energy levels. Ionizing radiation (found in gamma rays, X-rays and other sources) has higher energy levels and can be harmful to the body if you are exposed to large doses or for a long period of time.
* You can track radiation levels around you. Radiation is invisible, but that doesn’t mean you have to be blind to it. The Dosime device is a hybrid smart home and wearable personal dosimeter that captures real-time radiation exposure in the environment. The accompanying app provides an immediate assessment of the ionizing radiation present in the homes, buildings and spaces you live, work and play that can potentially impact your health without your knowledge. Dosime allows you to access accurate, reliable, easy-to-understand radiation information in real time to manage potential health risks and ensure peace of mind.
* You bring radiation into your home every day with things you purchase. Your cat’s litter box is a common radiation source in your home, while Brazil nuts and bananas also give off small levels of radiation. The glossy paper appearing in the magazines you read requires a radioactive finish to achieve that shine. The glaze used to decorate those antique jars could be radioactive if the uranium levels are high enough. Even your new granite countertops are a source of radiation as granite is one of the best rock sources for retaining natural radiation.
Radiation is around you every day, but that doesn’t mean you have to fear it. Remember, most radiation is naturally occurring and your exposure to it won’t turn you into a monster, even if a super power would be pretty cool. To learn more about the Dosime device and to see how it can help you monitor radiation levels around you, visit Dosime.com.
Alexia Fernández Campbell
Dec 1, 2016
Here’s an alarming statistic: Around one in four nurses has been physically attacked at work in the last year. Patients often kick, scratch, and grab them; in rare cases even kill them. In fact, there are nearly as many violent injuries in the healthcare industry as there are in all other industries combined. Healthcare workers make up 9 percent of the workforce.
There are currently no federal rules mandating that hospitals attempt to protect nurses from violence in the workplace, though some states have passed them on their own. State-specific measures include requirements that hospitals develop violence-prevention programs, such as teaching de-escalation techniques, and increased penalties for people convicted of assaulting healthcare workers. In October, California passed the toughest guidelines in the country, obligating healthcare employers to develop tailored violence-prevention plans for each workplace with employees’ input. But the problem has gotten so bad that the U.S. Department of Labor is considering setting nationwide workplace-safety standards for hospitals in order to prevent this kind of abuse.
Patients with dementia or Alzheimer’s and patients on drugs were the most likely to hurt nurses, according to one research study published last year in the Journal of Emergency Nursing. The study surveyed more than 700 registered nurses at a private hospital system in Virginia, and 76 percent said they had experienced physical or verbal abuse from patients and visitors in the previous 12 months. About 30 percent said they had been physically assaulted.
Working directly with patients in emotional and physical pain has always put healthcare workers at risk of violence. But in the past decade or so, there has been a 110 percent spike in the rate of violent incidents reported against healthcare workers. The intensifying abuse has a lot to do with money: During the Great Recession, public and private hospitals began slashing budgets at the same time people were losing jobs—and their health insurance. That meant fewer nurses and security guards available to help when patients got out of control, and more people turning to hospitals instead of private practice for medical care since they couldn’t be turned away due to lack of insurance. States also cut billions of dollars in funding for preventative mental-health services, which likely had a significant effect on the frequency of violence against doctors and nurses. Psychiatric patients are increasingly seeking treatment in hospital emergency rooms, where staff are often unprepared to deal with violent outbursts. “This is creating volatile, unpredictable situations,” says Bonnie Castillo, a registered nurse and director of health and safety for National Nurses United, a labor group representing more than 160,000 nurses across the country. Her organization has been pushing states to pass laws to protect workers in the healthcare industry.
A delirious patient kicked her so hard in the pelvis that she slammed into a glass wall and fell to the ground. She was two months pregnant.
There’s also a pervasive notion that dealing with unruly patients is just part of a nurse’s job. “We always feel discouraged from reporting it,” says Castillo. She said she was punished by a past employer for calling 9-1-1 after a patient attacked her. It’s not surprising then, that only 29 percent of the surveyed nurses who were physically attacked actually reported it to their supervisors. About 18 percent said they feared retaliation if they reported violence, and 20 percent said they didn’t report it because of the widespread perception that violence is a normal part of the job. A spokeswoman for the Inova Health System hospitals, where the nurses were surveyed, did not respond to a request to comment for this story, though it’s hardly a problem unique to one hospital.
Rose Parma, a registered nurse in California’s Central Valley, says nursing school did not prepare her for the brutality she would face in her career. Patients have spit on her, slapped her, and even threatened her life during the five years she has worked as a hospital nurse. But it reached an intolerable level about a year into her career, when a delirious patient kicked her so hard in the pelvis that she slammed into a glass wall and fell to the ground. She was two months pregnant. The pain was not as shocking as her supervisor’s response when she reported the incident. “The manager seemed so surprised and said ‘Has this never happened to you? Is this really the first time?’ As if it weren’t a big deal,” Parma says. The manager then told Parma she would see her the next day at work. “I literally thought I was going to die [during the attack], and they didn’t even offer me counseling.” (Her baby survived.)
As the Department of Labor considers implementing nationwide safety standards, individual hospitals are also taking their own measures. One hospital in Massachusetts offers self-defense classes for staff. Another in the state hosted a training exercise that simulated potentially violent hospital scenarios: gang violence in the emergency room, an outburst involving a mental-health patient, and an estranged ex-boyfriend in the maternity unit. But these types of precautionary measures are not the norm at hospitals across the United States, leaving many nurses unprepared for violent encounters. The lack of state or federal personal-safety standards as danger in the workplace grows may contribute to the shortage of nurses in the United States. When there are not enough nurses at hospitals, and those who are there feel stressed and unsafe, patients and staff all wind up suffering.
It is important to remember that if your employer provides insurance, it is focused on protecting your employer. Your employer’s policy may cover you, but only up to a point. Remember: Your employer’s policy is created to fit their specific needs and protects them first. Nurses and techs need coverage that puts their interests first; you can be sued at any time, for any reason. Malpractice insurance typically pays for a defense attorney and any settlement or judgment against the nurse or tech, up to the policy limits.
Depending on the policy, it will also often cover licensure defense. All malpractice insurance policies have limits of liability. If you are only covered by your employer’s insurance, other defendants employed at your entity may and probably do share your liability limits under the same policy. If you as well as others are named in a suit, your legal costs, including any settlement, could exceed your employer’s shared liability limits. This would mean out-of-pocket expenses for you.
Things to Keep in Mind
When selecting a policy, ask about an “occurrence” policy, which provides coverage for incidents that happen while the policy is in effect. There are also “claims-made” policies, which only cover if the claim is filed while the policy is active. Having your own malpractice insurance coverage does not make you a more likely target for a lawsuit. When something happens and a patient is injured, most attorneys will name everyone who was involved in the patients’ care in the lawsuit—whether you have your own coverage or not.
Some types of malpractice insurance may provide for medical expenses or property damage if you are assaulted at work or during work-related travel. Ask if your policy defines “workplace” as anywhere you are providing professional services, so this coverage will travel with you into the field.
Even if you plan to retire or keep your license active, you have a responsibility to anyone to whom you give advice, any place you volunteer, or any situation that requires emergency care. Your nursing license needs to be insured at all times. Ask about a Retirement/Leave Discount, which may include family leave, change to a non-nursing occupation, retirement, or disability.
If you currently carry malpractice insurance –great, take pause and review your policy’s limits. If you do not carry malpractice insurance, carefully consider looking into obtaining malpractice insurance to protect your license, it will provide greater piece of mind and is tax deductible.
Contact your JNESO Labor Representative or call the JNESO Office for additional information:
JNESO Celebrates our Radiologists!!!
The International Day of Radiology is building greater awareness of the value that radiology research, diagnosis, and treatment contribute to safe patient care, and better understanding of the vital role radiologists perform in healthcare delivery.
This year the day is dedicated to breast imaging and the essential role that radiologists play in the detection, diagnosis, and management of diseases of the breast.
JNESO recognizes the many innovations in radiology research that have revolutionized modern medicine, produced great technological leaps, enabled more effective and efficient care and saved countless lives. Moreover, modern medical technology provides people with less invasive methods of early cancer detection. The breast cancer death rate in the United States has dropped more than 30 percent since mammography use became widespread in 1990. In other countries where mammography screening programs are more organized and widespread, breast cancer deaths have nearly been cut in half.
Radiology professionals are working together to inform patients about the valuable role medical imaging plays in patient care. For more information visit: RadiologyInfo.org, an important resource that explains medical imaging tests and treatments in detailed, easy-to-understand language, helping patients to understand and prepare for imaging procedures.
Source: Radiological Society of America (RSNA.org)
May 3, 2016 | By Paige Minemyer
A new study published in The BMJ confirms that medical errors are the third leading cause of death in United States, behind only heart disease and cancer.
The study, led by Martin Makary, M.D., professor of surgery at the Johns Hopkins University School of Medicine, analyzed medical death rate data over an eight-year period and found that more than 250,000 deaths per year occur due to medical error, beating the Centers for Disease Control and Prevention’s (CDC) third leading cause of death–respiratory disease–by more than 100,000 cases.
The latest findings echo research conducted in 2013 that determined each year preventable adverse events lead to the death of 210,000-400,000 patients who seek care at hospitals, FierceHealthcare previously reported.
Makary’s research suggests that deaths stemming from medical error translate to 9.5 percent of all deaths each year in the U.S.
The reason for the discrepancy between the latest findings and the CDC statistics is that the federal agency’s way of collecting the data does not classify medical errors separately on the death certificate, skewing the numbers, according to the researchers.
“Incidence rates for deaths directly attributable to medical care gone awry haven’t been recognized in any standardized method for collecting national statistics,” Makary said in a statement. “The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used.”
But accurate statistics can better inform research and funding priorities, he said. “Top-ranked causes of death as reported by the CDC inform our country’s research funding and public health priorities. Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves,” Makary said in the study announcement.
Makary and coauthor Michael Daniel, research fellow at Johns Hopkins, offered the following suggestions to reduce death due to medical errors:
They also suggest that hospitals carry out a rapid and efficient independent investigation into deaths to determine the potential contribution of errors. “Sound scientific methods, beginning with an assessment of the problem, are critical to approaching any health threat to patients,” they wrote. “The problem of medical error should not be exempt from this scientific approach.”
However, they cautioned that most medical errors aren’t caused by inherently bad doctors, and that reporting these errors shouldn’t lead to punishment or legal action. Instead, they said medical mistakes are due to systemic problems, such as poorly coordinated care and the absence of safety nets.
Find more at: FierceHealthcare.com
For Immediate Release
Wednesday, May 18, 2016
CDC expanding groundbreaking disease identification tool
MicrobeNet allows better and quicker germ identification and health response
Everyone has heard of common germs like E.coli or influenza, but what about Streptobacillus moniliformis or Capnocytophaga? If not treated quickly, both can kill people within days. But they are so rare that doctors and labs probably have never seen them and may mistake them for more common diseases like meningitis. Enter MicrobeNet, an innovative online tool designed by the Centers for Disease Control and Prevention (CDC) that, since 2013, has helped laboratorians and doctors get the information they need to accurately diagnose causes of disease faster and save lives.
MicrobeNet provides laboratorians with unprecedented access to CDC’s virtual microbe library of more than 2,400 rare and emerging infectious bacteria and fungi at no cost. The recent multi-state outbreak of Elizabethkingia in Wisconsin, Illinois and Michigan underscores the need for a tool like MicrobeNet in diagnostic laboratories. Hospitals and health departments using MicrobeNet can identify rare bacteria like Elizabethkingia quicker, and know they’re comparing their results to the most comprehensive and accurate disease database available.
In partnership with Bruker Corp., CDC has recently added a new module to MicrobeNet that allows labs to search the protein signatures of the bacteria and compare them to the rare pathogens in CDC’s MicrobeNet library by using Bruker’s MALDI Biotyper systems. Using MALDI to test is extremely fast and cheaper to run than many other types of testing, making the technology increasingly popular among labs. The new MicrobeNet module will be immediately available to laboratorians and clinicians using the Bruker system in labs nationwide. Until the addition of the MALDI library, MicrobeNet offered two ways to search pathogens: by DNA sequence or biochemical tests (chemical reactions caused by the bacteria).
MicrobeNet can dramatically improve the health of people in the United States and around the world by cutting the time for testing from about a week to a few hours.
“MicrobeNet has the potential to revolutionize public health,” said John R. McQuiston, PhD, team lead for CDC’s Special Bacteriology Reference Laboratory and CDC’s lead for MicrobeNet. “This system helps public health labs and hospitals quickly identify some of the most difficult pathogens to grow and detect. In turn, MicrobeNet will help treat patients faster and allow health departments to respond to public health emergencies more effectively.”
The Board’s website address is: njconsumeraffairs.gov
The face on top of the license currently being issued by the Board of Nursing is tamper proof and contains the following statement: “THE FACE OF THIS DOCUMENT HAS A MULTICOLORED BACKGROUND AND MULTIPLE SECURITY FEATURES”.
A photocopied license in NOT acceptable evidence of current licensure. However, a license may be copied only for purposes of meeting the requirements of the employing organization’s personnel policy or regulatory purposes. (N.J.A.C. 13:45B-14.4(d)
WHAT EMPLOYERS CAN AND CANNOT DO WHEN INSPECTING EMPLOYEE LICENSES:
If members have concerns regarding Employers Inspecting your Nursing License, please contact JNESO’s Director of Practice: Barbara Conklin at firstname.lastname@example.org or call (800) 292-0542.
Read the CMS News Release
(OAKBROOK TERRACE, Illinois – September 28, 2015) Preventing patient falls and fall-related injuries is the focus of the new Sentinel Event Alert: Issue 55 released today by The Joint Commission. The new alert examines the contributing factors to patient falls and includes suggested solutions to be implemented by health care organizations to help reduce patient falls and falls with injury.
This topic was chosen for Sentinel Event Alert because patient falls with serious injury are among the top 10 sentinel events reported to The Joint Commission Sentinel Event Database. The Joint Commission has received 465 reports of patient falls with injuries since 2009, and approximately 63 percent of those falls resulted in death. The Joint Commission defines a sentinel event as a patient safety event (not primarily related to the natural course of the patient’s illness or underlying condition) that reaches a patient and results in death, permanent harm or severe temporary harm where intervention is required to sustain life. Although the majority of falls reported to The Joint Commission occurred in hospitals, the ECRI Institute also reports a significant number of falls occurring in non-hospital settings such as long-term care facilities.
An analysis of falls with injury reported to The Joint Commission Sentinel Event Database from January 2009 through October 2014 showed the most common contributing factors include:
The suggested actions in the Sentinel Event Alert address all of the identified contributing factors to patient falls. Listed resources in the alert include links to toolkits and research on falls prevention, and it introduces the Joint Commission Center for Transforming Healthcare’s Preventing Falls Targeted Solutions Tool®.
“Fall prevention is the responsibility of everyone in the organization and success is highly dependent on leadership playing a primary role. It is their commitment and approach that determines an organization’s ability to significantly reduce and sustain the reduction in falls,” said Ana Pujols McKee, MD, executive vice president and chief medical officer, The Joint Commission. “There are several proactive steps in the Sentinel Event Alert that leaders can initiate such as educating and raising awareness of the need to prevent falls resulting in injury, ensuring the implementation of a validated tool to identify the risk factors for falls, and establishing an interdisciplinary falls injury prevention team.”
Sentinel Event Alert is published periodically by The Joint Commission for health care professionals. It describes the common underlying causes of sentinel and adverse events and recommends steps to reduce risk and prevent future occurrences. Sentinel Event Alert topics are determined by the Joint Commission’s Patient Safety Advisory Group comprised of external members with significant expertise in health care and patient safety, and presided over by Ana Pujols McKee, MD, executive vice president and chief medical officer, The Joint Commission.
For more information about the sentinel event statistics and previous issues of Sentinel Event Alert, please visit The Joint Commission’s Sentinel Event Alert Web page.
Zika virus is spread to people through mosquito bites. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon.
Outbreaks of Zika have occurred in areas of Africa, Southeast Asia, the Pacific Islands, and the Americas. Because the Aedes species mosquitoes that spread Zika virus are found throughout the world, it is likely that outbreaks will spread to new countries. In December 2015, Puerto Rico reported its first confirmed Zika virus case. Locally transmitted Zika has not been reported elsewhere in the United States, but cases of Zika have been reported in returning travelers.
There is no vaccine to prevent or medicine to treat Zika. Travelers can protect themselves from this disease by taking steps to prevent mosquito bites. When traveling to countries where Zika virus (see map) or other viruses spread by mosquitoes have been reported, use insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens.
CDC: ZIKA Travel Health Notices
CDC: ZIKA Prevention
CDC: ZIKA Transmission
Zika testing recommendations have changed for pregnant women. Testing for Zika infection is becoming more difficult, making it harder to advise pregnant women about the chances their child might have a birth defect.
Read more at: StatNews.com
If you or a loved one stayed overnight in a hospital last year, you joined 17.5 million others who have utilized inpatient health care services across the country. From the moment you entered the hospital until the moment you left, who answered your questions, delivered your medication and responded to your calls for assistance? It was more than likely a nurse.
Nurses make up the largest group of health care providers in the country. They are on the front lines of health care delivery for an aging and increasingly sicker population. While Americans are living longer, government reports indicate that nearly half of adults over 65 are living with more than one chronic health condition.
Accessing health care is only expected to increase, as more than 7 million of the previously uninsured will now have health insurance as a result of the Affordable Care Act. And nearly 200,000 of those newly insured live in New Jersey. The health care industry is booming, but what about those delivering care?
In hospitals and other health care facilities in New Jersey and across the country, nurses are facing massive reductions in staffing budgets, forcing them to work with fewer resources as they care for sicker patients.
It’s a safety problem for nurses and patients alike.
The understaffing of nurses leads to nurse burnout, exacerbating a well-documented and growing nursing shortage. It also puts patients at risk of infections, bedsores, pneumonia, MRSA, cardiac arrest and accidental death. Studies have shown that increasing the number of patients under a single RN’s care beyond four increases the risk of death by 7 percent for all patients. That’s a scary statistic for anyone who has ever found themselves or a loved one in a hospital setting or long-term care facility.
Inadequate staffing is arguably one of health care’s biggest problems, and we as a state have yet to address it.
New Jersey does have a staffing disclosure law. Hospitals are required to report the nurse-to-patient staffing ratios to the Department of Health, and that information is publicly available on the department’s website.
Additionally, hospitals are required to post daily staffing ratios in the patient care area of each unit in their facility. But that’s simply not enough. It is time to implement a uniform, research-based mandate across all of New Jersey’s hospitals.
Last year alone, JNESO, a union that represents about 5,000 RNs, LPNs and other health care workers in New Jersey and Pennsylvania, received nearly 500 “short staffing” notices from its members, reporting an instance where they were understaffed and concerned for patient safety. And a 2010 study conducted by the University of Pennsylvania found that if New Jersey implemented a safe staffing law, hospitals would see 14 percent fewer surgical deaths.
These are powerful numbers.
JNESO has long advocated for a safe staffing mandate — a law that would require a nurse-to-patient staffing ratio per unit — uniform across all of New Jersey’s hospitals. The concept has been around for years, and getting it on the priority list of lawmakers remains one of JNESO’s top initiatives.
Join JNESO in working to get safe staffing on the legislative priority list by contacting your legislator and letting them know how important it is to take action on this now. Go to the top of this page and click on “Political Action Network – Take Action Now!”
Inaction on safe staffing is simply inexcusable. For the safety of our loved ones, our nurses and ourselves, we must work to ensure that health care providers are given the resources they need to effectively care for their patients.
This training is free of charge and meets PA BoN Act 31 training requirements, as well as Act 126 requirements. All other licensing-related questions should be referred to your respective board(s). Please note: If you are licensed by more than one board, the PA Department of State will apply your credit to all relevant boards.
How to Access the Online Training:
Go to www.reportabusepa.pitt.edu (If you have not previously registered, please click the “Registration” link at the top of page).
Enter your username and password to log on.
Members of each committee will meet regularly with management to raise concerns and to help ensure that problems are properly addressed and rectified. These committees are critically important as we seek to improve working conditions and staffing levels at every JNESO facility throughout NJ and PA.
Space is limited on each committee, so please contact us today to serve
as a member of your staffing committee.
Some locals have negotiated sub-committees, shared governance committees or specific staffing review processes [committee specifics vary by contract].
Standing together is the only way we will make a difference in the staffing levels and working conditions at our facilities. Staffing & Nurse Practice committee members will be released from duty to participate in these important discussions, so please consider becoming a member or learning more.
To learn more about the staffing/nurse practice committees at your local, or to serve as a member of the committee, please contact JNESO Director of Practice Karen May at KMay@jneso.org.
Consider measles in patients with a fever, rash, and cough, coryza and conjunctivitis—the three “C”s. Ask if they are vaccinated against measles and whether they have recently traveled internationally or if there’s measles in the community.
CDC’s Recommendations For Healthcare Professionals
What is the “Cullen Law?”
The “Cullen Law,” officially known as the “Health Care Professional Responsibility and Reporting Enhancement Act,” was passed by New Jersey in November of 2005. It requires health care facilities to notify the state Division of Consumer Affairs with any information regarding impairment, incompetence or negligence by a health care worker that could endanger patients. However, the law fails to clearly define what that means. This lapse has led employers to subjectively and erratically report actions, including simple human errors and mistakes that can be more a result of inexperience than incompetence.
The law was passed in response to the crimes of a nurse named Charles Cullen, who in 2004 was convicted of murdering at least 29 patients over several years while working at multiple hospitals throughout the region. The murders were viewed as a failure of the health care system, as existing reporting guidelines were not utilized by his employers and Cullen was able to move from one facility to the next without detection.
How Does the Law Affect You?
The “Cullen Law” mandates that health care professionals must be reported to the Division of Consumer Affairs within 7 days of a questionable action, and referred to the relevant state board overseeing a health care profession. This “rush to judgment” leaves little time for investigation or grievance procedure. While the law covers a wide group of professionals, the largest number of actions have been taken against nurses. Among the other professions covered are physical and respiratory therapists as well as social workers.
The “Cullen Law” does not provide clear guidelines for what type of action should be reported. A taskforce set up to develop guidelines did not reach consensus on a final reporting document, leaving considerable ambiguity. Employers are using their own discretion in determining what types of actions should be reported. Other professional boards covering other disciplines have their own guidelines and/or procedures. Since our only experience so far has been with nurses reported, we can only verify those outcomes.
After the Board of Nursing finishes investigating the charges brought before the Division of Consumer Affairs, they determine if a charge has merit, and if it does the nurse is sanctioned. If the Board of Nursing finds that the charge did not have merit, the nurse is issued a letter detailing the charges that were brought and saying the Board did not find enough evidence to bring action against the nurse at this time. Regardless of whether or not the nurse was sanctioned, under the “Cullen Law” the employer is mandated for seven years to provide detailed information to prospective employers about the charge or charges made against the individual. This information does not include any investigation outcomes, and this provision applies to all titles.
The impact of the “Cullen Law” is that highly qualified nurses and other health care workers with many years of service in their professions are not able to work in their field. The “Cullen Law” makes it nearly impossible for nurses who have been reported to the Division of Consumer Affairs to find employment both during the period of time their case is pending investigation and then for the next seven years even if the Board of Nursing does not take action against them.
Why is the Cullen Law Inadequate?
How Can You Protect Your Career in the Age of Cullen?
As JNESO works to garner legislative support for a change to the Cullen Law, it is important that you have the information needed to protect your license and your career. JNESO is here to help you every step of the way, so please do not hesitate to contact us with any questions about the law. Please keep in mind the following:
Active monitoring means that the state or local public health authority assumes responsibility for establishing regular communication with potentially exposed individuals, including checking daily to assess for the presence of symptoms and fever, rather than relying solely on individuals to self-monitor and report symptoms if they develop. Direct active monitoring means the public health authority conducts active monitoring through direct observation. The purpose of active (or direct active) monitoring is to ensure that, if individuals with epidemiologic risk factors become ill, they are identified as soon as possible after symptom onset so they can be rapidly isolated and evaluated. Active (or direct active) monitoring could be either conducted on a voluntary basis or compelled by legal order. Active (or direct active) monitoring and prompt follow-up should continue and be uninterrupted if the person travels out of the jurisdiction.
Active monitoring should consist of, at a minimum, daily reporting of measured temperatures and symptoms consistent with Ebola (including severe headache, fatigue, muscle pain, fatigue or weakness, diarrhea, vomiting, abdominal pain, or unexplained hemorrhage) by the individual to the public health authority. Temperature should be measured using an FDA-approved thermometer (e.g. oral, tympanic or noncontact). People being actively monitored should measure their temperature twice daily, monitor themselves for symptoms, report as directed to the public health authority, and immediately notify the public health authority if they develop fever or other symptoms. Initial symptoms can be as nonspecific as fatigue. Clinical criteria for required medical evaluation according to exposure level have been defined (see Table), and should result in immediate isolation and evaluation. Medical evaluation may be recommended for lower temperatures or nonspecific symptoms based on exposure level and clinical presentation.
Controlled movement limits the movement of people. For individuals subject to controlled movement, travel by long-distance commercial conveyances (e.g., aircraft, ship, bus, train) should not be allowed; if travel is allowed, it should be by noncommercial conveyance such as private chartered flight or private vehicle, and occur with arrangements for uninterrupted active monitoring. Federal public health travel restrictions (Do Not Board) may be used to enforce controlled movement. For people subject to controlled movement, use of local public transportation (e.g., bus, subway) should be discussed with and only occur with approval of the local public health authority.
Isolation means the separation of an individual or group who is reasonably believed to be infected with a quarantinable communicable disease from those who are not infected to prevent spread of the quarantinable communicable disease. An individual could be reasonably believed to be infected if he or she displays the signs and symptoms of the quarantinable communicable disease of concern and there is some reason to believe that an exposure had occurred.
Quarantine in general means the separation of an individual or group reasonably believed to have been exposed to a quarantinable communicable disease, but who is not yet ill (not presenting signs or symptoms), from others who have not been so exposed, to prevent the possible spread of the quarantinable communicable disease.
Use of Public Health Orders
Equitable and ethical use of public health orders includes supporting and compensating persons who make sacrifices in their individual liberties and freedoms for public good. Specifically, considerations must be in place to provide shelter, food and lost wage compensation, and to protect the dignity and privacy of the individual. Persons under public health orders should be treated with respect and dignity. Considerable thoughtful planning is needed to implement public health orders properly.
Recommendations for specific groups and settings:
For the purposes of risk exposure to Ebola, regardless of country, direct patient contact includes doctors, nurses, physician assistants and other healthcare staff, as well as ambulance personnel, burial team members, and morticians. In addition, others who enter into the treatment areas where Ebola patients are being cared for (such as observers) would be considered to potentially have patient contact and be at risk. Healthcare workers who have no direct patient contact and no entry into active patient management areas, including epidemiologists, contact tracers, airport screeners, as well as laboratory workers who use appropriate PPE, are not considered to have an elevated risk of exposure to Ebola, i.e., are considered to be in the low (but non-zero) risk category.
The high toll of Ebola virus infections among healthcare workers providing direct care to Ebola patients in countries with widespread transmission suggests that there are multiple potential sources of exposure to Ebola virus in these countries, including unrecognized breaches in PPE, inadequate decontamination procedures, and exposure in patient triage areas. Due to this higher risk, these healthcare workers are classified in the some risk category, for which additional precautions are recommended upon their arrival in the United States (see Table).
Healthcare workers who provide care to Ebola patients in U.S. facilities while wearing appropriate PPE and with no known breaches in infection control are considered to have low (but not zero) risk of exposure because of the possibility of unrecognized breaches in infection control and should have direct active monitoring. As long as these healthcare workers have direct active monitoring and are asymptomatic, there is no reason for them not to continue to work, including in hospitals and other patient care settings, nor is there a reason for them to have restrictions on travel or other activities. Review and approval of work, travel, use of public conveyances, and attendance at congregate events are not indicated or recommended for such healthcare workers. (Read the CDC’s Full Recommendations)
CDC Website Ebola: Tightened Guidance for U.S. Healthcare Workers on Personal Protective Equipment (10/21/14)
The (CDC) is tightening previous infection control guidance for healthcare workers caring for patients with Ebola, to ensure there is no ambiguity. The guidance focuses on specific personal protective equipment (PPE) health care workers should use and offers detailed step by step instructions for how to put the equipment on and take it off safely.
Recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center and National Institutes of Health Clinical Center are reflected in the guidance.
The enhanced guidance is centered on three principles:
Principle #1: Rigorous and repeated training
Focusing only on PPE gives a false sense of security of safe care and worker safety. Training is a critical aspect of ensuring infection control. Facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment, especially in the step by step putting on and taking off of PPE. CDC and partners will ramp up training offerings for healthcare personnel across the country to reiterate all the aspects of safe care recommendations.
Principle #2: No skin exposure when PPE is worn
Given the intensive and invasive care that U.S. hospitals provide for Ebola patients, the tightened guidelines are more directive in recommending no skin exposure when PPE is worn.
CDC is recommending all of the same PPE included in the August 1, 2014 guidance, with the addition of coveralls and single-use, disposable hoods. Goggles are no longer recommended as they may not provide complete skin coverage in comparison to a single-use, disposable full-face shield. Additionally, goggles are not disposable, may fog after extended use, and healthcare workers may be tempted to manipulate them with contaminated gloved hands. PPE recommended for U.S. healthcare workers caring for patients with Ebola includes:
Boot covers that are waterproof and go to at least mid-calf or leg covers
Single-use fluid resistant or impermeable gown that extends to at least mid-calf or coverall without integrated hood.
Respirators, including either N95 respirators or powered air purifying respirator (PAPR)
Single-use, full-face shield that is disposable
Surgical hoods to ensure complete coverage of the head and neck
Apron that is waterproof and covers the torso to the level of the mid-calf (and that covers the top of the boots or boot covers) should be used if Ebola patients have vomiting or diarrhea
The guidance describes different options for combining PPE to allow a facility to select PPE for their protocols based on availability, healthcare personnel familiarity, comfort and preference while continuing to provide a standardized, high level of protection for healthcare personnel.
The guidance includes having:
Principle #3: Trained monitor
CDC is recommending a trained monitor actively observe and supervise each worker putting PPE on and taking it off. This is to ensure each worker follows the step by step processes, especially to disinfect visibly contaminated PPE. The trained monitor can spot any missteps in real-time and immediately address.
PPE is Only One Aspect of Infection Control
It is critical to focus on other prevention activities to halt the spread of Ebola in healthcare settings, including:
The CDC reminds health care workers to “Think Ebola” and to “Care Carefully.” Health care workers should take a detailed travel and exposure history with patients who exhibit fever, severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain, unexplained hemorrhage. If the patient is under investigation for Ebola, health care workers should activate the hospital preparedness plan for Ebola, isolate the patient in a separate room with a private bathroom, and to ensure standardized protocols are in place for PPE use and disposal. Health care workers should not have physical contact with the patient without putting on appropriate PPE.
CDC’s Guidance for U.S. Healthcare Settings is Similar to MSF’s (Doctors Without Borders) Guidance
Both CDC’s and MSF’s guidance documents focus on:
CDC reminds all employers and healthcare workers that PPE is only one aspect of infection control and providing safe care to patients with Ebola. Other aspects include five pillars of safety:
CDC: Tightened Guidance for US Healthcare Workers on Personal Protective Equipment for Ebola
CDC Website Ebola: Signs and Symptoms
**Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.
CDC Website Ebola: Transmission
Because the natural reservoir host of Ebola viruses has not yet been identified, the manner in which the virus first appears in a human at the start of an outbreak is unknown. However, researchers believe that the first patient becomes infected through contact with an infected animal.
When an infection does occur in humans, the virus can be spread in several ways to others. Ebola is spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with:
During outbreaks of Ebola, the disease can spread quickly within healthcare settings (such as a clinic or hospital). Exposure to Ebola can occur in healthcare settings where hospital staff are not wearing appropriate protective equipment, including masks, gowns, and gloves and eye protection.
(Read the full CDC Transmission page)
CDC Website Ebola: Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals
Standard, contact, and droplet precautions are recommended for management of hospitalized patients with known or suspected Ebola virus disease (EVD) (See Table below). Note that this guidance outlines only those measures that are specific for EVD; additional infection control measures might be warranted if an EVD patient has other conditions or illnesses for which other measures are indicated (e.g., tuberculosis, multi-drug resistant organisms, etc.).
Though these recommendations focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting. In this guidance healthcare personnel (HCP) refers all persons, paid and unpaid, working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or aerosols generated during certain medical procedures. HCP include, but are not limited to, physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual personnel, home healthcare personnel, and persons not directly involved in patient care (e.g., clerical, dietary, house-keeping, laundry, security, maintenance, billing, chaplains, and volunteers) but potentially exposed to infectious agents that can be transmitted to and from HCP and patients. This guidance is not intended to apply to persons outside of healthcare settings.
(Read the full CDC Recommendations)
The goal of the POLST paradigm is to effectively communicate the wishes of seriously ill patients to have or to limit medical treatment as they move from one care setting to another. POLST is a voluntary process that:
The POLST form is not an advance directive. A POLST form represents and summarizes a patient’s wishes in the form of medical orders for end-of-life care. The POLST form is designed to be most effective in emergency medical situations. For more information or to obtain a POLST form, visit the NJ and Pa Department of Health websites listed below:
NJ POLST Form: http://www.state.nj.us/health/advancedirective/polst.shtml
Pa POLST Form: http://www.upmc.com/services/aginginstitute/partnerships-and-collaborations/pages/polst.aspx
NJSA 26:2H-29, et.seq.-POLST
NJSA 26:2H-58, et.seq.-Advanced Directives
NJSA 26:2H-68, – Do Not Resuscitate Orders
NJSA 46:2B-8.1, et.seq.-Powers of Attorney
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