Nursing in the Spotlight

What an exciting time for professional nursing. Lots of people are wringing their hands over the shortage and the aging of the nursing workforce, but there are many good things on the horizon as well.

Nursing is truly in the SPOTLIGHT! Everyone is trying to figure out what to do about the chaos in nursing. No less that 5 important reports have been issued in the past three months. I know that students are very busy and do not really have time to track these reports down and spend hours digesting them. So, what follows is the capsule version of the five important documents. Pay attention, it is your future they are discussing here!

#1. In Our Hands: How Hospital Leaders Can Build a Thriving Workforce, American Hospital Association, Commission on Workforce for Hospitals and Health Systems, April 2002

This shortage is different because:

• U.S. labor force is aging;
• Fewer potential workers behind the baby boomer generation;
• Careers in healthcare are seen as less attractive to those entering employment; and
• Many in the current hospital workforce are dissatisfied with their work.

5 Keys to solving the workforce crisis:

1. Foster meaningful work. Workers must find meaning in their work and be supported in efforts to provide high-quality patient care.

2. Improve the workplace partnership where staff are valued, have a voice in shaping policies and are rewarded and recognized.

3. Broaden the base of health care workers by attracting and retaining a diverse workforce of men and women, racial and ethnic minorities, and immigrants and older workers.

4. Collaborate with others to attract new workers.

5. Build societal support for public policies and resources needed to help hospitals hire and retain a qualified workforce including:

1. adequate payment rates for hospital care
2. financial support of information technology
3. regulatory reform

Mean vacancy rates: RN 13%

Health Careers are less attractive….

* In a manufacturing economy – healthcare was seen as hi tech.
* In today’s information economy – healthcare is low tech.

* In 1960’s & 70’s, healthcare was safe, secure and prestigious.
* Today, healthcare is seen as chaotic and unstable.

* In traditional society, healthcare was one of few options for women.
* Today, there are many choices.

* In long-stay hospitals, staff had strong, supportive relationships with pts.
* In short-stay systems, staff are focused on disease protocols, regulatory compliance, and documentation.

* In mass production societies where work controlled schedules, 24/7 was unattractive but acceptable.
* In information society where people schedule their work to their convenience, 24/7 is unacceptable.

Most nurses entered nursing to make a difference.
Today’s direct caregivers feel tired and burned out from a stressful, understaffed environment with little or no time for one-on-one relationship they desire.

Some of the tactical recommendations they are making:

• Empower teams, including physicians and nurses, to develop new work models.
• Build new work models based on workers’ competencies, education, and experience.
• Recognize and communicate the differences between generations.
• Incorporate magnet characteristics into work innovations.
• Modify work design and environments to retain older workers.
• Introduce new technologies that reduce paper records and the reprtitive entry of information.
• Assure that evening and night shift employees have access to the same administrative, educational, mentoring, and family support available to the day shift.

($20 at AHA website: www.ahaonlinestore.com )

#2. NURSING’S AGENDA FOR THE FUTURE: A CALL TO THE NATION, American Nurses Association, released April, 2002

This report evolved from a Call to the Profession – a call to determine nursing’s desired future state.

THE FUTURE VISION FOR NURSING:

“Nursing is the pivotal health care profession, highly valued for its specialized knowledge, skill and caring in improving the health status of the public and ensuring safe, effective, quality care.

The profession mirrors the diverse population it serves and provides leadership to create positive changes in health policy and delivery systems.

Individual choose nursing as a career, and remain in the profession, because of the opportunities for personal and professional growth, supportive work environments, and compensation commensurate with roles and responsibilities.”

2.7 million nurses in US

Nation’s largest health care profession

The 10 domains demanding action:

1. Leadership and planning
2. Delivery systems
3. Legislation/regulation/policy
4. Professional/nursing culture
5. Recruitment and retention
6. Economic value
7. Work environment
8. Public relations/communication
9. Education
10.Diversity

#3. HEALTH CARE’S HUMAN CRISIS: The American Nursing Shortage, Robert Wood Johnson Foundation report

Bobbi Kimball RN, MBA & Edward O’Neil Ph.D. (released May 30, 2002)

Nursing shortage is being driven by

a. nurses dissatisfaction with the profession
b. Lack of appeal among minorities and men

The shortage is about to get worse.

Traditions “fixes” are not working.

“Silo effect” – a number of meaningful solutions are being tried, but each group is working solo – not collaborating and sharing solutions.

RECOMMENDATIONS:

1. Develop new models of nursing and healthcare provision and advance the study of nursing’s contributions to healthcare outcomes and patient satisfaction.

2. Reinvent work environments and nursing education to address the needs and values of those currently in the profession and appeal to a new generation of nurses.

3. Establish a national nursing workforce measurement and data collection system.

4. Create a clearinghouse of effective strategies to advance cultural change within the nursing profession.

5. Form a National Forum to Advance Nursing, an independent body that would draw together a wide range of interested parties to work on the recommendations above.

#4. NURSE-STAFFING LEVELS AND THE QUALITY OF CARE IN HOSPITALS. New England Journal of Medicine, 346(22), May 30, 2002. Jack Needleman, Ph.D., Peter Buerhaus, Ph.D., RN, Soeren Mattke, MPH, Maureen Stewart, BA, and Katya Zelevinsky.

Patients in hospitals with low numbers of registered nurses are more likely to have complications, stay in the hospital longer, and die from treatable conditions than patients in hospitals with more RNs.

Analyzed the discharge records of more than 6 million patients in 799 hospitals in 11 states in 1997.

• Patients in the highest staffed hosps experienced cardiac arrest and shock 9.4% less than lower-staffed hosps.
• 9% fewer UTIs
• 6.4% fewer hospital-acquired pneumonias
• 5% fewer incidences of stomach or intestinal bleeding.
• 4 hours less in hospital
• Surgical pts were 6% less likely to die of surgical complications.
• “Failure to rescue” death rate was 2.5% higher in understaffed hospitals.( pts who die from treatable conditions that might be reversed including pneumonia, shock, cardiac arrest, upper GI bleeds, sepsis or blood clots.

RNs made the difference. LVNs and NA levels were not significantly related to outcomes.

#5. HEALTH CARE AT THE CROSSROADS: Strategies for Addressing the American Nursing Shortage

Joint Commission for the Accreditation of Healthcare Organizations

(accessible here )

This report is the first of a series of white papers by JCAHO to address areas of health care where public policy is needed. In summary, they say that healthcare organizations must:

1. Create of organizational cultures of retention (i.e. Magnet status, for example.)

2. Bolster the nursing education infrastructure (increased funding for scholarships; establish a standardized, post-graduate residency program; emphasize team-training in nursing education; create nursing career ladders commensurate with education and experience)

3. Establish financial incentives for investing in nursing (base funding incentives on achievement of quantifiable, evidence-based, and standardized nursing-sensitive goals.

(JCAHO, page 10)

The recommended tactics for the hospital environment are listed below. Similar tactics are also included in the report for nursing education and funding.

• Create a culture of retention for nurse staffing
• Adopt fair and competitive compensation and benefits packages for nurses
• Minimize the paperwork and administrative burden that take the nurse away from patient care.
• Adopt a zero-tolerance policy for abusive behaviors by physicians and other healthcare practitioners.
• Measure, analyze and improve staffing effectiveness.
• Provide the management training and resources that nurse executives need to attain and maintain a culture of retention.
• Delegate authority to nurse executives and other nurse managers, and, in turn, to staff nurses for patient care and resource deployment decisions.
• Limit the use of mandatory overtime to emergency situations.
• Set staffing levels based on competency and skill mix applicable to patient mix and acuity.
• Adopt information, ergonomic, and other technologies designed to improve work flow and reduce risks of error and injury.
• Recognize and reward hospitals that adopt the basic characteristics of “magnet” hospitals.
• Diversify the workforce to broaden the base of potential workers and to improve patient safety and health care quality for patients of all origins and backgrounds.

“If staffing levels and work environments are not safe for the nurses, they will not be safe for the patients.” (JCAHO, page 14)

Isn't it exciting to see so many powerful groups who are interested in solutions to the nursing shortage? Now you have to get involved and help them make decisions. How do you do this? Well, you keep informed, finish your nursing studies, and get out there in the healthcare environment. Once there, you vow to be part of the solution, not part of the problem. We need your creative new ideas, your innovative approach to things, your fearless confidence that things can get better.

Thank you for choosing to be a nurse; we need you. In the future editions of WOW!, we will discuss exactly what kinds of opportunities are lurking out there to satisfy your desires to be in control of your life, to forge entrepreneurial roles, and to find meaning and satisfaction in your nursing career. If it was easy, everyone would do it. You are special!

Respectfully,

Lynn

K. Lynn Wieck, a nurse

Useful LINKS

www.texasnurses.org

Texas Nurses Association, check out the
Young Professionals District - Perfect answers for the adjustment - into - practice questions of new graduates.

 Library of previous

WOW! pages

v1,#1 A Message from Dr. Wieck

v1,#2 Spotlight on Nursing

v1,#3 Creating a Positive Attitude

v1,#4