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Now Is the Time to Include All Health Care HR Professionals

Dear ASHHRA Colleagues:

Now is the time when all health care HR professionals, no matter what role they play or title they have, should experience the benefits of an ASHHRA membership. In the past, that might have been an unrealistic expectation, given our organizational budget constraints. However, now with the new ASHHRA Corporate Membership, launched this past April, organizations with five or more HR practitioners can join at a reduced rate. We want to make it possible for all health care HR professionals to belong to ASHHRA. The corporate membership option allows your organization an affordable way to support each of its HR professionals as they develop, learn, and grow into valued leaders. ASHHRA certainly has been an important factor in my own career development. For information about Corporate Membership rates, visit the Membership section of www.ashhra.org.

As we head into the second half of the year, I want to remind you of important upcoming activity and event deadlines:And as always, if you have questions or concerns, please feel free to contact me. Have a great week!

Regards,
Jeanene Martin, M.Ed., MPH, SPHR
2008 ASHHRA President


Headlines

ASHHRA News
2008 Conference Speakers' Books Now Available

Legal
"Ninth Circuit Rules That Hospital's Restriction on Nurses' Union-Related Buttons Violated NLRA"
"Fiduciary Liability Landscape Uncertain After Supreme Court Decision in LaRue"
"House Votes to Expand Reach of Disabilities Law"

Workforce
"The Other Big Workforce Shortage"
"Smart Accounts"
"The Effect of High Nursing Surveillance on Hospital Cost"

Compensation
"Nurses' Salaries Top Docs'"

General HR
"Web of Deceit"
"Preparation for Staffing Shortages Now Will Mitigate Challenges Later"

Benefits
"Building a Better 401(k)"
"Adding Benefits Without Adding Expense"
"Fun and Games"
"How To: Choose A Health Care Plan for Your Company"

Physicians
"Engaging Physicians"
"The Disappearing Doctors"

Management and Leadership
"Welcome to the Labyrinth"
"A Different Voice: Nurses on the Board"


ASHHRA News

2008 Conference Speakers' Books Now Available

In her book, Care Packages for the Workplace, ASHHRA conference keynote speaker Barbara Glanz tells you how to bring into the workplace those little touches that mean so much.

Michael Cohen, presenter of the ASHHRA pre-conference session, "What You Accept is What You Teach," has a new book out: The Power of Self Management. Learn how to take control of and responsibility for your own successes.

You can purchase both of these popular books on the ASHHRA online bookstore.
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Legal

"Ninth Circuit Rules That Hospital's Restriction on Nurses' Union-Related Buttons Violated NLRA"
Mondaq (06/06/08) Keating, Gregory C.; Ruiz, Roberta L.

The Ninth Circuit Court of Appeals has ruled that Sacred Heart Medical Center (SHMC) violated the rights of employees under the National Labor Relations Act (NLRA) when it prevented nurses from wearing union-related buttons in locations where patients and families could see them. Initially, SHMC allowed union members to wear buttons created by the Washington State Nurses Association (WSNA), which represents about 1,200 of the system's employees. However, when nurses wore buttons, which said "RNs Demand Safe Staffing," managers issued a memo requesting the buttons not be displayed around patients and families. Hospital managers believed patients and their families would infer that the hospital did not have safe staffing procedures already in place. The WSNA filed a complaint with an administrative law judge who ruled that nurses' rights were violated by the memo, though the decision was overturned by the National Labor Relations Board in 2006, which prompted an appeal to the Ninth Circuit Court of Appeals by WSNA.
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"Fiduciary Liability Landscape Uncertain After Supreme Court Decision in LaRue"
National Underwriter (Property & Casualty - Risk & Benefits Management Edition) (06/09/08) Gusman, Phil

The recent U.S. Supreme Court Decision in LaRue vs. DeWolff, Boberg & Associates may have a variety of impacts on the pension benefits landscape. Some legal experts have argued that the decision could clear the way for individuals to sue their 401(k) providers for money damages under ERISA on behalf of themselves instead of on behalf of the plan as a whole. Opinions on the long-term impact of the case vary, but most agree that it has raised some very important questions for insurers, fiduciaries and 401(k) participants. First, the Supreme Court ruled that a former plan participant can bring a lawsuit. The court also found that individuals can bring a suit in regard to their own account and that they can sue for monetary damages. Some defense lawyers have argued that this change could expose employers to jury trials, making them easier targets for plaintiffs' lawyers. However, most fiduciary experts contest that ERISA itself precludes the concept of a jury trial. Concerns with the decision include worries that plaintiffs may be able to file claims under Section 502(a)(2), which allows the collection of monetary damages. Previously, all 401(k) claims had to be filed under Section 502(a)(3), which only allows equitable relief. Despite these questions, fiduciary insurers say it is too soon to tell whether the case will have a major impact on their business, and most believe that any ramifications can be effectively handled through effective underwriting and deductible changes.
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"House Votes to Expand Reach of Disabilities Law"
Associated Press (06/26/08)

The U.S. House voted on June 25 in favor of revisions to the Americans With Disabilities Act (ADA) that could provide greater anti-discrimination protections to employees who use hearing aids or take medication for cancer, epilepsy or diabetes. The bill, now en route to the Senate for consideration, reverses many of the limitations put in place by the U.S. Supreme Court beginning in 1999. The court's decisions have excluded functionally disabled workers from the anti-discrimination protections of the ADA. The modified ADA, which was passed by a vote of 402 to 17, defines a disability as any physical or mental deficiency that "materially restricts" a major life function, whereas the current terminology is "substantially limit." "Now what kind of person on the Supreme Court of the United States has some difficulty understanding that if you have to use a hearing aid, that does not lessen the nature of the disability?" said Rep. John Conyers (D-Mich.), chairman of the House Judiciary Committee. Lawmakers contend the changes will clear up any vagueness in the legislation and outline which workers are protected against discrimination in the workplace. The Bush Administration supports the bill and continues to work on updates to the ADA rules related to public access.
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Workforce

"The Other Big Workforce Shortage"
Modern Healthcare (06/02/08) Hilborne, Lee

The nationwide shortage of medical laboratory professionals is almost as serious as the nurse shortage, according to some human resource experts. Workers in this field often make less than their colleagues in other healthcare fields, and many technologists compete for positions with scant opportunities for advancement. Now, fewer than 4,700 students graduate every year from accredited training programs, according to the U.S. Bureau of Labor Statistics, and the number of accredited medical technology programs plummeted from 709 to 222 between 1975 and 2007. In the American Society for Clinical Pathology's (ASCP) 2005 Wage and Vacancy Survey, 44 percent of the responding laboratories across the country said they had difficulty filling laboratory technician positions, with some positions taking up to two months to fill. Current shortages in the laboratory personnel field would require a 559 percent hike in available candidates for some regions. Since Baby Boomers hold a large number of these positions, the employment gap will only increase in the next decade. Laboratory technicians are responsible for early disease detection and other diagnostic services, and public care and safety are at stake if more job opportunities are not created, say experts. The ASCP is currently working with the Coordinating Council on the Clinical Laboratory Workforce to determine how the healthcare profession can amend the situation. In the meantime, laboratory professionals should meet with other local technological workers to develop strategies and brainstorm ways to increase training and employment opportunities.
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"Smart Accounts"
Human Resources Executive Online (06/02/08) Starner, Tom

In 2007, IBM announced it would spend $40 million on lifelong learning accounts as part of the "Global Citizen's Portfolio," a suite of programs that help employees enhance their skills and expertise. IBM's learning program provides employees who have spent more than five years with the company a 50 percent match up to $1,000 for their 401(k)-like learning account, which can be used for any learning program. Although there are no tax benefits, Congress could offer tax incentives to employers and employees using these programs. Although some critics question if workers will spend the money wisely, a study shows that 98 percent of employees who contribute to these accounts choose an education program related to their careers. Employers can use these learning accounts as a tool for recruiting and retaining the best talent. Healthcare employers find these accounts very useful, particularly for workers required to obtain continuing education credits that may not be covered by tuition assistance programs.
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"The Effect of High Nursing Surveillance on Hospital Cost"
Journal of Nursing Scholarship (06/01/08) Vol. 40, No. 2, P. 161; Shever, Leah L.; Titler, Marita G.; Kerr, Peg

Patient safety and care improvement are the latest goals of hospital care today, but the impact of nurses on patient care is often hard to gauge given that charges for nursing care often are lumped in with hospital room charges. A study led by Marita Titler of the University of Iowa Hospitals and Clinics examines nursing treatment costs as they impact patient outcomes related to older adults at risk for falling. Surveillance, which requires nurses to examine clinical data to monitor a patient's ongoing status, was assessed in terms of cost and patient outcomes. Because patient falls and patient lengths of stay already are correlated to hospital costs, the study examines how consistent surveillance by nurses can improve those outcomes. The study examined more than 10,000 hospitalizations and discovered high nursing surveillance cost $191 more than low nursing surveillance; but researchers note that savings associated with less treatment may make such surveillance worthwhile for patients with a high risk of falling. The study shows that only 157 falls occurred under high nursing surveillance, versus 324 under low nursing surveillance. Researchers hope the assessment of nursing care costs will enable hospitals to develop cost-benefit analyses related to nursing care and patient outcomes that can be used to improve overall patient care.
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Compensation

"Nurses' Salaries Top Docs'"
Dallas Business Journal (06/27/08) Tsai, Joyce

A new study by Merritt Hawkins & Associates finds that some specialty nurses are paid more than family-practice physicians despite concerns about a shortage of family doctors. Merritt Hawkins' yearly review of physician and certified registered nurse anesthetist (CRNA) recruiting incentives estimates that the average CRNA earns $185,000 a year versus $172,000 earned annually on average by family doctors. Merritt Hawkins Vice President of Business Development Kurt Mosley says that with a shortfall of about 65,000 family-practice doctors, incentives for these doctors must be improved before those gaps can be filled. He says, "It's a lot of hours and a high-hassle practice, and we are going to need to change the way we compensate them." Jefferson Physicians Group President Dr. Guy Culpepper remarks that the findings of the Merritt Hawkins study illustrate the low value attributed to primary-care doctors, and the healthcare system's preference for procedures. Christopher Bettin with the American Association of Nurse Anesthetists says CRNAs have responsibilities that bear a close resemblance to those of anesthesia physicians, and he comments that more training programs and better salaries helped address the CRNA shortage.
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General HR

"Web of Deceit"
Human Resource Executive (06/08) Vol. 22, No. 9, P. 57; Greenstein, Louis

Pre-employment exams can be a great way to narrow down a large pool of qualified applicants, but these tests should not be the only tool used by employers. Candidates can cheat these exams, but employers can prevent cheating by proctoring exams onsite or at an offsite facility. Other options include checking test-takers identification, having them review test policies and ensuring proctors monitor applicants' behavior during the test. However, for employers without the ability to conduct proctored tests, online exams can provide a low-cost solution. Using tests with computer-adaptive technology that personalizes the test for each applicant is one way to cut down on cheating in the online environment. Any pre-employment exam should be followed up with verification, and applicants should be informed that verification questions will be asked before the test begins. Employers also should keep in mind that some candidates may be better test takers than others, which is why the recruitment process should incorporate more than one pre-employment tool. Some other possible tools include in-person interviews, reference checks and other techniques.
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"Preparation for Staffing Shortages Now Will Mitigate Challenges Later"
Materials Management in Healthcare (06/08) Vol. 17, No. 6, P. 48; Ricupito, Gene

Hospitals must not only fill in medical staffing gaps, but also gaps along the supply chain. The U.S. Bureau of Labor Statistics reports that there will be a gap of 10 million between the number of job openings and the number of available workers. Hospitals and others must address potential workforce shortages soon because some positions require specialized knowledge and skills. Those facilities seeking to fill highly technical vacancies must recruit aggressively and offer incentives that meet and exceed those offered by other healthcare facilities and industries. If vacancies are tough to fill, experts warn patient care could suffer as clinicians find resources hard to come by when needed. Experts suggest retaining current workers who are eligible for retirement through either additional incentives or flexible scheduling, particularly in the sterilization department. Hospitals and other employers also need internal and external assessment programs to identify and cultivate workers who may work in other departments. Once possible candidates are identified, hospitals can then assess candidates' skills as they relate to the job opening. Experts also recommend the creation and enhancement of staff education programs beyond traditional continuing education credit programs, allowing workers to attend vocational training and conferences.
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Benefits

"Building a Better 401(k)"
Financial Week (06/30/08) Vol. 3, No. 25, P. 11; Bruno, Mark

Financial Week has found a potential blueprint for the Perfect 401(k) in the way several employers approach their plans. Annette Grabow, manager of retirement benefits at construction company M.A. Mortenson, is seeking 100 percent participation not through automatic enrollment but by engaging employees in financial planning at the annual road show, on her intranet, and through worksite materials. She also mails customized boxes rather than letters, which are likely to end up in the garbage. Matching employees' contributions dollar for dollar in actual cash and increasing the match with a worker's tenure has helped Devon Energy recruit workers in the competitive oil and gas industry, and 87 percent of its workforce now participates in the 401(k). Intel was one of the first to build a set of customized target-date funds, and use its leverage in negotiations with fund managers to keep pricing very low for participants. IBM offers annuities in an IRA to make it easier to provide participants with a way of withdrawing funds from their 401(k), and assets can be rolled over into offerings such as fixed-income or inflation-protected annuities. Meanwhile, Demco, a small supplier of library furniture and equipment in Madison, Wis., added a Roth component so participants can prepay their taxes and avoid the hit when they withdraw contributions in retirement.
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"Adding Benefits Without Adding Expense"
Rough Notes (06/08) Vol. 151, No. 6, P. 78; Strazewski, Len

Insurance agents and brokers can help employers expand their benefit packages to meet employee needs without going over budget. Many employers, as a result, are seeking help from insurance agents and brokers with regard to the establishment of voluntary benefit programs. Through these programs, workers can obtain additional coverage through workplace enrollment and payroll deductions. However, a recent Life and Health Insurance Foundation for Education survey reveals just 11 percent of working Americans would rely on supplemental disability insurance in the event of a debilitating injury or illness. The survey also uncovered that a lack of disability coverage is not tied to excessive costs, but a lack of access. Employers and insurers should work together to create streamlined processes for these benefits. Unum, for instance, in 2008 began offering a program with a simple enrollment process with fast application processing that does not place too many demands on employers. The program provides Web-based tools, online paperless processing and responses within 24 hours.
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"Fun and Games"
Incentive Magazine (06/08) Vol. 182, P. 28; Chapman, Ben

Employers across the globe are using not only cash bonuses and travel to motivate employees, but also soft incentives like doggy day care and organic food. Google offers its workers bonuses for the purchase of hybrid or electric cars, while eBay provides workers with meditation and prayer rooms so they can decompress. Zango indicates that soft incentives help employees meld and create a culture of teamwork and camaraderie even with executives. In addition to soft incentives, Zango displays large plasma screens with projections of organization targets, department targets and other information to ensure employees are on the same page with executives about the company's mission and goals. Orange Element reports that it provides workers with additional vacation and leave time, as well as one day off where each department takes a field trip. Managers at the firm notice that the additional time off and field trips reduce stress among workers and bolster morale. Meanwhile, Parkland Health & Hospital System offers a small organic market in the conference room with the help of local organic farmers. The food provides workers with healthy alternatives, and any proceeds from food sales directly benefit the hospital. The system also instituted Free Food Friday, which provides a variety of foods to all workers from area restaurants. Other soft incentives employers should consider are recreation rooms with pinball machines and other activities, a lighthearted blog for employees to contribute to and outings where workers can play baseball and other sports.
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"How To: Choose A Health Care Plan for Your Company"
Inc. Magazine (06/08) Vol. 1, No. 3, P. 52

In an ideal situation, every company would be able to provide every employee with health insurance, but in the real world doing so is often a struggle. Some of the barriers that prevented small businesses from getting insurance have been removed, and laws now prohibit insurance companies from discriminating in the small-group market and against individual employees based on health history, but cost is still a significant problem. Small businesses generally pay more for insurance than big businesses, and typically get less for their money, so it comes as no surprise that the number of small businesses that provide insurance has dropped since 1999, according to the Kaiser Family Foundation. Only 45 percent of companies with fewer than 10 employees offer health plans. Despite the difficulties, offering health insurance is a smart choice, as it works as a powerful tool for recruiting and retaining talented staff and it also promotes a healthier and more productive team. The first step towards obtaining health insurance is determining your budget and your needs. There is no general rule on how much a business should pay for healthcare. A survey by the National Federation of Independent Business shows that nearly half of small businesses that provide insurance spend at least 7.5 percent of payroll on healthcare, while a quarter of those companies spend more than 15 percent. Unless the employer is set on a particular insurer, comparison shopping with an independent agent, who sells policies for multiple carriers, is the best option. Insist that the agent not only search for a variety of plans from one insurer, but also similar plans from multiple carriers, and be sure that the agent will run interference with the insurer when the employer or employees have customer service issues. Reevaluate policies every year to make sure it meets the needs of the firm, particularly if the organization recently expanded.
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Physicians

"Engaging Physicians"
Healthcare Executive (06/08) Vol. 23, No. 3, P. 78; Reinertsen, James L.

Many healthcare organizations are struggling to reduce the number of surgical mistakes and hospital-acquired infections, and any initiatives to accomplish these tasks will need the support of physicians. For the most part, doctors are reluctant to support initiatives to improve quality scores and reduce lengths of stay, which should prompt hospitals to reframe these issues. Hospitals must address these problems as not only facility issues, but as issues that impact how doctors care for patients and manage their time. Rather than setting a specific score goal related to the CMS Core Measures, hospitals should suggest a reduction in unnecessary deaths, which will ultimately improve a CMS score. Hospitals also need to treat physicians like healthcare partners; otherwise, doctors remain concerned primarily with their own performance and patient outcomes. Engaging the most important physicians in initiatives from the onset is one option, but experts also note employees and doctors should be able to provide feedback that challenges the current organizational structure and protocols if they are ineffective. Doctors should receive raw data, which they can use to draw their own care conclusions and foster interactive dialogue about care improvement options.
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"The Disappearing Doctors"
Health Affairs (Quarter 2, 2008) Vol. 27, No. 3, P. 850; Gilsdorf, Janet R.

Residents are at the core of medical care in teaching hospitals, providing care to current patients while the residents receive the training they need to become competent specialists in the future. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted work rules that limited residents to no more than 80 work hours weekly. Additionally, residents were limited as to how many days in a row they could work, how many hours in a day, and how long they had to rest between shifts. These rules were designed not only to protect young physicians, but to prevent medical errors caused by exhausted doctors. However, University of Michigan Medical Center Director of Pediatric Infectious Diseases Janet Gilsdorf says these restrictive work hours are leaving many units without coverage because there is currently a shortage of resident doctors. Gilsdorf indicates the ACGME rules effectively reduced the resident physician workforce by 25 percent, without replacing them with more doctors. ACGME rules stipulate that there may only be a certain number of residents working in a hospital at one time. Hospitals are hiring more physician assistants and nurse practitioners to fill in the gaps, but these workers also have limitations on their work schedules. While these staff members are limited in some cases to 40 hours per week, they receive the same pay as residents, causing hospital costs to skyrocket. Because patients do not regularly see the same physician resident, Gilsdorf worries that patient safety is at risk because miscommunication becomes more probable as the number of handoffs rise.
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Management and Leadership

"Welcome to the Labyrinth"
Pink (06/01/08) Vol. 3, No. 7, P. 56; Eagly, Alice H.; Carli, Linda L.

Women, unlike men, become strong leaders by navigating a complex labyrinth of professional obstacles and detours. One of the first obstacles is realizing how behavior and personality can be interpreted differently by employers based upon gender; for instance, men are perceived as assertive when they are firm, while in many cases a woman would be viewed as condescending. These perceptions and subsequent reactions can highlight an underlying pattern of discrimination, but women merely have to educate themselves about the warning signs and adopt solutions to prevent perceptions from becoming career obstacles. The U.S. Department of Labor Statistics reports that 26 percent of chief executives and 37.5 percent of managers are women, up from 19 percent and 36 percent, respectively. Some other stumbling blocks for women aspiring to leadership positions are societal expectations of family obligations, wage and promotion expectations and stereotypical "male" characteristics of leadership. Women should overcome these obstacles through self-confidence, mentoring and networking.
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"A Different Voice: Nurses on the Board"
Trustee (06/08) Meyers, Susan

Several surveys in 2007 and 2008, including one conducted by the Robert Wood Johnson Foundation (RWJF), reveal that very few hospital boards include nurses. Some say the traditional role of nurses as care implementers has prevented them from entering the boardroom as healthcare decision makers. However, as more and more nurses hold more than one college degree and leadership positions within the hospital and community, their presence could be necessary to boardroom dynamics. RWJF's "Nurse Leaders in the Boardroom" campaign hopes to foster connections between nurses and healthcare organizations because nurses are at the center of patient care and directly impact quality and safety. Quality care and patient safety are areas where nurses have the most expertise, which can help boards make appropriate decisions, says RWJF senior program officer Susan Hassmiller. A recent Nursing Economics study reveals that chief nursing officers are more attune to Institute of Medicine patient safety reports than hospital executives. "Many nurse leaders also have good financial backgrounds [and] strategic thinking and can bring a lot of high-level skill sets to the governance of hospitals," says Pamela Thompson, CEO, American Organization of Nurse Executives. Experts add that including nurses in board decisions is only a natural progression, given that nurses can demonstrate evidence-based safety and quality improvements through their in-depth knowledge of the patient care process. As the Centers for Medicare and Medicaid Services decides whether full payment is contingent upon hospitals disclosing patient satisfaction data, boards will need nurse input to determine how best to capture that data.
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