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On-the-job training

Facility employee health nurses guide employees into a wellness state of mind

Monday March 5, 2012
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Lynn Hudson, RN, collaborates with Keith Wood on his diabetes care plan.
(Photo by Lynn Hudson, RN)
All is not well for hospital employees. Like the general population, nurses and others who work in hospitals have their share of health woes. Many facilities are trying to change that for practical reasons, in part to save on their own healthcare costs. The savings can be significant, but so can the impact on the lives of healthcare employees across the nation and on the patients for whom they care.

Researchers have estimated that for every $1 spent on wellness programs, U.S. businesses could save more than $3 in medical expenses, and more than $2 in absenteeism costs, according to a study published in the January 2010 issue of Health Affairs.

But many healthcare leaders also have loftier goals in mind — to set an example for the public.

In a report last year, the American Hospital Association called for hospitals to be leaders in creating a “culture of health” — a climate in which wellness programs are developed and promoted for employees and, ultimately, expanded to local communities. Such programs can include smoking cessation classes, health risk assessments, Weight Watchers meetings and healthier cafeteria fare. They also can include incentives such as discounted gym memberships and lower health insurance premiums.

Two key factors helped drive the AHA report, said Carol A. Watson, RN, PhD, CENP, FAAN, clinical professor and MSN-CNL program coordinator at the University of Iowa College of Nursing. First was a need for hospitals to be exemplary in elevating employee health. “We’re the ones who should know the most about how to do this; we should be leading the way for other businesses within our community,” she said.

The second driver was the national reform agenda. “We need to be transitioning to a culture that is not acute-illness and episodic-oriented, but that is really about managing health and managing disease. Again, who better to lead than hospitals?” Watson said.

To improve employee wellness, hospitals first should gather baseline data about their workers’ health — including exercise frequency, smoking status, weight, blood pressure control, cholesterol levels and diabetes incidence — through questionnaires and, if possible, biometric screenings, said Watson, who represented the American Organization of Nurse Executives on the AHA’s Long-Range Policy Committee, which created the report. Although participation typically is voluntary, some employers make these steps mandatory for workers seeking insurance coverage, or charge nonparticipants more for coverage. Unions including the California Nurses Association have opposed some of the requirements related to wellness programs, raising concerns about financial penalties and privacy.

The next step for hospitals is to develop programs — such as weight loss, smoking cessation or exercise initiatives — that target employees’ needs, Watson said.
After that comes the hardest step — getting employees engaged. Incentives — first, positive ones (such as cheaper health insurance or gym memberships) can help, but later negative ones (like insurance premium penalties for uncontrolled blood pressure or other unhealthy behaviors) also might be helpful. Finally, Watson said, measuring outcomes and return on investment — for instance by documenting changes in direct healthcare costs or absenteeism — is key, especially because current health system priorities have focused much more on caring for the sick than on maintaining health.


Paula McGown, RN
A force for change

One recent study of a voluntary, incentive-based workplace wellness program at Vanderbilt University in Nashville, Tenn., which includes the medical center, has charted outcomes for seven years. The findings suggest lasting changes can be achieved.

According to the study, published in the December 2011 issue of the Journal of Occupational and Environmental Medicine, the most consistent change among employees in Vanderbilt’s “Go for the Gold” wellness program was in physical activity, with those who exercised at least once a week increasing from 72.7% in 2003 to 83.4% in 2009. Improvements also were steady in people’s eating choices, smoking rates and seat-belt use. Gains, which have continued throughout the seven years of the program, were greatest in the first two years, leading researchers to suggest that, for employees, the wellness program served as a “wake-up call.”

The Vanderbilt program, developed and supported in-house, has a high annual participation rate, averaging near 80%, said Paula McGown, RN, CFNP, CPA, administrative officer for faculty/staff health and wellness programs at Vanderbilt. The university employed more than 22,000 people at the end of its 2010 fiscal year, with about three-quarters of them working for the medical center.

Before the program’s launch, the number of smokers at Vanderbilt already was well below the national average of about 20%, but now it’s less than 10%, McGown said. Obesity rates in the program, meanwhile, have increased minimally every year. “We actually do consider that a win, because if you look at the nation as a whole, [obesity is] going up at a much steeper rate. We have kind of flattened that curve,” she said.

The rate among her colleagues is about 1 in 4, compared with 1 in 3 nationwide.

Before the “Go for the Gold” program was launched, fewer than one-quarter of employees completed an annual health-risk assessment. That figure increased to more than two-thirds in the new program’s first year, and reached four-fifths or higher in years four through seven. The average cost per participant was about $200, excluding expenses related to Vanderbilt’s fitness facility.

To raise employee awareness for the program’s first year, an incentive of $10 per month in the next year’s worth of paychecks was offered, McGown said. The second year, as organizers added a “wellness action program” — an online component encouraging healthful activities and requiring employees to meet a set number of goals — an extra $5-a-month incentive was provided. A year later, with the addition of the program’s third tier — an annual, internally produced video program on health topics such as self-care or preventive screenings — another $5-a-month incentive was added.

While the impact of $20 a month in incentives may vary depending on employees’ position and income, it’s probably a secondary motivator compared with simply feeling better — and, for many workers, being a role model for patients, McGown said.


Carol A. Watson, RN
A dent in diabetes

At East Alabama Medical Center, a 340-bed facility in Opelika, employee wellness includes a disease management component, with diabetes in its crosshairs. About 240 employees and dependents on the hospital’s health insurance, most of them with type 2 diabetes, take part, said Lynn Hudson, RN, CDE, who educates inpatients and outpatients at the facility.

The program, called Check for Success, was launched in 2006 and is based in the facility’s Diabetes and Nutrition Center. Participants sign a contract agreeing to attend their appointments, take their medicines, follow an exercise plan, check their blood sugar and bring their meters in for data downloads. In turn, they receive diabetes education, free diabetes medicines and supplies, Hudson said.

New enrollees have an initial assessment visit plus three weekly classes, totaling 10 hours, covering diabetes self-management. The classes take a didactic approach rather than just lectures, Hudson said. Then, participants receive two individual follow-up sessions with a dietitian. After that, employees can come back as often as they want, but must have a follow-up visit quarterly to remain eligible for the free medicines and supplies.

Keeping employees engaged can be challenging, Hudson acknowledged, although the program’s rewards are crucial in that regard. Over the course of the first six months in the program, for example, patients generally lose weight, improve their A1c levels, and continue to receive free meds and supplies. “They’re getting a direct reward for their behavior — that’s a huge cost saving personally,” Hudson said. “They also get to come and problem-solve to see what they are doing right and what they can improve on.”

Among program participants, diabetes-related claims for a recent 12-month period were 5% lower — and overall medical claims, excluding prescriptions, 11% lower — than for the previous 12 months, figures show.

Besides the diabetes management initiative, and Weight Watchers and smoking cessation programs, EAMC also has delved into other wellness efforts — for instance, an outdoor fitness course, Zumba classes on the parking deck, a “Wellness Wednesday” email with tips, mandatory biometric screenings, and an “Exercise Pays” program offering free membership at a hospital-owned health club for employees who exercise 150 minutes a week. “It is like a family vibe here, and they do want to provide everyone with opportunities to improve their health,” Hudson said. “Most people work here for 20, 30 years, so really it’s an investment.”

Watson said she hopes hospitals, as part of their wellness programs, begin to focus more on shift workers, who can be particularly sleep-deprived and stressed. Better meal options could help, as could dedicated space for “power napping” and ready access to exercise equipment, for instance, in staff lounges. “We have to make sure we’re addressing the needs of people who are staffing our organizations 24/7,” she said.

Overall, nurses know how they should be eating and exercising, and tending to health issues like hypertension, but often they don’t actually do it. “I think we have an obligation as clinicians,” Watson said, “to also walk the talk.”

Call to action

To read the American Hospital Association report “A Call to Action: Creating a Culture of Health,” visit AHA.org/Advocacy-Issues/HealthforLife/Culture.shtml. The report’s recommendations for hospitals include:

• Serving as a health role model for the community, for instance by working with local employers to build an integrated, regional approach to wellness;

• Creating a culture of healthy living starting with top management and trustees, and making this a strategic priority

• Providing a variety of program offerings, such as a health risk assessment, biometric screening and at least one intensive coaching activity;
• Offering positive and negative incentives, first to increase participation level and later to encourage positive outcomes;
• Tracking participation and outcomes, such as overall participation, numbers completing an HRA and numbers with reduced cholesterol levels;
• Measuring for return on investment, ideally over several years, gauging healthcare savings and savings garnered through improved productivity; and
• Focusing on sustainability, by dedicating appropriate resources, conveying that wellness is a long-term priority for the hospital and motivating employees over time.



Karen Patterson is a freelance writer. Post a comment below or email specialty@nurse.com.