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National Nursing Shortage Means Big Signing Bonuses
Signing Bonus MONEY TALKS Hospitals are using 5-figure signing bonuses to recruit OR nurses.

A housing allowance, tuition reimbursement and, best of all, a signing bonus of $10,000 or more: these are among the inducements some hospitals are offering OR nurses to fill the ever-increasing number of positions available. But some worry that recruiting nurses with financial inducements will encourage job hopping and lead to lower retention rates.

A job board that includes a curated list of classifieds that offer at least a $10,000 signing bonus for nurses includes more than 300 listings from all over the nation, including Florida, Pennsylvania, Ohio, California, Arizona and Nevada. In addition to a singing bonus, some of these jobs also promise relocation expense reimbursement, tuition reimbursement, continuing education and/or a housing allowance.

And then there are places that go further. One Washington D.C. hospital is offering a $20,000 signing bonus along with up to another $20,000 for relocation expenses, while a West Virginia hospital gives a $10,000 signing bonus along with housing assistance and tuition reimbursement.

Not everyone thinks this is a good thing. Both the American Nurses Association and American Nurses Credentialing Center have expressed concern that signing bonuses could hurt retention and lead to job-hopping. To prevent this, fine print on many of these bonuses avoid lump sum payments or require the nurses to return the bonus if they leave before a set period of time.

The American Nurses Association estimates a million new registered nurses will be needed over just the next three years. Last month Moody's Investor Service warned to expect an "extreme nursing shortage" over the next few years. Meanwhile the number of nursing jobs available is expected to grow by 15% over the next 10 years, according to the U.S. Bureau of Labor Statistics .

Richard Abowitz

Updated Guidelines for Cleaning and Sterilizing Cataract Instruments
Cataract Surgery OCULAR INSTRUMENTS Check out what's new in the latest cleaning and sterilization guidelines for cataract surgery instruments.

If your facility hosts cataract cases, you might want to get your reprocessing techs a copy of the latest cleaning and sterilization guidelines for intraocular surgical instruments.

Taking into account the unique conditions of intraocular surgery, the specialty-specific guidelines from the Ophthalmic Instrument Cleaning and Sterilization (OICS) task force outlines the minimum cleaning and sterilization standards based on a consensus of experts representing 3 sponsoring societies — the American Society of Cataract and Refractive Surgery (ASCRS), the American Academy of Ophthalmology (AAO), and the Outpatient Ophthalmic Surgery Society (OOSS).

This document is an update of original recommended practices for cleaning and sterilizing intraocular surgical instruments published in 2007. A couple of highlights:

  • Enzymatic detergents. Citing that there are no studies showing the use on enzymatic detergent reduces the rate of endophthalmitis, the new OICS guidelines state that if "intraocular surgical instruments are thoroughly rinsed with critical water promptly after each use, the routine use of enzyme detergents is unnecessary and should not be required for routine decontamination of ophthalmic intraocular instruments." Enzymatic solution that remains on intraocular instruments is a leading cause of toxic anterior segment syndrome (TASS). Studies have shown that enzymatic solution is notoriously difficult to completely rinse from instruments.
  • Short-cycle steam sterilization. Short-cycle sterilization used in accordance with the IFU of FDA-approved sterilizers are appropriate for routine use in between sequential same-day ophthalmic cases. You can't interrupt the sterilization process, but you can interrupt the drying process if the instruments are used immediately and transported appropriately. Some surveyors consider short-cycle sterilization the same as immediate-use steam sterilization, but after meeting with the task force, CMS clarified that short-cycle and IUSS are not the same.

    Recommendations for the re-use of phaco tips and ultrasonic cleaning are also included in the guidelines that were released on Friday.

    JoEllen McBride, PhD

  • Colorado Hospital Suspends Surgeries After Instrument Cleaning Breach
    Sterilizing Instruments CAUSE FOR CONCERN Porter Adventist Hospital says instruments were not properly pre-cleaned before sterilization.

    A hospital in Denver, Colo., has suspended all surgeries after revealing inadequately cleaned instruments put orthopedic and spine surgery patients at risk of suffering post-op infections and contracting HIV or hepatitis B and C.

    Porter Adventist Hospital says in a statement that the infection control breach involves the improper manual pre-cleaning of instruments before the tools underwent machine washing cycles and steam sterilization. Its ORs will remain shuttered until the Colorado Department of Public Health & Environment (CDPHE) determines it's safe for surgeries to resume.

    The CDPHE was notified of the instrument cleaning issue on Feb. 21, 2018, and the next day conducted an on-site inspection of the hospital's infection control practices. Following the inspection, the CDPHE advised the hospital to notify patients who underwent surgeries between July 21, 2016, and Feb. 20, 2018, of their possible exposure to bloodborne pathogens.

    CDPHE investigators conducted another on-site inspection on April 5, the day Porter Adventist suspended surgeries due to "a potential change in water quality relative to surgical equipment." The CDPHE suggested Porter Adventist extend the warning about improperly cleaned instruments to patients who had procedures done from Feb. 21 to April 5.

    The risk of infection is considered "very low," according to the CDPHE, which says it is unaware of any infections associated with the cleaning breach. Mark Salley, a CDPHE spokesman, says the department can't comment further on active investigations.

    Porter Adventist says patient safety remains its top priority and has sent letters to all patients who underwent surgery during the period in question to warn them of their potential risk of infection and offer the opportunity to be tested for bloodborne pathogens. Hospital spokeswoman Chrissy Nicholson did not respond to a request for comment.

    Daniel Cook

    InstaPoll: When Do You Count Instruments

    Per your facility's policy, for which cases do you count instruments before and at the end of the case? Tell us in this week's InstaPoll.

    Meanwhile, a whopping 87% of the 341surgical facility leaders we polled last week are having a hard time finding fentanyl.

    Are you having a hard time getting fentanyl?

    • extremely 51%
    • somewhat 36%
    • not at all 19%

    Dan O'Connor

    News & Notes
    • Study: silver-nylon dressing reduces SSIs in total joints patientsResearchers have found that the use of silver-nylon antimicrobial dressings significantly reduces the rate of surgical site infections in total joint-replacement patients compared to standard dressings, according to a study published in the Journal of the American Academy of Orthopaedic Surgeon Global Research & Review.
    • Frailty more important than age Elderly patients who exhibit traits of moderate to high frailty — weakness, fatigue and weight loss, for example — are at greater risk of suffering complications during routine outpatient hernia, breast cancer and thyroid procedures, according to research published in JAMA Surgery. Surgeons should consider frailty instead of age when deciding if patients are suitable candidates for same-day surgery, say the researchers.
    • When can athletic patients return to play after hip arthroscopy? A literature review study published in The American Journal of Sports Medicine hoped to establish if the current evidence is sufficient for either a functional test or a "Return To Play"(RTP) best practice. "54.5% (12 of 22) of studies did not provide a guideline for RTP duration after hip arthroscopy, 36.4% (8 of 22) recommended a duration of 4 months, while 9.1% (2 of 22) recommended 3 months," the review found. The conclusion therefore is that as of now no standard can be established. "The majority of rehabilitation protocols are not evidence-based and rely on expert opinion. No validated functional test currently exists to assess RTP."