Hospital group nixes hiring of applicants who use tobacco

LYNN – The Massachusetts Hospital Association (MHA) is taking their “no-smoking” policy to a new level with an initiative stating that they will no longer hire individuals who use tobacco products as of Jan. 1.

Lynn Nicholas, president and CEO of the MHA, said the initiative does not affect current employees.

“I am not pressuring my employees to quit smoking, although I’m sure they feel that way indirectly,” says Nicholas. “The goal of our organization is to heal people. I care about my workforce very much and I want them to be healthy.”

She hopes the initiative can lead the way in reducing unnecessary deaths.

“Eight thousand people in Massachusetts die each year from tobacco use,” says Nicholas. “I think people forget about the statistics. If this can save lives and reduce the number of patients in our hospitals who are there directly or indirectly because of tobacco, that would be significant.”

Nicholas adds that the initiative could contribute to the pressure on reducing health-care costs. Tobacco-related disease and deaths cost the state six billion dollars a year. “There’s enormous pressure on reducing the cost of healthcare. I thought in my own way as a small employer, we could put more emphasis on preventable disease and even more emphasis on extending life and reducing the cost of healthcare,” she said.

This proposal will act as a model for hospitals and health care facilities that are members of the MHA, but does not require them to comply.

Hallmark Health and North Shore Medical Center (NSMC) facilities are members of the association and are already tobacco-free workplaces, meaning employees, patients and visitors are prohibited from smoking on-site.

With an approximate workforce of 3,000 employees, Director of Hallmark Health Richard Pozniak says the initiative will be difficult for large health-care facilities to implement.

“The MHA has a much smaller employee workforce than a facility such as Hallmark Health, which makes it easier for them to implement the initiative,” says Pozniak.

Hallmark Health facilities include Melrose-Wakefield Hospital, Lawrence Memorial Hospital, Hallmark Health Medical Center in Reading, Hallmark Health Cancer Center in Stoneham, CHEM Center for Radiation Oncology in Stoneham, CHEM Center for MRI in Stoneham, Hallmark Health VNA and Hospice in Malden and Hallmark Health Medical Associates.

Pozniak says all of the facilities have been tobacco-free workplaces for the past two years.

“As a community based health-care system, we believe it’s important to take a stand against what we know is the leading cause of preventable death and disease, which is smoking,” he said.

He noted that future job applicants who smoke will still be considered for a position.

“If there’s a qualified person applying and that person smokes, we are not requesting that they give up smoking, but that they do not smoke on Hallmark Health property,” says Pozniak. “If they so choose to give up smoking to improve their health and well-being,, we will help them through the process.”

Hallmark Health offers nicotine replacement products and a smoking cessation program for employees who smoke.

“If you use tobacco, we recognize that our tobacco-free policy is a challenge. We ask our employees to speak with their physician about ways to manage the challenge of smoking and to seek our resources,” Pozniak says.

North Shore Medical Center (NSMC) facilities, including Union Hospital in Lynn and Salem Hospital, have no plans to put the initiative into place.

“As a health-care facility, our goal is to keep patients and employees healthy, but at this point I don’t think there’s any chatter or plans to do something that drastic,” says NSMC Director of Media Relations Kevin Ronningen.

“This (initiative) sets a precedent, but I’m not sure how it will shape up,” he says.

Students at North Shore Community College (NSCC) had mixed opinions about the new initiative.

“I think it’s a bit hypocritical,” says student Alex King. “It’s almost saying that people who smoke aren’t capable of caring for other people and I don’t think that’s the case.”

Kenneth Vielleux agrees. “I don’t think people should be refused a job because they smoke,” he says.

Vielleux’s friend, Ryan Soares De Sousa, said the initiative is “a little cruel,” but thinks that it’s a good thing. “I think it’s a step in the right direction,” he says.

Student John Jones works at BayRidge Hospital in Lynn, which recently became a tobacco-free workplace.

Jones thinks the initiative is “a little drastic.”

“I don’t think the fact that you smoke should have any effect on getting a job, especially during these tough economic times,” he says. “People are having enough trouble finding jobs and something like this is just going to make matters worse.”

Students Jessica Bashore and Elvis Matos agree.

“It’s discrimination,” says Bashore. “People who smoke can be just as qualified for jobs in healthcare as people who don’t.”

Matos says people who decide to smoke are making a personal choice to affect their own health and shouldn’t be “punished” because of it.

“Smokers are people too. Just because they smoke doesn’t mean they can’t help people.”


Nursing Home Negligence

Falls in Nursing Homes

Litigators who work with cases involving long term care know how significant the issue of falls can be. Falls are the leading cause of injury and death by injury in adults over 65. Approximately half of the 1.6 million nursing home residents in the U.S. fall each year, and a report by the Office of the Inspector General found that about 10% of Medicare skilled nursing residents experience a fall resulting in significant injury; and, more than 1/3 of hospital falls result in injury. In the rehab setting, rates are often higher – for example, fall rates among stroke patients have been shown to be very high. Immobility and falls can lead to poor outcomes.

Fear of falling is defined as a geriatric syndrome. It not only occurs in older adults who have fallen, but in those with impaired mobility and is associated with decreased physical ability and depression. Care of older adults requires that clinicians be aware of the myriad of issues related to falls including knowledge of this syndrome, increased risk and interventions needed to prevent injury related to falls.

Just about every resident in a long term care setting, including assisted living and sub-acute rehab, is at risk for falling. Between medications, functional and medical issues and advancing age, older adults in most settings are prone to falling.

There are well established standards of care related to fall prevention; but, as I continue to review records related to issues like falls, I am amazed at how often these basic standards are not being practiced. The basics of a fall prevention program include assessment and ongoing reassessment of risk, ensuring a safe environment, medication review, providing therapy as needed, individualized interventions, and staff education.

Basic nursing practice includes assessment, planning (Care plan), putting interventions in place and then evaluating outcomes to determine if those interventions are appropriate and effective. Assessment includes completing fall risk assessments on admission and then as needed. Very often, the fall risk assessments completed by nurses in LTC are inaccurate. The tools utilized in long term care typically include these risk factors: history of falling, use of ambulatory aids, gait/balance issues, medications, secondary diagnoses (i.e. diabetes) and mental status. Care planning is the next step in nursing care - it is the standard of care that as the resident’s status changes, assessments and care plans must be updated, and often, are not. For example, with each fall, there should be updates, or if there is a new diagnosis, i.e. stroke, or worsening dementia, updated interventions should be put into place, with ongoing evaluation of effectiveness.

Care planning and interventions very often are generic and not individualized. For example, a toileting schedule that includes only after meals and before bedtime may not be appropriate. If a resident has issues with constipation or incontinence, this may lead to the need for more frequent toileting to prevent falls. The “make certain call bell is within reach” for residents with dementia is an example of a generic intervention. Older adults with dementia may not recognize a call bell or remember to use it. The debate about use of bed and chair alarms go on – they are a part of an individualized care plan, not a solution to preventing falls. Often, I see delays in putting interventions in place, i.e. with the resident who is incontinent NOT being put on a toileting plan immediately. The other common issue I see when reviewing records is the lack of updating care plans as the resident’s status changes – with every fall, with worsening dementia, physical decline, or new medical diagnosis (i.e. Parkinsonism).

Nurses reviewing records need to pay attention to the MDS, risk assessments, care plans and Interdisciplinary notes with attention to where the standard of care is not being met.
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