Posts Tagged ‘nurses’

Burnout Affects 30 Percent of Nurses

Wednesday, August 29th, 2012

With hospitals slashing costs to cope with growing financial pressures, nurses believe that the resulting insufficient staffing is detrimental to patients.  A team from the University of Pennsylvania has identified a key reason for this: Hospitals where relative fewer caregivers work typically provide inferior care.  If hospitals reduced their proportion of burned-out nurses to 10 percent from the prevailing 30 percent, they would prevent 4,160 cases a year of the two most-common hospital-acquired infections and save $41 million in Pennsylvania alone.  “It is costing hospitals more money not to spend money on nursing,” said Linda H. Aiken, one of the study’s authors and director of the Penn Nursing School’s Center for Health Outcomes and Policy Research.

The researchers determined that the nurses studied averaged 5.7 patients on a typical shift, said Rutgers University professor Jeannie Cimiotti.  “Maybe they are staffed a little bit above what they should, but if they (hospitals) can provide an organizational climate that’s conducive to nursing, I think they’d be fine,” Cimiotti said. “That doesn’t mean you can overburden them because workload is one of those factors that does contribute to burnout.”

“Most burnout is related to high workload,” said Patricia Eakin, an ER nurse who is president of the Pennsylvania Association of Staff Nurses and Allied Professionals.  Patients nowadays need a whole lot of care. There’s a lot of equipment, a whole lot of fancy things. A lot of things that take a lot of time and a lot of attention.”

Historically, the number of nurses per patient was low following World War I.  At what would ultimately become Baylor University Medical Center, the hospital in 1919 accommodated 225 patients who were cared for by a nursing staff of 12 graduates and 100 students.  As recently as the 1980s, nurses often cared for eight or nine patients (Insert Nurse Together link here.)  The night shift could see a single nurse caring for as many as a dozen patients, often without a Certified Nursing Assistant (CNA) to assist.

The shift in the United States from Florence Nightingale’s concept of multi-bed wards (which often contained 30 or more beds and were typically staffed by one or two nurses) to private and semi-private rooms started in the years following World War II and was mostly complete by the 1970s.  Private hospital rooms at this time were primarily reserved for patients whose families could afford to pay extra to keep their relative out of a ward and hire a private duty nurse to provide one-on-one care.  According to Jean C. Whelan, PhD, RN, “Private-duty nursing was the employment of nurses by individual patients for the delivery of care.  Patients hired their own nurse, who cared for them either in their homes or in the hospital.  Patients paid the nurse for her services with cash, based on a predetermined fee.  The nurse, generally employed for the duration of an illness, cared for only one patient at a time.  In essence, the private-duty nurse delivered highly individualized care to paying patients for as long as a patient needed and could pay for the nurse’s services.”

According to a U.S. National Library of Medicine of the National Institutes of Health Study, thousands of nurses — the vast majority of them women — migrate each year in search of better pay and working conditions, career mobility, professional development, a better quality of life, personal safety, or sometimes just novelty and adventure.  The percentage of foreign-educated physicians working in Australia, Canada, the United Kingdom, and the United States is currently reported to be between 21 and 33 percent, while foreign-educated nurses represent five to 10 percent of these countries’ nurse workforce.”

In 1994, nine percent of total registered nurses were foreign-born RNs; by 2008 that percentage had risen to 16.3 percent, or about 400,000 RNs.  Of those, approximately 10 percent had immigrated to the U.S. during the previous five years. About one-third of growth in RNs between 2001 and 2008 was fueled by foreign-born RNs.  The news is not all positive, though.  According to Newsweek, “While pay has risen in some regions to attract more nurses, in recent years it has flattened at the national level.  That’s why up to 500,000 registered nurses are choosing not to practice their profession — fully one-fifth of the current RN workforce of 2.5 million.”

Bringing those badly needed nurses from overseas is not always easy, said William R. Moore of El Centro Regional Medical Center in California, who has been waiting two years for 20 nurses from the Philippines he recruited to obtain visas.  In the meantime, Moore can’t find talent in the area.  “We’re in the poorest and least literate county in California, right in the middle of the desert,” says Moore. “We’re not a destination for (American) nurses.”

As the role of registered nurses has evolved over the years to encompass increased responsibility, so too, have the educational requirements.  A two-year associate degree (AND) or a four years bachelor’s degree — typically a Bachelor of Science in Nursing (BSN) — are the two primary degrees required in the 21st century.  Many nurses opt to pursue their Master of Science in Nursing (MSN) degree, which requires a minimal commitment of two years to complete the course work.  Others go even further in their educations, studying for a Doctor of Philosophy (PhD) or a Doctor of Nursing Practice (DNP).

Studying for a BSN degree — like all college educations – doesn’t come cheaply.  According to the Registered Nurse Education Requirements website, “Tuition and clinical fees together make up the total cost of nursing education while the tuition fee for a two-year nursing course in a community college is just $1,400, the clinical fees can are considerably higher at $4,000 plus per semester.  For a bachelors course the students end up paying almost $7,000 to $8,000 in clinical fees while the tuition is still lower at just $2,000 to $3,000 per semester.  Apart from this, students will also have to incur the cost of books, parking, basic living expenses and housing in case of out-of-town colleges. The cost of training at hospital affiliated nursing schools can be higher at $55,000 for resident student and over $100,000 for non-residents.”

Healthcare Employment on a Strong Growth Trajectory

Monday, April 16th, 2012

Healthcare employment will continue to grow much faster than employment in general, with the number of jobs in home care and other ambulatory settings expected to grow by more than 40 percent by 2020, according to a new study from the Center for Health Workforce Studies (CHWS) at the State University of New York at Albany.

Recent statistics from the Department of Labor focus on an expected hiring shift away from hospitals, as the system emphasizes preventive care and fewer admissions, said Jean Moore, CHWS director.  “For a long time, acute-care services tended to trump everything else, and that seems to be changing,” Moore said.  “There’s a growing awareness that it’s penny-wise and pound-foolish not to pay attention to preventive and primary care.”

Hospitals also are expected to keep hiring — nearly one million between now and 2020 — for a growth rate of 17 percent – as baby boomers age and need more inpatient care.

Physicians’ offices and other healthcare professionals are projected to hire 1.4 million people by 2020, a 36 percent increase.  The number of home health care jobs will soar by 872,000 – that’s an 81 percent growth rate.  The total number of ambulatory-care jobs will grow by 2.7 million by 2020, or 44 percent.

According to Kaiser Health News, healthcare is projected to be a growth industry, even if the Supreme Court strikes down the Patient Protection and Affordable Care Act (ACA).  “One of the things I wasn’t expecting was how much growth there was even during the recession,” Moore said.  “I would have expected some tempering of the growth.”

Although total U.S. employment declined by two percent between 2000 and 2010, healthcare employment rose 25 percent — demonstrating the sector’s expanding share of the economy.  By 2020, nearly one of every nine American jobs will be in healthcare.  When you consider that four million new health jobs will be created and people retiring from existing ones, more than seven million new workers will be needed.  That includes more than one million nurses.

According to the report, administrative healthcare jobs were cut during the economic slump from 2008 to 2010, a time when providers added nursing and other clinical positions.  Recent reports suggest that hospitals are hiring additional administrative staff to keep up with the increased regulation required by the ACA.  “They may be rehiring the people they had to let go when times were tight,” Moore said.

Healthcare employment totaled 14.19 million in October of 2011, an increase from the 13.88 million a year earlier, according to the Bureau of Labor Statistics.  Hospital jobs increased by 84,000 during the same time period.  Ambulatory services — physician offices, outpatient clinics and home health agencies added more than 173,000 positions.

Demand is strongest for general practitioners, nurse practitioners and physician assistants at private practices, community clinics, hospitals and long-term care facilities.  Demand also is high for physical therapists.  Some analysts predict that the shortage of physical therapists will increase as healthcare reform goes into effect.  Fewer uninsured Americans translates to a greater demand for physical therapy.  In response, medical schools are expanding and developing physical therapy training programs.

If anything, the physical therapist shortage will worsen, because in 2000, 15.6 percent were between the ages 50 and 64; 10 years later, 32 percent were in that age bracket, according to a report from the American Physical Therapy Association (APTA).  Unemployment among physical therapists remains remarkably low: In 2010, only 0.4 percent — one in 250 — of physical therapists were jobless.  “Nobody knows how accountable-care organizations and medical homes will shake out, but healthcare reform in general will decrease the number of uninsured, which will increase demand for physical therapists,” said Marc Goldstein, senior director of research for the APTA.  “Physical therapy programs are being developed or expanded, so the current level of 6,000 graduates annually should creep up.”

A survey by Sullivan, Cotter and Associates, Inc., a nationally-recognized compensation and human resource management consulting firm, over the last year, nearly 75 percent of respondents reported they increased their physician staffing levels; adding an average of 12 specialists and nine primary-care physicians to their staffs.  Another 75 percent said they plan to increase their physician staffs and mid-level providers over the next year.  “These data are consistent with the labor market shift in physician employment that has been occurring over the past few years,” said Kim Mobley, practice leader for physician compensation.  “We expect this trend to continue for some time.  This shift in the labor market has resulted in what has become a highly competitive market for physicians as organizations and physicians align to provide services in a high quality, more efficient manner.”

Nurse Burn-Out, Depression Can Be Fatal to Patients

Tuesday, July 26th, 2011

The horror began last September 14 when an experienced Seattle nurse realized she’d overdosed a fragile baby with 10 times too much medication. The stunned nurse told nearby staff at the Cardiac Intensive Care Unit at Seattle Children’s Hospital what had transpired.  “It was in the line of, ‘Oh my God, I have given too much calcium,’” recalled a fellow nurse.  In the nurse’s 24-year career, all of it spent at Seattle Children’s, dispensing 1.4 grams of calcium chloride — instead of the correct dose of 140 milligrams — was the sole serious medical mistake she’d ever made, according to the public investigation.  “She was devastated, just devastated,” said her partner and co-parent of their two children.  That mistake turned out to be the start of a life that unraveled, contributing not only to the child’s death, an eight-month-old girl, but also to Hiatt’s firing, a state nursing commission investigation — and Hiatt’s suicide at age 50.

This story highlights the twin casualties caused by serious medical errors: The patient is the first victim, the person hurt or killed by a preventable error.  The second victim is the healthcare professional who has to live with the aftermath of making it.

There is no question that patients are the primary concern in a nation where one in seven Medicare patients experience serious harm because of medical errors and hospital infections each year.  Another 180,000 patients die, according to a study by the Department of Health and Human Services’ Office of Inspector General.  That’s nearly twice the 98,000 deaths attributed to preventable errors in the important 1999 report “To Err is Human,” by the Institute of Medicine, which fired up the nation’s patient-safety movement.  In the real world, doctors, nurses and other medical workers who commit errors are often traumatized, with reactions ranging from anxiety and sleeping problems to doubt about their professional abilities – as well as thoughts of suicide, according to two recent studies.

This sad story raises the issue of healthcare provider depression and burnout.  Writing on the allnursing.com website, an anonymous nurse says “While visiting in the lounge one day, we discovered that every nurse there was on an anti-depressant.  I have had ‘Treatment Resistant Depression’ for about 20 years — as long as I’ve been a nurse.  Now I am totally burned out, on major meds, and am seeking disability due to depression/anxiety.  I believe years of long hours, high stress, high expectations and little appreciation (from management, not patients) has contributed to this.  How many other jobs consider you a traitor because you call in sick?  And trying to get off for a sick child is an unforgivable sin.  How many other jobs want you to work overtime on the days you are scheduled, call you at all hours of the night or day when you are off, first pleading with you to come in, then laying a guilt trip on you if you say “NO!”  And let’s not forget the mandatory in-services and CEUs (continuing education units) that take time away from your family.  If any profession should understand the importance of the individuals’ physical, mental, social and spiritual self it should be nursing — -after all we are taught in nursing school about treating the patient as a whole, not just a disease!  Why don’t we treat our staff the same way.”

According to Anthony Cirillo on the Hospital Impact website,“Two studies suggest that nurses working in hospitals are much more susceptible to depression than their counterparts in clinics, schools or other locations, especially if their hospital is high-volume.  A study in Journal of Clinical Psychiatry looked at the relationship between bed occupancy rates and absenteeism and found that those working in units that were 10 percent more crowded than the optimal rate had twice the rate of depressive illness than their counterparts in less crowded units.  The second study, appearing in Health Policy, is based on data from the 2005 National Survey of the Work and Health of Nurses in Canada. While looking at absenteeism in general, the report notes that depression is a “significant determinant” for missed work among RNs and LPNs, and that those who work in a hospital are more likely than those working in other settings to miss work.  One thing we might first observe is that with health reform, things will get much worse before they get better.  At some point, the estimated 35 million newly insured Americans will seek healthcare, potentially burdening the system.  And, of course this all impacts recruitment and retention and even further impacts whether folks choose to enter into the profession.”

According to the Nursing Center website, “Studies have also shown that nurses (the vast majority of whom are women) may be especially at risk.  This study surveyed 150 medical-surgical nurses from three hospitals to determine the prevalence and predictors of depression among female nurses.  All participants had at least a year of nursing experience and worked at least 20 hours per week.  Most (93 percent) were white; they averaged 38 years of age and 10 years’ hospital nursing experience.  Thirty-five percent of nurses had mild-to-moderate depressive symptoms; the most common included restless sleep, poor motivation, feeling bothered, and concentration problems; many reported feeling hopeful, happy, or joyful on only two days (or fewer) during the week before filling out the questionnaire.  Somatic symptoms, stressful major life events, greater occupational stress, and lower income were correlated with the presence of depressive symptoms.  Fatigue and low energy were bothersome to 43 percent of nurses; pain in extremities and joints, trouble sleeping, and back pain were also common.  Having a mortgage or loan of more than $10,000 within the previous year was the most commonly reported (43 percent) stressful major life event.  Others included changes in sleeping habits, vacation, and holidays.  The most highly ranked occupational stressors were having insufficient time to provide emotional support to a patient and to complete nursing tasks, being required to complete many non-nursing tasks (such as paperwork), and inadequate staffing.”

Mixed Verdict on Level of RN Staffing and Better Patient Outcomes

Wednesday, April 20th, 2011

Elevated levels of nurse staffing can lead to better patient outcomes, though not necessarily in safety net hospitals – which provide healthcare to low-income, vulnerable and uninsured persons — according to a report published by the American Public Health Association. According to a study funded by the Robert Woods Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative, researchers examined discharge records for 1.1 million patients in 872 units — including 285 intensive-care units — at 54 University HealthSystem Consortium hospitals and found relationships between patient outcomes and the length of time that nursing care patients received.

Although staffing levels were similar, outcomes were enhanced in non-safety net facilities, where more registered nurses were associated with lower mortality rates from congestive heart failure, infections and bedsores, as well as shorter stays. There were also fewer “failure to rescue” deaths, where nurses did not note or initiate treatment in life-threatening situations.   “Higher levels of nursing skill and more nurses providing more hours of care, overall, are correlated with better care — shorter hospital stays, fewer infections and lower rates of failure to rescue,” said Mary Blegen, RN, PhD, FAAN, professor in Community Health Systems and director of the Center for Patient Safety at the University of California San Francisco School of Nursing.  “We suspect that the increase in mortality rates due to congestive heart failure in safety-net hospitals are a function of patients’ overall health, rather than staffing rates, but more research needs to be done.  We also need to know more about how non-RNs affect patient care.”

There’s another side to this issue, however.  A study published in the New England Journal of Medicine found that a lack of adequate nurses has a direct correlation to higher patient morality rates.  A study of nearly 200,000 nursing shifts determined that staffing of “RNs below target levels” is linked to increase patient deaths.  Some of the under-staffing is a result of efforts to control costs.  In one finding, when inadequate numbers of nurses were on duty, inappropriate and dangers levels of patient transfers and discharges occurred.  Shortages also lead to higher turnover rates.  According to the study, the risk of death increased two percent for patients cared for by shifts staffed by too few RNs.  The typical patient was exposed to three nursing shifts, which created a six percent increased risk of death.  Elevated levels of shift turnovers resulted in four percent more deaths.  The American Nursing Association believes that policymakers must focus on reimbursement systems that reward hospitals for maintaining adequate nurse staffing.

The Doctor Can’t See You Now

Tuesday, February 22nd, 2011

As Baby Boomers celebrate their 65th birthdays at the rate of one every eight seconds, the nation’s physician shortage is growing. “This is not a surprise, of course, but I hope that the oft-repeated statistic will force our nation and our government to face the harsh reality of America’s current physician shortage, our growing underserved populations, and the dismal issue of access for those newly insured after 2014 under provisions of the Patient Protection and Affordable Care Act,” said Cecil B. Wilson, M.D., and president of the American Medical Association (AMA).

According to Wilson, the AMA anticipates that the nation will be short by at least 125,000 physicians by 2025.  This year, 22 states and 17 medical specialty organizations are reporting dwindling numbers of practitioners.  Many physicians have so many patients that they have to limit the number of Medicare enrollees they can see because reimbursement rates are not high enough to make a profit.  “For decades, we have watched the physician population move into cities and high-population areas, leaving vast areas of this country woefully underserved,” Dr. Wilson said.  “There still is a primary-care shortage — at least partially because pay differentials for primary-care physicians make it even more difficult to repay medical school debts, which average $155,000.  We see an even larger shortage in the Hispanic, black and other minority communities — partly because of high medical school costs but also because there are few role models for those kids.  And then there is 2014, the year of shrinking access.  That year, when the full provisions of the health reform law kick in, we will see 32 million more patients — people who up to now have been uninsured and often without a physician.”

Complicating the situation is the fact that the Department of Health and Human Services estimates that as many as 33 percent of physicians practicing today will retire over the next 10 years.

The outlook for primary-care physicians is especially grim, according to the Association of American Colleges (AAMC). The AAMC estimates that the nation will need an estimated 45,000 primary-care physicians and 46,000 surgeons and medical specialists once the new healthcare law is fully implemented.  “It’s certainly the worst (shortage) that we’ll have seen in the last 30 years,” said AAMC chief advocacy officer Atul Grover.  “For the first time since the 1930s, our number (of physicians) per capita will start to drop in the next couple of years.  That’s fewer doctors per person, but at the same time, since people are aging and have more chronic illnesses, each person is going to need more healthcare.  That’s a pretty bad situation.”

At present, the United States has 709,700 physicians (in all specialties) with a demand for 723,400 – that’s a shortfall of 13,700 doctors.  By comparison, in 2020, there will be 759,800 physicians (in all specialties) with a need for 851,300 physicians; essentially that represents 91,500 too few doctors.  Once healthcare reform kicks in, 32 million more Americans will have access to medical insurance and 36 million to Medicare.  “As more people get insured, they are going to seek out the care they probably should have been getting all along but haven’t been able to necessarily access.  That’s why those numbers look worse in the next 10 years than we previously had estimated,” Grover said.

Peter J. Weiss, M.D., respectfully disagrees.  In fact, he thinks that the physician shortage is all in the AMA’s Dr. Wilson’s head. “It’s simple, when the doctor supply goes up — the amount of care, and the profits, rise too,” according to Weiss.  “I’m not blaming physicians for this problem, the causes of inappropriate care are complex, but if we just got rid of unnecessary care, would we have a ‘physician shortage?’  Lastly, historically doctors have acted aggressively to protect their turf – both as a profession and within specialties.  How much routine healthcare could be rendered by nurse practitioners, nurses, pharmacists and other more numerous and less costly providers?  Studies suggest that a huge fraction of care doesn’t need to be rendered by a doctor, but what prevents this?  You know the answer — the physician lobby.”

Hospitals Need to Step Up Hiring to Keep Up With Demographics

Tuesday, February 16th, 2010

There will be a shortfall of 109,600 physicians by 2020 and 260,000 full-time nurses by 2025.  Demographic trends will not allow hospitals and other healthcare providers to maintain their current staffing patterns, according to a new American Hospital Association (AHA) study.

Assuming current trends remain the same, the researchers say that there will be a shortfall of 109,600 physicians by 2020 and 260,000 full-time nurses by 2025.  This will occur at a time when other industries will experience similar employee shortfalls.  The study, entitled Workforce 2015:  Strategy Trumps Shortage, notes that hospitals will have to retain their current employees while bringing in new physicians and nurses to provide necessary services.

“Hospitals and health systems need to rapidly implement these strategies, learn early implementation insights, and share successful practices.  Employers in other fields face the same challenges and are likely to use similar strategies,” the AHA study notes.  As an example, hospitals and other healthcare providers must redesign workflows by seeking employee input.

Florida Eases Nursing Guidelines to Aid Haiti Relief

Monday, February 8th, 2010

In the wake of the devastating Haiti earthquake, Florida Governor Charlie Crist has signed a temporary order allowing nurses licensed in other states to practice in the Sunshine State.  The move allows Florida nurses leeway to travel to Haiti to assist in earthquake-relief efforts. Unless extended, the order expires in 90 days.Florida nurses heading to Haiti to assist in earthquake relief.

Before coming to Florida, nurses must prove they have a valid license in their home states, and have no health complications, history of disciplinary actions or criminal history.  Once cleared, the nurses will receive a practice letter from the Florida Board of Nursing.  Out-of-state nurses with practice letters will be paid for their work, a change from the past.

According to U.S. Census Bureau Statistics, Florida has the highest percentage of Haitian-Americans in the country, many of whom are nurses who are volunteering to work on earthquake relief.  The Service Employees International Union reports that at least 600 of its members have volunteered to travel to Haiti, many of them nurses and physicians who are originally from Haiti and speak Creole.  National Nurses United has a list of 8,000 members who have volunteered for disaster relief.

“Medical Home” – Closest Care to a House Call

Wednesday, December 30th, 2009

Medical home approach to healthcare can cut hospitalizations and ER visits.  It’s almost – but not quite – a house call.

A new healthcare concept called “medical home” is emerging across the country, especially in Illinois.  It is primary care devoted to prevention and to helping people with chronic conditions such as diabetes or arthritis manage their illness.  In a medical home, a physician oversees a team of nurses, physicians’ assistants and health coaches who make certain that their patients get the care, support and education they need.  Another benefit is that the plan frees up the doctor’s time to focus on the more serious medical issues.

Medicare recently announced a similar initiative, and healthcare reform legislation could champion medical homes.  One pioneer in the field is Group Health Cooperative, a Seattle-based HMO that plans to convert 26 clinics in Washington and Idaho to medical homes.  The pilot program, established two years ago, reduced ER visits by 29 percent and hospitalizations by 11 percent while improving the quality of care, according to a report in the September issue of the American Journal of Managed Care.

For medical homes to function properly, physician compensation will have to change, says Dr. David Swieskowski, chief executive of the Des Moines-based Mercy Clinics, Inc.  The model works optimally when physicians are full-time, salaried employees.  This payment arrangement is fairly rare, and insurance companies don’t reimburse physicians for taking extra time to talk to patients.

Medicaid introduced a version of medical homes in Illinois through Medicaid in 2006 and 2007.  During that time, Medicaid assigned 1.9 million people to physicians who agreed to coordinate care for an extra monthly fee.  As a result, immunizations, vision screenings and other types of basic care have improved, state officials say.

I’ve Got One Word for You – “Healthcare”

Tuesday, April 7th, 2009

If Benjamin Braddock graduated from340x1 college today, the clueless Mr. Robinson would likely tell him to go into healthcare – not plastics — as he advised the befuddled young man in the classic 1967 movie “The Graduate”.

Although the economy is shedding jobs at an alarming rate, the healthcare industry added 371,600 jobs during 2008.  That momentum has not slowed, despite the fiscal crisis and recession.  While the economy lost 1.9 million jobs during the fourth quarter of 2008, healthcare added 93,200 jobs.  Hospitals hired 11,900 new workers in December, bringing the nation’s total hospital workforce up to approximately 4.71 million.  Physicians’ offices hired 5,600 more staff, bringing that workforce up to nearly 2.3 million employees.

Ambulatory-care centers saw 1,100 jobs vanish during December, a 0.2 percent loss.  Still, that fast-growing sector grew to 521,700 jobs during all of 2008, a 1.7 percent increase compared with the previous year.

“The only major private industry sector that continued to add a significant number of jobs was healthcare”, notes Keith Hall, commissioner of the Bureau of Labor Statistics.

According to a new Ernst & Young study on business risk, the global war for talent will be top of the mind for CEOs.  Nowhere will this be more evident than in healthcare.  There remains a chronic shortage of surgeons and family-practice doctors.  Part of this is because U.S. medical schools held enrollment to 16,000 students a year from 1980 to 2005, fearing a glut of doctors under managed care.  Perhaps the hiring by hospitals is a correction to 25 years of no-growth within certain specialties and the continuing dearth of nurses.