Category Archives: Workforce issues
This is part of the September 2013 issue of Sharing Nursing's Knowledge.
“When Malia and Sasha were being born, we spent 90 percent of the time with the nurses and 10 percent with the OB/GYN. When my grandmother got sick and was passing away at the end, it was nurses who were caring for her in an incredibly compassionate but also professional way. And you’re absolutely right that one of the keys to reducing our health care costs overall is recognizing the incredible value of advanced practice nurses and giving them more responsibilities because there’s a lot of stuff they can do in a way that, frankly, is cheaper than having a doctor do it, but the outcomes are just as good … we have to upgrade a little bit the schools of nursing and make sure that they’re properly resourced so that we have enough instructors. And, in fact, as part of the Affordable Care Act, one of the things that we thought about was how are we going to expand and improve the number of nurses and making sure that they can actually finance their educations. And so there are some special programs for nurses who are committing themselves—as well as doctors who are committing themselves—to serving in underserved communities.”
-- President Barack Obama, Remarks by the President in Town Hall at Binghamton University, WhiteHouse.gov, August 23, 2013
“One of the nurses showed me some of the babies who were close to my size when I was an infant and I was able to see the babies that were grown and ready to go home. The nurses also offered me tips on how to become a nurse, that I would go through a four-year program to get my BSN (Bachelor of Science in Nursing) degree, as well as training in a nursing program, and then a MSN (Masters of Science in Nursing) degree… I felt so connected to the babies. It’s incredible that I was once like them … I think my visit made my hope to become a NICU nurse even greater.”
-- Samantha Konwai, high school student, Saint Peter’s Welcomes Former Preemie as She Pursues Career as Neonatal Nurse, Home News Tribune, August 19, 2013
This is part of the August 2013 issue of Sharing Nursing's Knowledge.
The nursing community may have mixed feelings about Nurse Jackie, but the critics love her.
Last month, Edie Falco, who plays the troubled emergency room nurse at the center of the Showtime dramedy, was nominated for an Emmy Award for outstanding lead actress in a comedy series—for the fourth year in a row. She won the award in 2010.
The show has also been nominated for four other Emmy awards this year, bringing its total number of Emmy nominations to 20. This year’s winners will be announced on Sept. 22.
The show, and Falco in particular, have also received award nominations from the Screen Actors Guild as well as the Hollywood Foreign Press Association, which doles out the Golden Globes.
The nursing community, however, is torn about impact of television’s most prominent leading nurse character, who began the series as a drug-addicted and ethically-challenged emergency room nurse, according to Joseph Turow, PhD, a professor of communications at the University of Pennsylvania and the author of Playing Doctor: Television, Storytelling and Medical Power.
“Some people think Nurse Jackie is a refreshing perspective on the importance of nurses in health care,” Turow said. “One of the things that is quite clear on the show is that she’s quite competent and doesn’t take a whole lot of garbage from physicians.”
On the other hand, he says, “she’s a mess personally—an addict and an adulterer. There are people who say ‘This is not the image we want to depict of nurses.’” One such group is the American Nurses Association, which said it was disappointed by the show’s “distasteful portrayal of nurses and nursing” when it premiered.
Regardless of the feelings she inspires, Nurse Jackie is going to continue to get more attention and likely more acclaim—especially if Falco wins a second Emmy for the role. But even if she loses, the show will go on; it will start its 6th season in 2014.
Nurses are at particularly high risk for burnout or “compassion fatigue,” which can leave them feeling overwhelmed and worn out. They “provide direct, 24/7 care, and they often must confront the limits of what medicine can do for people,” Cynda Hylton Rushton, PhD, RN, FAAN, an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program and a professor at the Johns Hopkins School of Nursing, tells the Washington Post. “Nurses can begin to feel helpless or have a sense that they are not actually helping.”
And when the clinician suffers, so does the patient, she adds. “We don’t provide the quality care we want to offer when we ourselves are depleted.”
Hospitals and organizations around Washington, D.C., are taking note, and are finding ways to help nurses relax and re-energize through the creative arts, the Post reports.
At the Georgetown Lombardi Comprehensive Cancer Center in the District, nurses participate in an arts and humanities program that uses activities like journal writing, dance and movement, quilting, painting, and ceramics to help nurses manage stress and come to terms with their experiences. At Inova Mount Vernon Hospital in the D.C. suburb of Alexandria, nurses are learning how to knit. And at Gilchrist Hospice Care, outside of Baltimore, nurses are meditating.
“The positive energy transcends to patient care,” Laurie Dohnalek, who directs oncology and medicine services for the nursing service at MedStar Georgetown University Hospital in D.C., tells the Post. “No matter what you do or how you do it, art is an opportunity to express yourself and work through things you might not be able to work through in other dimensions. As nurses, our priority is to be the best we can be for ourselves and for our patients, and this is a positive way to do that.”
What do you think? What other ways can hospitals help nurses avoid or overcome burnout? Register below to leave a comment.
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.
What policies optimize nurses' role in solving the shortage of primary care practitioners? What approaches will promote and incentivize interprofessional education and practice in health care so as to improve the quality and safety of care? What promising state and federal initiatives are likely to achieve the Institute of Medicine's recommendation to increase the proportion of nurses who hold a baccalaureate or higher degree to 80 percent by the year 2020?
These and other crucial issues confronting nursing and the health care system are the focus of the Robert Wood Johnson Foundation (RWJF) Charting Nursing’s Future policy briefs. Launched in 2005, the series now includes 20 briefs covering a range of topics, including:
- Unlocking the potential of school nursing;
- Expanding the nation’s capacity to educate nurses through state-level partnerships;
- Improving the recruitment and retention of older and experienced nurses as a way to stem the looming nursing shortage;
- Understanding the relationships among such issues as access, cost, payment systems, and quality of care;
- Optimizing nurses’ role in closing the health care quality and safety “gap”;
- Addressing the nurse faculty shortage through public and private partnerships;
- Strengthening public health nursing;
- Driving policy change with data collected and analyzed by state nursing workforce centers;
- Easing the nursing shortage through government, school and employer collaborations; and more.
Cassandra Okechukwu, MSN, ScD, is an assistant professor in the department of social and behavioral sciences at the Harvard School of Public Health, and an alumna of the Robert Wood Johnson Foundation Health & Society Scholars program.
With the arresting title of “Why women can’t have it all,” Anne-Marie Slaughter’s Atlantic magazine article generated many discussions on the issues women face in balancing competing work and family demands. However, these discussions have not addressed the vast disparities in the types of work-family issues women face and the limited resources available to many working women. Also painfully missing from the discussion are the health implications of these competing work and family demands.
One group for which these issues cannot be separated is nursing home workers. Data from the Bureau of Labor Statistics (BLS) show that the majority of nursing home workers are drawn from racial/ethnic minority groups and low-income communities; as such, many face significant health disparities. For example, racial/ethnic minority and low-income populations have a disproportionate burden of diagnosis of several cancers that are related to adiposity—including cancers of the lung, esophagus, endometrium, colon and rectum, kidney, pancreas, gallbladder and thyroid.
Four in 10 physicians say their typical patient load “exceeds safe levels” at least once a month, causing the quality of care they provide to suffer, according to a study by researchers at Johns Hopkins University, published online in the Journal of the American Medical Association (JAMA). More than one-third of physicians (36%) reported their workloads exceeded safe levels at least weekly.
In the survey of more than 500 self-identified hospitalists in an online physician community, respondents said their workloads had caused patient care to suffer. Respondents reported that inadequate time with a patient had caused them to order potentially unnecessary tests or procedures, and that their workloads had “likely contributed” to a host of poor patient outcomes, including morbidity and mortality.
Among the other problems physicians attributed to excessive workloads: inability to fully discuss treatment options; delayed admissions and discharge; increased readmissions; worsened patient satisfaction; and worsened overall quality of care.
Eileene Shake, DNP, RN, NEA-BC, is CEO of the Foundation for Nursing Excellence. The Robert Wood Johnson Foundation Human Capital Blog asked scholars and experts to consider what the election results will mean for health and health care in the United States.
The 2012 election is over and now, as health care leaders, we are trying to figure out how to move forward with implementing the Affordable Health Care Act (ACA). Yes, there will be an influx of Americans entering the health care system who did not have access to health care in the past. The impact on nursing will be significant as nurses are being recognized as important to providing care to the large number of new patients entering the system. Nurses will be key players working on interdisciplinary teams to redesign how health care is delivered. Nurses and advanced practice nurses will need to practice to the full extent of their education in order to care for the increased number of citizens entering the health care system.
There will be less resistance to implementing the ACA and more emphasis will be placed on how to implement it. Hospitals are already putting processes in place to reduce readmission rates for patients with chronic disease. New programs are being implemented to manage health care after the patient is discharged to reduce readmission rates. Nurses are following up with patients to ensure they are taking their medications, checking their blood pressure, and following their therapeutic diets. It is important to note that there will still be some resistance to implementing the ACA from states that do not feel they can afford to pay for the health care program.
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.
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.
A report from the consulting firm Accenture finds a significant drop in physicians who practice independently, from 57 percent in 2000 to 39 percent in 2012. Business costs and expenses were the top concerns influencing physicians’ decision to seek employment (cited by 87 percent of survey respondents).
For those who remain independent, alternative business models are becoming more common. Accenture estimates that one-third of independent physicians will adopt subscription-based care models, like high-end concierge medicine and direct pay models.
“Doctors who convert to subscription-based models that shift the focus away from service volume will not only access greater financial rewards, but will also gain the flexibility to get back to the basics of patient care,” the report says. “Patients could also reap the rewards by gaining enhanced access to care at a service level they can afford.”
Accenture estimates that only 36 percent of physicians will be practicing independently by the end of 2013. The survey of 204 physicians who represented an equal split of primary care and specialty physicians was conducted in May.