Re: Staffing Watch, H&HN, Nov. 10

The American Medical Association's statements on the Institute of Medicine report supporting an increased role for advanced practice nurses—that nurse practitioners (NPs) are deficient in training and clinical experience—is comparing apples to oranges, as NP roles and those of physicians are different:

  • Physicians are trained in an acute care model, while NPs are trained in a chronic illness model.
  • Physicians are trained primarily in hospitals, while NPs are trained primarily in community clinic settings.
  • The majority of physicians (± 97%) are training to be [sub]specialists while ± 83% of NPs train in general practice.

The AMA statement is in opposition to predictions on the nation's changing health care needs going back at least a decade. We will always need specialists, though not as many as presently exist. Other Western countries either have a 50:50 or 67:33 ratio of generalists to specialists. Ours is 33:67, or two specialists for each generalist. As only 2 to 3 percent of medical students evince interest in general practice, as many generalists are reaching retirement age, as there are too few generalist residencies available, and as many of the current residency openings remain unfilled, the AMA's suggestion would result in a significant disjunction between providers and patients.

Our primary need is for generalists able to work with chronic conditions in community settings. The AMA should shift its focus by developing additional community-based general practice residency programs, and encouraging students to enter them.

M. Bennet Broner, PhD
Principal, The Scrivener's Desk
Health Care Services Consultant

Truus H. Delfos-Broner, RN, CNM, MPH
Women's Health Coordinator
School of Medicine
University of Alabama, Birmingham

Engaged Staff Washes Hands

Kadesha Thomas's December 2010 article in H&HN titled "Hand Hygiene Surveillance Gets a 21st-Century Makeover" does a great job explaining what hospitals are doing to monitor and enforce hand-hygiene compliance among their employees.

One of the greatest contributors to health care-acquired infections is poor hand washing or lack thereof by hospital employees. While increased surveillance, systems and signage may have an impact on hand washing, HR Solutions Inc. has conducted new research linking hand-washing compliance to employee engagement.

A recent study, which included 245,609 employees from 45 U.S. health care organizations, found a near-perfect positive Pearson correlation between hand-washing compliance (defined as washing hands or using antibacterial hand sanitizer before and after contact with a patient) at health care facilities and employee engagement. Thus, as engagement levels rise, so does hand-washing compliance.

The study does not suggest that engagement causes hand-washing compliance or vice versa. Nonetheless, as the number of health care-acquired infections soars, this data could provide a new way for health care facilities to address the issue of hand hygiene.

Kevin Sheridan
CEO, HR Solutions Inc.

Benefits of Bundling

RE: "Bundle Up," H&HN Weekly, Nov. 15

Hats off to David Webber for outlining the key benefits of bundled payment in a captivating article: true alignment of interests by the stakeholders, improved quality of care metrics and financial gain. Who can argue that this will take time; however, it is the direction of the future in my experience.

Marty Diamond, FACHE
President and CEO
The Diamond Group, Dallas
Senior Fellow, UCSF Center for the Health Professions