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Social media nightmare for health IT

Social media nightmare for health IT | nursing | Scoop.it

 

Few healthcare IT policies these days are as delicate, sensitive and potentially emotionally explosive as efforts to restrict or regulate employee social media activity. And yet hospital hierarchies are routinely stepping on these political minefields as providers try to protect their reputations.

Consider a recent incident at the 2,478-bed New York Presbyterian Hospital.

An ER nurse posted a photograph of a trauma room – no staff or patients were in the picture – after caring for a man who had been hit by a subway train. The caption: "Man vs. 6 train." The image simply showed a room that had seen a lot of action moments before. The veteran nurse was fired after the incident, according to an ABC News report, not because she had breached hospital policy or violated HIPAA, but, as she put it: "I was told I was being fired for being insensitive."

This legitimately raises key issues around what a hospital's social media policy should be. This specific incident, though, appears to be an impressively poor choice for the hospital to have selected to make its stand. First, there really was no privacy issue at play. The photo shows nothing more than a slightly messy trauma room. The caption is vague and is hardly worse than a police officer posting a car accident image, with a note warning people against drinking/texting while driving. (To be precise, the injured car would be recognizable to the patient along with friends and family, especially if a license plate were visible, whereas a generic trauma room photo isn't.)

An even bigger problem with using this incident is that the nurse, Katie Duke, didn't even take that photograph. It was taken by a staff doctor and the doctor had posted it on the doctor's Instagram page. Nurse Duke had merely reposted it. The consistency killer? The doctor "was not reprimanded," ABCNews reported. To be fair, it's not clear whether the doctor's post included the "Man vs. 6 train" comment. Given that it appears that the comment – as opposed to the image – is the trigger here, the hospital's disciplinary process may or may not have been inconsistent.

Let's get back to the social media policy issues. I would hate to have to issue a concrete definition – acceptable to our friends in Legal – of "sensitivity." What if there had been no image and the nurse had simply said something like "A grim reminder at the ER today about how dangerous and deadly subways can be. Don't take any chances – ever." Is that insensitive? And if not, how is it meaningfully different than what Duke reposted? She specified the subway line, which, by itself, isn't insensitive nor especially revealing. And she used an image of the trauma center, which showed nothing. Would it have made any difference had she posted a generic trauma center image from Google Images?

If no patient or hospital privacy has been violated, what is the issue? The issue is that she was accused of violating hospital policy. We've now gone full circle. What is reasonable to ban, as long as no one's privacy nor hospital confidentiality is violated? (Classic hospital confidentiality: "Wow, my hospital is getting away with amazing markups. We just charged a patient $XXX for something, and I saw the paperwork that we only paid $X for it." The employee would be using information that she/he could only know because she worked there. That's a fine violation.)

Can a hospital ban employees from saying anything hospital-related on their social media posts? What if it's entirely positive, as in "Our surgical team is brilliant. We saved patients today that most surgeons would have lost"?

Here's the IT nightmare. What if the hospital says, "We're going to decide this on a case-by-base basis"? Danger, Will Robinson! Danger! Then things fall to IT to become the social media police. Are you to then track every social media feed of every employee and to then – gulp – review every posting for appropriateness? And somehow management thinks that this action will avoid lawsuits?

The simple fact is that a social media policy that covers what an employee does in his or her personal time is highly problematic. On the other hand, there certainly is social conduct that has to be dealt with. What if a doctor set up a site that identified herself as working at this identified hospital and then said how her team tries to inflict as much pain as possible and that they then place bets on when different patients will scream or pass out?

The easiest route from an administrative perspective – but certainly not from a legal perspective – is to adopt something akin to the Pentagon's infamous Don't Ask Don't Tell. That would be a program where there was zero effort to uncover such naughty social posts (as IT breathes a major sigh of relief) but a strict policy for punishing employees and contractors who engaged in bad behavior that the hospital happened to learn of.

The problem is that it leads to inconsistent punishment – with most people never getting caught – and to even vindictive behavior, with employees reviewing the social posts of a rival, looking for anything that might get them into trouble.

That policy might simply prohibit posts that reflect poorly on the hospital, which is vague enough to allow senior management to make customized decisions. As long as healthcare doesn't decide that it needs to proactively check on all posts – a thankless task that would almost certainly fall to IT, which would try to automate much of that assignment from Hell – any concrete policy is better than none.

 


Via Plus91
Patti Hamilton's insight:

What is the real problem here?  Is it breach of confidentiality, heightened risk management by hospitals, limits to freedom of expression, or could it be the lack of sensitivity of doctors and nurses?

 

What is your opinion?

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Health Care Rationing: The Roar and the Silence - Huffington Post

Health Care Rationing: The Roar and the Silence - Huffington Post | nursing | Scoop.it
No discussion means no probing, no deep thinking, no careful exchange of ideas. We do, indeed, ration health care in the United States; we just don't talk about it, with the result that we ration it altogether irrationally.
Patti Hamilton's insight:

Rationing is the feared "R" word in health care.  Of course every time the US passes a national budget, a hospital balances its books, individuals decide what food to buy....they are making rational decisions about resources. That looks like rationing to me.

 

What are your thoughts?

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Nurse-Patient Ratio Law in MA Raises Cost, Quality Concerns - MedPage Today

Nurse-Patient Ratio Law in MA Raises Cost, Quality Concerns - MedPage Today | nursing | Scoop.it
Mandated staffing ratios are good for nurses, but experts debate patient safety benefits
Patti Hamilton's insight:

Massachusetts will not have exactly the same legislation found in California but it has adopted mandated ratios.  Read about intended and unintended consequences from this type of legislation.

Patti

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Nurse Staffing and Patient Safety - New York Times

Nurse Staffing and Patient Safety - New York Times | nursing | Scoop.it
The American Nurses Association and others respond to an Op-Ed article about nurse-patient ratios.
Patti Hamilton's insight:

Yes, here is another link to a news story about the need for better nurse staffing.  Lack of action is not coming from lack of awareness.  What can we do to assure that patients in hospitals receive adequate care regardless of time of day or day of the week?

Patti

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Nursing Student with Crippling Anxiety Sues University for Failing Her Twice - Reason (blog)

Nursing Student with Crippling Anxiety Sues University for Failing Her Twice - Reason (blog) | nursing | Scoop.it
'On several occasions during the exam... breaking down and crying'
Patti Hamilton's insight:

Please give us your opinion about this case.  What is fair and appropriate accommodation? Is that realistic for a nursing student?

Be sure to watch this video of the newscast.http://wnep.com/2015/05/12/student-suing-misericordia-university-officials-after-failing-to-pass-course/

 

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These are the things people who are forced to work long hours miss the most - Washington Post (blog)

These are the things people who are forced to work long hours miss the most - Washington Post (blog) | nursing | Scoop.it
Those long hours in the office probably aren't doing you or your employer any good
Patti Hamilton's insight:

I found this very interesting.  It is a totally different approach to what important things are missed-this time focusing on nurses and other workers.  It seems nurses are not alone in going to work when ill.

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A descriptive study of nurse-reported missed care in neonatal intensive care units - Tubbs-Cooley - 2014 - Journal of Advanced Nursing - Wiley Online Library

A descriptive study of nurse-reported missed care in neonatal intensive care units - Tubbs-Cooley - 2014 - Journal of Advanced Nursing - Wiley Online Library | nursing | Scoop.it
RT @PIPSQC: Nurse-reported missed care in neonatal intensive care units http://t.co/X1R4SLmvkA #ptsafety #patientsafety #wenurses #nursecha…
Patti Hamilton's insight:

There are no surprises here.  Nurses appear to prioritize in much the same way in the NICU as in other units.  Oral care and education are items of care most often missed.

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Mean Girls of the ER: The Alarming Nurse Culture of Bullying and Hazing - MarieClaire.com (blog)

Mean Girls of the ER: The Alarming Nurse Culture of Bullying and Hazing - MarieClaire.com (blog) | nursing | Scoop.it
It's not only threatening the profession, it's putting patients' lives at risk.
Patti Hamilton's insight:

As we celebrate nurses and their work let's remember the price they sometimes pay for serving others.

Patti

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Rescooped by Patti Hamilton from Digital Media Literacy + Cyber Arts + Performance Centers Connected to Fiber Networks
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Funding needed for school nurses to keep students physically, mentally healthy

Funding needed for school nurses to keep students physically, mentally healthy | nursing | Scoop.it
All students, especially those who are medically fragile, can benefit from additional funding being resourced for school nurses Read More »

Via Chuck Sherwood, Senior Associate, TeleDimensions, Inc
Patti Hamilton's insight:

In the late 1980s I worked with the Texas School Nurses' Association to gather data on health needs of Texas school children.  Still, we lack qualified school nurses in every school in Texas.

Patti

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Darren Nutting's curator insight, May 6, 3:36 PM

Always take care of yourself. That gives you the best chance to take care of others at your full potential!

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Californians Report Fewer Health Care Access, Financial Issues - California Healthline

Californians Report Fewer Health Care Access, Financial Issues - California Healthline | nursing | Scoop.it
A Commonwealth Fund study finds states that have expanded Medicaid, such as California, have a lower percentage of residents who report problems accessing needed care, compared with non-expansion states.
Patti Hamilton's insight:

You won't find many surprises here. 

Now, if we could just get the Commonwealth Fund to fund our research on nurse staffing legislation.

Patti

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Nurses Confess: 4 Insider Secrets That Could Affect You - ABC News

Nurses Confess: 4 Insider Secrets That Could Affect You - ABC News | nursing | Scoop.it
Nurses let ABC News in on the secrets of their profession.
Patti Hamilton's insight:

This is a fascinating look at hazards to patients and nurses in hospitals. At the end, the advice these nurses give may surprise you.

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Nurse-To-Patient Mandate Reintroduced In Congress - KPBS

Nurse-To-Patient Mandate Reintroduced In Congress - KPBS | nursing | Scoop.it
A measure that would mandate minimum nurse-to-patient ratios in all hospital units has been reintroduced in Congress.
Patti Hamilton's insight:

I find this sound clip interesting because Australia has several types of nurse:patient policies (different in every one of the states there).

In the US at the national level  there has been strong resistance to ratio measures but also to policies such as Texas' which mandate nurse staffing committees responsible for overseeing staffing patterns and examining their effect on patient outcomes.

Are you a ratio fan?  Why or Why Not?

Patti

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Effects of increasing nurse staffing on missed nursing care - Cho - 2015 - International Nursing Review - Wiley Online Library

Effects of increasing nurse staffing on missed nursing care - Cho - 2015 - International Nursing Review - Wiley Online Library | nursing | Scoop.it
Effects of increasing nurse staffing on missed nursing care
(1:7 vs 1:17)

http://t.co/nD7ehVp4ap
Patti Hamilton's insight:

This is a brand new paper on the connection between missed care and staffing.  A word of caution in interpreting the findings.  The usual manner of measuring missed care is to ask nurses to identify specific tasks that are missed.  Often these tasks are items of care that most often are carried out during 7a to 7p shifts when the staffing is richest.  After hours, the time with lean staffing, may be times when items of care are "missed" because they are not usually performed after hours (walking, feeding, bathing).  An association between lean staffing and missed care needs to be examined very carefully for other confounding variables and for the effect of instruments not well suited for all contexts.

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Michael West: developing cultures of high-quality care

Michael West: developing cultures of high-quality care | nursing | Scoop.it
In the first of our series of lectures on leadership in the NHS, Michael West, Professor of Organisational Psychology at Lancaster University Management School, looked at how leaders can develop a culture of high-quality care and patient safety in...
Patti Hamilton's insight:

I found this lecture to fit closely with our own observations and findings- especially the notion that there is "slippage" from our vision to our language and our focus.

Check it out.

 

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Gitmo nurse who refused to torture inmates faces Navy retaliation – lawyer ... - RT

Gitmo nurse who refused to torture inmates faces Navy retaliation – lawyer ... - RT | nursing | Scoop.it
Despite a Guantanamo Bay nurse, who refused to force-feed inmates on hunger strike in Guantanamo Bay, receiving recognition from the nursing association for his ethical stand, the US Navy has threatened to revoke his security clearance, his lawyer...
Patti Hamilton's insight:

There are many questions still unanswered about this case but on the surface I believe the nurse did the honorable thing by refusing to participate in this form of treatment.

 

What are your thoughts?  What would you still like to understand about the situation?

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AHRQ Patient Safety Network - Missed Nursing Care

Patient Safety Primers > Missed Nursing Care:

https://t.co/smGU4OAJfd http://t.co/NXM8d6PVgx
Patti Hamilton's insight:

Some good information here for use by those of us interested in Missed/Rationed nursing care.

Patti

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Nurse germ protection—at home!

Nurse germ protection—at home! | nursing | Scoop.it
As nurses, we need to ensure that the germs we deal with at work don’t make their way to our home. Here are some practical strategies that can help.
Patti Hamilton's insight:

Good suggestions!  I cringe when I see folks in scrubs eating in restaurants or in stores carrying small children. Whether heading to or from work, these ways of spreading germs are troubling.

 

Check out this post also. http://candornews.com/2012/08/01/by-wearing-scrubs-in-public-medical-professionals-may-ironically-be-making-us-more-sick/

 

What are your thoughts?

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Why doctors' group is wrong about empowering nurse practitioners - Los Angeles Times

Why doctors' group is wrong about empowering nurse practitioners - Los Angeles Times | nursing | Scoop.it
In September 2013, just as Covered California was preparing to enroll a million new patients in the state's healthcare system, the state Senate caved to pressure from the California Medical Assn.
Patti Hamilton's insight:

I would really like to hear from my APN friends about the conclusions reached in this article.

Patti

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Research shows nurses are short on time, not compassion

Research shows nurses are short on time, not compassion | nursing | Scoop.it
More nurses and higher education levels - not a change in values - are needed if nursing in Britain is to regain its world-leading status.

Via irissorg
Patti Hamilton's insight:

I was particularly struck by this:

 

Research undertaken in the UK found that student nurses go into the profession with strong values and high ideals. They have a determination to provide high-quality, holistic care and to always have time for patients and their families.

But after just 15 months in the job, almost a third of these same nurses are described as having “crushed ideals” and more than half have “compromised ideals” – compromising one or more ideals on a daily basis. They felt they were unable to practice nursing in the way they or their patients expected."

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Ask the care expert ... about often missed areas - McKnight's Long Term Care News

Ask the care expert ... about often missed areas - McKnight's Long Term Care News | nursing | Scoop.it
We should go over selecting footwear, socks or whatever the resident prefers to wear and to be sure that the socks or stockings are cleaned daily.
Patti Hamilton's insight:

This is one example of missed care that may have escaped our notice.

Thanks, Sherrie, for pointing this out.

Patti

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TPS to put nurses in all schools - Toledo Blade

TPS to put nurses in all schools - Toledo Blade | nursing | Scoop.it
With some help from a local health-care company, all students in Toledo Public Schools soon will have access to a nurse on a daily basis.
Patti Hamilton's insight:

Wow, how nice to see one city's solution to the lack of nurses in all public schools.

Patti

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Unfinished nursing care, missed care, and implicitly rationed care: State of the science review

RT @IJNSJournal: Unfinished nursing care, missed care, and implicitly rationed care: State of the science review http://t.co/lryDOoOakB
Patti Hamilton's insight:

We did it!!!! 

Terry did the bulk of the work and finally this baby was born.

Check it out.

Patti

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The difference between Night/Day shift nurses

The difference between Night/Day shift nurses | nursing | Scoop.it
Click here to view more Nurse Videos
Patti Hamilton's insight:

Anyone interested in why there is more missed care during day shifts MUST see this video.  He highlights the difference in activity and the need to make decisions based on ABC priorities.

This is wonderful!!!!!!!!!!!

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TV nurse to address social media concerns - Shreveport Times

TV nurse to address social media concerns - Shreveport Times | nursing | Scoop.it
Nurse Katie Duke works social media, from Instagram and Twitter to Facebook and YouTube.
Patti Hamilton's insight:

I remember when this incident happened.  The nurse lost her job for re-posting a photo of a bloody trauma room after the patient was moved, the physician who sent her the photo did not lose his job.

 

 Now this nurse is using a bad experience to create a new role for herself in social media.

 

What are your thoughts about the rights of health care providers to be "insensitive" online if they do not divulge personal information about patients or employers?

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Why Data Handoffs Matter | The Health Care Blog

Why Data Handoffs Matter | The Health Care Blog | nursing | Scoop.it

Chief information officers (CIOs) and chief medical information officers (CMIOs) have spent the better part of two decades on a quest for interoperability; yet, their Achilles heel lies in the “information” part of their titles. If information is the sole beacon of efficiency and value, the invaluable contours of human suffering, personal preferences and humanity itself are lost.

Information is the first step to developing knowledge and understanding, but what physicians and patients rely on in the real clinical setting, rife with changes, are knowledge, understanding and empathy. The cold, hard calculus of a=b does not always apply when dealing with people because they are much more complex and complicated than binary machines with screens. If it were so easy, there would be no problem reaching 100% compliance with medication or a plan of action.

Sadly, all data lives in a database; which might as well be called a wait-a-base; after all, the data just sits there and waits for someone to look at it.

The fundamental problem with today’s information architecture is that all data are not created equal. Data, information and knowledge degrade with each new doctor that becomes involved. In addition, systems design lacks an understanding of how the human computer works in the context of illness, anxiety or uncertainty. Healthcare is a people business in need of data, not a data business in need of people. Data are the means; people are the beginning and the end.

 

Today’s environment is laden with an emphasis on revenue, cost and quality, while big data, mobile devices and the Affordable Care Act also bring promise. The follies of contrived informatics harm the system it serves and the patients (and doctors) that rely upon it.

A brief look at history reveals that the origin of “data” in healthcare is borne out of the medical claim, whose original purpose was to unlock the cash register, not create a knowledge system for understanding what matters most to doctors and patients. Instead, it was a system that wanted information to adjudicate cash. When the claim became the center of gravity, the ability to navigate knowledge and understanding devolved into a world where structured data and interoperability became the prizes.

Recalling the childhood game of “telephone” will illuminate part of the problem with informatics.

Today’s environment is laden with an emphasis on revenue, cost and quality, while big data, mobile devices and the Affordable Care Act also bring promise. The follies of contrived informatics harm the system it serves and the patients (and doctors) that rely upon it.

A brief look at history reveals that the origin of “data” in healthcare is borne out of the medical claim, whose original purpose was to unlock the cash register, not create a knowledge system for understanding what matters most to doctors and patients. Instead, it was a system that wanted information to adjudicate cash. When the claim became the center of gravity, the ability to navigate knowledge and understanding devolved into a world where structured data and interoperability became the prizes.

Recalling the childhood game of “telephone” will illuminate part of the problem with informatics.

“…the origin of “data” in healthcare is borne out of the medical claim, whose original purpose was to unlock the cash register, not create a knowledge system for understanding what matters most to doctors and patients.”

Getting a patient to agree to a care plan requires a belief in that plan and as with belief systems, there is an expectation of trust (or blind faith). Trust and communication are the bedrock of relationships; EHRs value transactions of data, not relationships.

Medical decision making requires the use of knowledge, experience and data; however, the current paradigm relies almost solely on the latter. It may be useful to look at the works of Heinz Von Forester, an Austrian American scientist and the father of second-order cybernetics (they investigate the construction of models of cybernetics), to appreciate the critical role of knowledge-based systems and the influence of those that create them.

Each new doctor that gets a hand-off from another doctor is often given the homogenous data file of the continuity of care document. Similar to the telephone game, the data have already changed once they have been received, and there is no data set for what has historically worked (knowledge) and for what patients’ preferences are (U-data). Furthermore, the feedback loop does not exist to ensure fidelity of understanding.

The American College of Physicians recently published a position paper (1) that basically states that all electronic medical records were built for defensive medicine and billing while adding unnecessary complexities to the lives of doctors and patients. The article says:

“Electronic health records should be leveraged for what they can do to improve care and documentation, including effectively displaying prior information that shows historical information in rich context; supporting critical thinking; enabling efficient and effective documentation; and supporting appropriate and secure sharing of useful and usable information with others, including patients, families and caregivers…Physicians must learn to leverage the enormous and growing capabilities of EHR technology without diminishing or devaluing the importance of narrative entries. Failure to do so will inevitably influence the way we think and teach to the detriment of patient care.”

Health is a foundational attribute of  life; it is existential and important. Information about what happened to us, what is happening to us and what could happen to us is all wrapped into a non-linear, non-local model. Different data types are often simultaneously dependent and independent on other data types; they interact with each other in non- linear and often non-obvious ways.

It’s time to take a deep breath and think more holistically about what needs to be accomplished for people, both proactively and reactively. If zeal for efficiency and cost containment drive strategy, they might result, but an amazing opportunity will have been missed—the opportunity to design a system to enable actionable information, wrapped in the context of the data types elucidated above; to use mobile technology whenever possible; and to teach how to observe, listen and respect the powerful nature of U-data.

The art of medicine in the context of religion, beliefs, fears, suffering and socio-economic status cannot be homogenized by data architecture. There needs to be a move towards integrating what matters to individuals with what is the matter with them. A recent study in the Harvard Business Review elucidated why people trust human judgement over algorithms; To err is human, but when an algorithm makes a mistake we’re not likely to trust it again. Furthermore, algorithms are unable to factor in the concept of the ‘benefit of the doubt’.

Healthcare has many interfaces where systems, subjects and organizations meet and interact. These multitudes of connections lend themselves to hyper-complexity; yet when boiled down to a functional unit, there is a human being in need of care. Losing sight of this element fails the entire system.

According to Sir William Osler, M.D., a Canadian physician often called the “father” of modern medicine, “The practice of medicine is an art, not a trade, a calling, not a business, a calling in which your heart will be exercised equally with your head.”

1 – Kuhn T, Basch P, Barr M, et al. “Clinical Documentation in the 21st Century: Executive Summary of a Policy Position Paper From the American College of Physicians.” Annals of Internal Medicine. Published online Jan. 13, 2015.

 


Via Technical Dr. Inc.
Patti Hamilton's insight:

As I read this I immediately saw the connections to Institutional Ethnography.  For example, the author correctly points out that information is "Worked up" by everyone in the loop and rich historical context about the patient and her/his experiences is lost. Real understanding is lost due to the way in which information is collected and transmitted.

 

What are your thoughts?
Patti 

 

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Hospitals Fail To Protect Nursing Staff From Becoming Patients - NPR

Hospitals Fail To Protect Nursing Staff From Becoming Patients - NPR | nursing | Scoop.it
Nursing employees suffer 35,000 back and other injuries nearly every year.
Patti Hamilton's insight:

I am still trying to decide what I think about Nina Pham's lawsuit against THR Presbyterian Hospital in Dallas over exposing nurses to undue risk.  When I saw this NPR story I thought it might help me to sort out the complex issues involved.

What do you think?

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