Transcript The New Nursing Shortage Why It Is

The New Nursing Shortage
Why It Is
What We Can Do About It
What is happening?




The burden of care for nurses, patients and
families has demonstrably increased since
1990
Nurses and families are very concerned about
the erosion of care and fearful about hospital
safety
Nurses report increasing dissatisfaction with
their work in hospitals that have cut staff, that
require frequent overtime, and have replaced
nurses with assistive personnel
Research has shown that these phenomena are
related to adverse nurse and patient outcomes
Connecticut Nurses’ Association
ANA Survey of 7300 nurses




75% feel the quality of nursing care
at the facility in which they work has
declined over the last 2 years
40% would not feel comfortable
having a family member cared for in
the facility in which they work
54% would not recommend their
profession to their children or friends
50% feel exhausted and discouraged
when they leave work
Connecticut Nurses’ Association
ANA Survey of 7300 nurses


44% are discouraged and saddened by
what they couldn’t provide for their
patients
40% feel powerless to effect change
necessary for safe, quality patient care
Connecticut Nurses’ Association
Tightening Supply




Aging of the nursing workforce
Nurses leaving bedside care roles
Decline in student enrollments
Shortage of nursing faculty
Connecticut Nurses’ Association
Safety Issues


AHA/ Picker Institute Survey – 1997: The
perceived “thinness” of hospital nurse
staffing was reflected in a universally
mentioned experience: “If I hadn’t stayed in
the hospital room with my mother (or child or
spouse), they never would have gotten the
correct medication or care on time”
Dr. Don Berwick – Institute for Healthcare
Quality Improvement: “so many of my
colleagues and friends have told me they were
afraid to leave their loved one in the hospital
for fear that something bad would happen”
Connecticut Nurses’ Association
Safety Issues



Decreased RN staffing is correlated with
increased medication errors
Nurses who had only an associate degree were
more than nine times as likely as those with a
bachelor of science to be charged with
violations
Broadening nursing assistants’ responsibilities
to include seemingly routine tasks has a
negative effect on the quality of the information
available to physicians and nurses and also
leads to medication errors (Preuss 1998)
Connecticut Nurses’ Association
Safety Issues


Both nurses and physicians
reported that heavy
workloads caused nurses to
postpone or miss tasks
Nurses described a
troubling erosion of their
capacity for empathy
because of the difficulty
they had finding time for
even basic physical care
Connecticut Nurses’ Association
Pay Issues


Stagnant for last 5 years
Not competitive with
other options for women
Connecticut Nurses’ Association
Regulation and Licensing



Establish standards for safe patient care, while
acknowledging the extraordinary difficulty of
doing so
Establish training standards and competency
(certification) exams for previously licensed
personnel, through both national and hospitalbased strategies
Find new ways to regulate the sites in which
nurses practice (for example, closing beds when
RN staff is reduced below a particular level and
adding clinical nurse specialists to units)
Connecticut Nurses’ Association
Regulation and Licensing





Require that clinical assignments be given only
to persons qualified to perform them
Require that all staff performing clinical tasks
be properly identified
Prohibit the use of mandatory overtime
Encourage state legislatures to establish
commissions on nursing
Establish licensing requirements that reflect the
different capabilities of nurses with different
educational credentials
Connecticut Nurses’ Association
Financing


There is an absence of effective
reimbursement incentives for
quality care in general and nursing
care in particular
There is a lack of funding for clinical
training costs of nursing education
Connecticut Nurses’ Association
Role of Governing Boards



Become more systematically
involved in overseeing the quality of
care.
Request that the senior nurse
executive attend all board and
executive committee meetings.
Elect more nurses to hospital
boards
Connecticut Nurses’ Association
Recruiting and Educating
Nurses



Improve work conditions, compensation,
and benefit packages
Recruit among high school students
Tie repayment and forgiveness of
educational loans and grants to the
recipient remaining in nursing, in
hospitals and other health care agencies,
for periods of time related to the extent
of support granted
Connecticut Nurses’ Association
Recruiting and Educating
Nurses


Make nursing education more efficient by
reducing the number of nursing schools
in community colleges and increasing
capacity in baccalaureate and graduate
degree programs
Increase faculty capacity to educate
nurses through the use of distance
learning
Connecticut Nurses’ Association
Organization of Nursing
Services in Hospitals




Have a strong chief nurse executive with the
formal power to act as an advocate for both
patients and nurses
Adopt the ANA Principles of Nurse Staffing,
either as an industry standard or by regulation
Require hospitals to report nurse-to-patient
ratios publicly on a regular schedule
Establish protocols to prevent the
circumvention of technologies designed to
prevent medical errors
Connecticut Nurses’ Association
Organization of Nursing
Services in Hospitals




Establish a more effective standard hierarchy of
expertise in nursing service
Provide opportunities for education and career
progression for all hospital positions
Require hospitals to collect and report better
data related to the quality of nursing care and
patient outcomes
Encourage hospitals to improve working
conditions in order to be eligible for Magnet
Hospital Recognition
Connecticut Nurses’ Association
10 Nursing-Sensitive Quality
Indicators for Acute Care Settings










Mix of RNs, LPNs, and Unlicensed Staff Caring
for Patients
Total Nursing Care Hours per Patient Day
Pressure Ulcers
Patient Falls
Patient Satisfaction with Pain Management
Patient Satisfaction with Education Information
Patient Satisfaction with Overall Care
Patient Satisfaction with Nursing Care
Nosocomial Infection Rate
Nurse Staff Satisfaction
Connecticut Nurses’ Association
An Interesting Idea

Many hospitals will boost nursing pay scales
and upgrade information systems to improve
patient monitoring and record keeping. That is
the conventional wisdom. But unconventional
wisdom will be to get in line with the core values
of the primary caregivers in every health care
organization – nurses. Hospitals have thrived by
catering to physicians. That was important, and
still is. But there are three times as many
practicing nurses as active physicians.
Becoming a nursing-driven organization would
change some fundamental processes at many
hospitals and health systems.
Connecticut Nurses’ Association

Healthcare executives must join
their caregivers in putting patients
first, and then figuring out how to
make money. In any industry, the
organization that provides
customers with the highest value is
the winner. – Russ Coile’s Health
Care Forecast
Connecticut Nurses’ Association
References

Arkansas Nurses’ Association Town Hall Forums

When Care Becomes a Burden: Diminishing
Access to adequate Nursing by Claire Fagin, PhD,


RN, FAAN sponsored by Milbank Memorial Fund
Russ Coile’s Health Care Forecast Special report.
Aspen Publishers, Inc. 2001
ANA’s Safety & Quality Initiative & ANA’s Staffing
Survey @ www.ana.org/readroom/fssafe99.htm
Connecticut Nurses’ Association