In 2003, the Institute for Healthcare Improvement and the Robert Wood Johnson Foundation launched Transforming Care at the Bedside (TCAB), a nationwide, nurse-focused effort to improve health care delivery. TCAB recognized that nurses often hold the key to making hospital care more effective, patient-centered and efficient. David Harrington, RN, BSN, CMSRN, has been a nurse at Providence St. Vincent Medical Center since 2006 and a TCAB leader there for two years. Erin Hochstein, RN, BSN, PCCN has been a staff nurse at Providence since 2010 and a TCAB leader for two years. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

As nurses, we are with our patients and their families during some of the most pivotal moments in their lives, which is a true honor. Yet, with the ever-increasing demands of health care, the responsibilities of nurses have become greater, pulling us away from the bedside. To curb this trend we were given the opportunity, at Providence St. Vincent Medical Center, to adopt Transforming Care at the Bedside (TCAB), a program that gives bedside staff the chance to streamline care and improve patient outcomes.

By allowing us direct input on our workflow, we have the opportunity to develop rapid tests of change that we implement over the course of one shift.  This adjustment in practice empowers frontline nurses to be catalysts of change for patient care, permitting us creative liberty in finding solutions to practice and system issues we face on a daily basis.

The Providence St. Vincent TCAB team began its journey in 2010 by visiting Prairie Lakes Hospital in Watertown, South Dakota, one of the original TCAB pilot sites, as part of an innovation grant provided by Providence Health & Services. Nurse representatives from three medical-surgical units along with hospital leaders were introduced to TCAB in action. As newly appointed TCAB leaders, we returned from the trip feeling motivated, inspired, and ready for change.

Most nurses are satisfied with their jobs, but 72 percent report that “risks loom ahead for the nursing profession,” according to a survey by the health care staffing company Jackson Healthcare. Among the risks the nurses identified as concerns: workload increases, a nursing shortage, and increased liabilities and litigation involving nurses.

Seventy-six percent of nurses who responded to the survey, “Vital Signs 2012: A National Nursing Attitudes and Outlook Report,” said they were satisfied or very satisfied with their jobs. Only 5 percent of nurses reported being “very dissatisfied” with their work.

The survey also found a “significant spike” in the number of nurses planning to retire in the next 10 years.

“Nursing is a great profession at the moment,” Richard L. Jackson, chairman and CEO of Jackson Healthcare, said in a news release about the findings. “It provides good pay, rewarding work and a nice balance between personal and professional life. However, with so many seniors approaching retirement, a potential nursing shortage, more litigation in the medical profession and a potential explosion of newly insured patients thanks to the Affordable Care Act, nurses fear the future and changes coming to their profession.”

Read the report.

A survey of registered nurses by the health care staffing firm AMN Healthcare finds that roughly nine out of 10 nurses (91%) are satisfied with their career choice, up significantly from the firm’s 2011 survey.

Registered nurses’ job satisfaction has also increased in the last year. In the new survey, 66 percent said they plan to continue as they are (in career and job), compared to 55 percent who gave that answer in 2011.

Despite high levels of satisfaction, close to one-third of respondents plan to leave the profession or reduce their workload in the near future. Five percent of RNs say they are likely to retire now that the economy is beginning to recover (up from 3% in 2011).

The survey also finds that 40 percent of nurses plan to pursue further education in nursing in the next one to three years: 17 percent plan to pursue a BSN, 18 percent a master’s, and 5 percent a doctoral degree.

AMN Healthcare’s 2012 Survey of Registered Nurses was distributed via email to 88,288 RNs nationwide in April 2012.

Download the report here.

Twelve-hour nursing shifts cause higher levels of burnout and negatively affect patient care, according to a study published this month in Health Affairs.

Researchers from the University of Pennsylvania found that more than 80 percent of nurses working shifts of eight or more hours were satisfied with the scheduling practices at their hospitals, but “the percentages of nurses reporting burnout and an intention to leave the job increased incrementally as shift length increased.” Nurses who worked shifts longer than 8-9 hours were up to 2.5 times more likely to have burnout and job dissatisfaction.

Long nursing shifts also have consequences for patients. In hospitals with high proportions of nurses working long shifts, patients perceived worse care, both overall and in nursing-specific factors. Patients in these hospitals reported that nurses didn’t communicate well or respond quickly, and said their pain was not well controlled. For many patient outcomes, dissatisfaction increased as the proportion of nurses working longer shifts increased, the study says.

The researchers hypothesize that nurses may underestimate the impact of working long shifts because long shifts mean working fewer days a week, which may be appealing.

Accrediting bodies should consider policies for nurses—like those already in place for medical residents—limiting the number of hours they can work a week, the research team suggests, and boards of nursing and nursing management should monitor nurses’ hours and overtime, and promote a workplace culture that facilitates manageable work hours.

What do you think? Are long shifts good for nurses or patients? Is there a way to help nurses keep flexible schedules without compromising their job satisfaction and patient care? Register below to leave a comment.

Read the study abstract.

In the next one to three years, more than half of the nation’s physicians plan to retire, cut back on the number of patients they see, work reduced hours or take other steps that would reduce patient access to care, a survey from The Physicians Foundation finds. According to A Survey of America’s Physicians, which polled more than 13,000 physicians, a continuation of this trend could mean the loss of 44,250 physicians from the workforce in the next four years.

The survey finds that physicians are seeing fewer patients per day than they did in 2008, and 26 percent of physicians have closed their practices to Medicaid patients. Fifty-two percent have already or are planning to limit Medicare patient access to their practices.

More than three-quarters (77.4 percent) of the physicians surveyed are somewhat or very pessimistic about the future of the medical profession, and more than 84 percent agree that “the medical profession is in decline.” However, younger physicians, female physicians, employed physicians (as compared to those who own practices) and primary care physicians are generally more positive about their profession.

“The survey was conducted in the context of one of the most transformative eras in the history of modern healthcare,” the introduction to the study notes. “Physicians are at the vortex of these changes… It is a challenging and uncertain time to be a doctor. The results of the survey reflect this uncertainty and should be taken in the context of current events. As the course of healthcare reform becomes clearer, attitudes and perspectives may change. However, we believe the survey reveals what doctors are thinking today and is relevant to healthcare professionals, policy makers, media members, and to anyone who has been seen by a physician or who will be.”

Read the survey.

How do nurse faculty members spend their time?  How do they assess key aspects of their work-life?
 
In 2010 the Robert Wood Johnson Foundation’s Evaluating Innovations in Nursing Education program (EIN) conducted a nationwide survey of full-time nurse faculty focusing on their employment characteristics, workloads and attitudes toward work-life. More than 3,000 respondents completed the survey, answering questions about more than 60 characteristics of work-life.
 
Now, using an online tool—the Nurse Faculty Query (NuFAQs)—you can search the survey results. The interactive tool allows you to customize the findings to suit your interests in faculty with particular backgrounds or rank, in specific settings or circumstances.
 
To see a brief demonstration and begin using this resource, click here.
Read more about NuFAQs in the latest issue of Sharing Nursing’s Knowledge.

Carol S. Brewer, PhD, RN, FAAN, a professor at the University of Buffalo School of Nursing, leads the Robert Wood Johnson Foundation (RWJF)-supported RN Work Project with Christine T. Kovner, PhD, RN, FAAN. The 10-year, longitudinal study is the only one of its kind to study the careers of new nurses. Most recently, the RN Work Project released a study on the recession’s impact on new nurses.

Human Capital Blog: Your most recently-published study looked at registered nurses in the recession. Can you review the most important findings?

Carol Brewer: What we found was fairly interesting and fits with some of the other studies and data we’ve collected on new graduates in the recession. We found that the nurses’ intent to stay at their current job and their organizational commitment was higher than before the recession. We also found some indicators that the work environment was a little better. The nurses report that their relationship with physicians was better, and they had a lighter workload and fewer organizational constraints.

We can interpret this in a few different ways. One is that there has actually been a change for the better in the work environment, and stress and workload are going down a little bit. But we also found that nurses perceived fewer job opportunities, so they may feel like they can’t leave their jobs because there aren’t many other opportunities. They could be making their perceptions fit their reality, which would cause them to rate their environment higher than if they knew they had options and could afford to be pickier.

More likely, these nurses are just biding their time. We found that, despite perceiving fewer opportunities, the nurses were more likely to be searching for a job. Even though the perception is that things seem to be little better with their current employer, they’re still looking for other jobs.

A new study in the Archives of Internal Medicine finds that some of the key characteristics of medical homes promote stronger morale and job satisfaction among providers and staff at community health centers.

In a survey of more than 600 employees at 65 clinics participating in the Safety Net Medical Home Initiative, more than half (53.7 percent) reported being satisfied with their jobs. About one third (32.8 percent) rated their morale as good. In particular, clinics with high scores on three key characteristics – access to care, communication with patients and quality improvement – enjoyed higher morale and job satisfaction among providers, and higher morale among other staff.

While employees at clinics with the characteristics of a patient-centered medical home reflected positively on their jobs, the study also finds that they are at higher risk for burnout. Only half of the respondents (49.5 percent) at such facilities agreed with the statement, “Occasionally I am under stress at work, but I don’t feel burned out.”

Read more about the study.