Additional paperless processes are also being designed for the future, such as on-line applications and on-line payment.  More information will be provided as those phases move towards implementation.

For questions or more information please contact the Nursing Commission at 360-236-4709 or nursing@doh.wa.gov.

• To see NCQAC’s power point presentation related to the new paperless system for license renewal, download this PowerPoint presentation:  paperless-licensing-0309.ppt
• Attached is the list of confirmed sites for the March 24th Paperless Licensing Video Announcement.  If you wish to attend you may do so at one of these sites.  NOTICE: THE MARCH 27 VIDEO ANNOUNCEMENT HAS BEEN CANCELLED : Paperless Licensing Video Announcement Confirmed Sites (Excel format file)
  

To evaluate nurse sleep patterns and the resulting safety risks, researchers from Grand Valley State University in Grand Rapids, Mich., studied data from 895 full-time hospital staff R.N.s. Participants completed daily logs over four weeks, recording their work hours, sleep duration, drowsy and sleep episodes at work, and drowsy driving occurrences. During the study period, nearly 67 percent of nurses reported at least one drowsy driving incident, and 3 percent reported drowsy driving after every shift. The risk of drowsy driving and near or actual motor vehicle accidents nearly doubled when nurses drove following shifts longer than 12.5 hours. The majority of the 281 near or actual car crashes recorded during the study occurred following these extended shifts.

Working at night also significantly increased drowsy driving risk, with 79.5 percent of night-shift nurses reporting at least one such incident. In addition, nearly two-thirds of participants reported difficulty staying awake at work at least once during the study period, and 16.9 percent of nurses actually fell asleep at least once during a shift. Nurses who experienced such on-the-job fatigue had nearly triple the risk of experiencing drowsy driving.

The researchers note that, despite recommendations suggesting seven to eight hours of sleep, only 20.8 percent of participants reported sleeping for at least six hours before each shift. They add that nurses’ risk of drowsy driving increased by 9 percent for each hour of sleep lost. In light of the findings, the authors recommend that hospitals pay greater attention to nurse fatigue and implement strategies to prevent drowsy driving to protect the safety of nurses and the public.

Full Article:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2276124

When asked how hospital administrators can be better made aware of these possible rates of improved patient outcomes, lead review author Robert Kane, MD, said, “The issue is not making them aware of the possibility, it’s convincing them that it is in their best interests to act on it. From a business perspective, the savings in reduced lengths of stay would not offset the costs of the added staffing. The case would have to be made in terms of image and liability.”
The systematic review aimed to examine whether there was a link between a hospital’s registered nurse-to-patient ratio and the health outcome of the patients under their care.

Kane, of the University of Minnesota School of Public Health, and colleagues write that “nurses are crucial to providing high-quality care,” and “increasing the nurse-to-patient ratios has been recommended as a means to improve patient safety.”

The researchers evaluated 27 studies of patient outcomes in relation to the registered nurse-to-patient ratio. Per shift, RN staffing averaged about three patients per RN in intensive care units, four patients per RN on surgical units and four patients per RN for medical patients. Registered nurse staffing ratios came from the American Hospital Association and other nursing surveys.

The studies included in the review used data on patient outcome rates from sources such as the Uniform Health Discharge Data Sets and Centers for Medicare and Medicaid Services databases.

Kane and fellow reviewers found that a greater number of RNs on staff was associated with a reduction in the number of hospital-related deaths and other negative outcomes. Their results showed that by increasing the number of full-time RNs on staff per day by one, there were 9 percent fewer hospital-related deaths in intensive care units, 16 percent fewer in surgical patients and 6 percent fewer deaths in medical patients.

For every 1,000 hospitalized patients, the reviewers estimated that an increase by one full-time RN per patient day could save five patient lives in intensive care units, five lives on medical floors and six surgical patient lives.

Moreover, increasing staffing by one RN per patient day resulted in lower rates of hospital-acquired pneumonia, respiratory failure and cardiac arrest in intensive care units. Patients’ length of stay in the hospital was also shorter by 34 percent in intensive care units and by 31 percent in surgical units.

The review acknowledges that while increased nurse-patient ratios can lead to better patient outcomes, it is difficult to maintain a reasonable number of RNs on staff in light of the current shortage of available RNs.

“A sufficient supply of nurses is critical to providing our nation’s population with quality healthcare as these studies note; yet, hospitals are currently facing a nursing shortage,” agreed Jo Ann Webb, senior director of federal relations and policy for the American Organization of Nurse Executives. “This need will only be exacerbated in the coming years to accommodate growing patient needs and to replace retiring nurses.”

“The US Bureau of Labor Statistics has projected that by 2014, our nation will need an additional 1.2 million new and replacement nurses,” Webb said.

Kane RL, et al. “The Association of Registered Nurse Staffing Levels and Patient Outcomes: Systematic Review and Meta-Analysis.” Med Care 45(12), 2007.

Source: Health Behavior News Service

Next month, the International Agency for Research on Cancer, the cancer arm of the World Health Organization, will add overnight shift work as a probable carcinogen. The American Cancer Society says it will likely follow. Up to now, the U.S. organization has considered the work-cancer link to be ”uncertain, controversial or unproven.”

The higher cancer rates don’t prove working overnight can cause cancer. There may be other factors common among graveyard shift workers that raise their risk for cancer.

However, scientists suspect that overnight work is dangerous because it disrupts the circadian rhythm, the body’s biological clock. The hormone melatonin, which can suppress tumor development, is normally produced at night.

If the graveyard shift theory eventually proves correct, millions of people worldwide could be affected. Experts estimate that nearly 20 percent of the working population in developed countries work night shifts.

Among the first to spot the night shift-cancer connection was Richard Stevens, a cancer epidemiologist and professor at the University of Connecticut Health Center. In 1987, Stevens published a paper suggesting a link between light at night and breast cancer.

Back then, he was trying to figure out why breast cancer incidence suddenly shot up starting in the 1930s in industrialized societies, where nighttime work was considered a hallmark of progress. Most scientists were bewildered by his proposal.

But in recent years, several studies have found that women working at night over many years were indeed more prone to breast cancer. Also, animals that have their light-dark schedules switched develop more cancerous tumors and die earlier.

Some research also suggests that men working at night may have a higher rate of prostate cancer.

Because these studies mostly focused on nurses and airline crews, bigger studies in different populations are needed to confirm or disprove the findings.

There are still plenty of skeptics. And to put the risk in perspective, the ”probable carcinogen” tag means that the link between overnight work and cancer is merely plausible.

Among the long list of agents that are listed as ”known” carcinogens are alcoholic beverages and birth control pills. Such lists say nothing about exposure amount or length of time or how likely they are to cause cancer. The American Cancer Society Web site notes that carcinogens do not cause cancer at all times.

Still, many doubters of the night shift link may be won over by the IARC’s analysis to be published in the December issue of the journal Lancet Oncology.

”The indications are positive,” said Vincent Cogliano, who heads up the agency’s carcinogen classifications unit. ”There was enough of a pattern in people who do shift work to recognize that there’s an increase in cancer, but we can’t rule out the possibility of other factors.”

Scientists believe having lower melatonin levels can raise the risk of developing cancer. Light shuts down melatonin production, so people working in artificial light at night may have lower melatonin levels.

Melatonin can be taken as a supplement, but experts don’t recommend it long-term, since that could ruin the body’s ability to produce it naturally.

Sleep deprivation may be another factor in cancer risk. People who work at night are not usually able to completely reverse their day and night cycles.

”Night shift people tend to be day shift people who are trying to stay awake at night,” said Mark Rea, director of the Light Research Center at Rensselaer Polytechnic Institute in New York, who is not connected with the IARC analysis.

Not getting enough sleep makes your immune system vulnerable to attack, and less able to fight off potentially cancerous cells.

Confusing your body’s natural rhythm can also lead to a breakdown of other essential tasks. ”Timing is very important,” Rea said. Certain processes like cell division and DNA repair happen at regular times.

Even worse than working an overnight shift is flipping between daytime and overnight work.
”The problem is re-setting your body’s clock,” said Aaron Blair, of the United States’ National Cancer Institute, who chaired IARC’s recent meeting on shift work. ”If you worked at night and stayed on it, that would be less disruptive than constantly changing shifts.”

Anyone whose light and dark schedule is often disrupted — including frequent long-haul travelers or insomniacs — could theoretically face the same increased cancer risk, Stevens said.

He advises workers to sleep in a darkened room once they get off work. ”The balance between light and dark is very important for your body. Just get a dark night’s sleep.”
Meanwhile, scientists are trying to come up with ways to reduce night workers’ cancer risk. And some companies are experimenting with different lighting, seeking a type that doesn’t affect melatonin production.

So far, the color that seems to have the least effect on melatonin is one that few people would enjoy working under: red.

Source: Associated Press