The New Nursing Shortage

1. The New Nursing Shortage Why It Is What We Can Do About It

2. 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

3. 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

4. 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

5. Tightening Supply • Aging of the nursing workforce • Nurses leaving bedside care roles • Decline in student enrollments • Shortage of nursing faculty Connecticut Nurses’ Association

6. 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

7. 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

8. 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

9. Pay Issues • Stagnant for last 5 years • Not competitive with other options for women Connecticut Nurses’ Association

10. 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 hospital-based 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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