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Slide 1: Kathryn Wilt The Pennsylvania State University Nursing 501 Spring 2009
Slide 2: Objectives  Learn current statistics about the nursing shortage  Understand reasons for the nursing shortage  Review effects of the nursing shortage on patient care outcomes and the nursing environment  Explore options to relieve the current nursing shortage including the use of APN’s
Slide 3: As a nurse, have you ever needed to take a mental health day? Have you experienced first hand the results of the nursing shortage?
Slide 4: Facts about the Nursing Shortage  2.5 million RN’s practice in United States  Predictions for the future:  500,000 vacancies for RN’s by 2025  55 percent of nurses plan to retire between 2011 and 2020 (Source: Nursing Management, July 2006)  Need for RN’s increases 2-3% per year  30,000 additional new graduate nurses needed yearly to fill gap, an increase of 30% (Source: The Future of the Nursing Workforce in the United States: Data, Trends and Implications, 2008)  Aging population will only increase need for RN’s
Slide 5: Facts about the Nursing Shortage  US Bureau of Labor Statistics: 500,000 new nursing positions will be created by 2016 (23.5% increase)  Nursing is #1 profession in terms of job growth (Source: US Bureau of Labor Statistics, Monthly Labor Review, November 2007)  In July 2007, US hospitals reported 116,000 RN vacancies, or a national RN vacancy rate of 8.1%  The average annual turnover rate for all nurses in a hospital setting is 14%, but over 25% for 1st year nurses (Source: PricewaterhouseCoopers’ Health Research Institute , July 2007)
Slide 6: Facts about the Nursing Shortage  1 in 5 hospital nurses report that they intend to leave their current jobs within a year
Slide 7: Reasons for the Shortage Workload/environment: leads to burnout, high turnover, and absenteeism Nursing education and nursing faculty : - lack of supply /capacity issues Perceptions of nurses: better career choices, greater professionalism, better pay
Slide 8: Reasons for the Shortage Workloads and environment lead to turnover/absenteeism  Increased patient acuity without adequate resources  Increased physical demands of job  Floating assignments  Mandatory overtime  Lack of respect/autonomy  Burnout
Slide 9: Reasons for the Shortage The environment of nursing The pace Physically compromised patients Safety issues Simple accommodations for the Caregivers (bathrooms, break rooms) Clutter Inadequate space Aesthetics Noise!
Slide 10: Reasons for the Shortage Nursing education Enrollment in schools of nursing not growing fast enough to meet demand Demand requires approximately 90 percent more (about 30,000) new nurses. 40,285 qualified students turned away in 2007. Shortage of nursing school faculty Nursing education losing financial ground (Source: AACN’s report on 2007-2008 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing)
Slide 11: Reasons for the Shortage Public Perceptions  High regard for nurses but inadequate supply - Why?  Do we see ourselves differently than the public does?  Survey in 2006-2007: What Are the First Words That Come to Mind When You Hear the Term “Registered Nurse?” Survey Results (Highly) knowledgeable, skilled Caring, compassion Hardworking, long hours, overworked, stress Help, helpful Professional Public Response (%) 17 16 12 9 8 Registered Nurses (%) 6 20 5 1 23 (Source: Donelan, et al., (2008) Public perceptions of nursing careers: The Influence of the media and Nursing Shortages, Nursing Economics, 26, 3, 143-165).
Slide 12: Effects of the Nursing Shortage Patient Care Compromised Increased Health Care Costs Diminished Nurse Well Being Decreased Professionalism Loss of Knowledge High Turnover Costs (Photo Credit: Wanted 50,000 Nurses , Life Magazine, January 6, 1942)
Slide 13: Effects of the Nursing Shortage Hospitals with high patient/nurse ratios have worse outcomes – for patients and nurses!  Sentinel study showed that each additional patient added to a nurses load was associated with a 7% increase in odds of failure to rescue within 30 days of hospital admission  Patients with a nurse caring for 8 or more patients have a 30 percent greater chance of dying than if their nurse cares for four patients  For each patient over a 4:1 ratio, the odds of nurse burnout increased by 23 % and job dissatisfaction increased by 15 % 1994 ) (Aiken et al., (2002) Hospital nurse staffing, patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16) 1987-
Slide 14: Effects of the Nursing Shortage Too many patients + too few nurses =  Lack of attention/fatigueMedical Errors  Patient care compromised • Increased morbidity (infections) • Increased length of stay • Increased health care costs  Depression/anxiety in nurses  Lack of work/life balance
Slide 15: Effects of the Nursing Shortage Too many patients + too few nurses =  Injury to nurses  One measure of the hazards of health care is the fact that RNs have a higher rate of injury and illness than do U.S. construction workers. (Source: Workforce Trends among U.S. Registered Nurses, A Report for the International Council of Nurses ICN Workforce Forum Stockholm, Sweden September 21-October 1, 1997 )
Slide 16: Effects of the Nursing Shortage  Lost knowledge - very little experiential knowledge of nurses is shared and documented  Losing “efficiency knowledge” - or how to get a job done faster and better  Do health care organizations consider high cost of losing intellectual capital?
Slide 17: Effects of the Nursing Shortage  Replacement costs for nurses are about two times a regular nurse’s salary with higher costs for specialty nurses.  Assuming a nurse turnover rate of approximately 20 percent the total cost of turnover is estimated at $12.3 billion dollars
Slide 18: Strategies to Improve Nurse Staffing 4 Keys to the Future Supply – Recruitment and Retention Education - Type and Supply Distribution Utilization
Slide 19: Strategies to Improve Nurse Staffing Supply  Registered Nurse Safe Staffing Act (HR 4138)  Hospitals to develop staffing systems that ensure an adequate number of registered nurses – Bill died in the 110th Congress. “OK, sounds great. But what if there aren’t enough nurses available?” What about: traveling nurses, LPN’s, unlicensed workers, unqualified nurses?
Slide 20: Strategies to Improve Nurse Staffing Supply  Retain older nurses  Retain new graduates and nurses at all stages of their careers  Improve work environment (Photo credit: Nurse and her robot)  Increase the number of enrolled nursing students and retain them through graduation
Slide 21: Strategies to Improve Nurse Staffing Supply  Fully fund Title VIII programs (Public Health Service Act (42 U.S.C. 201 et seq.) –encourage health care facilities to implement the Magnet concept  The Magnet™ program recognizes a workplace that fosters nursing excellence and supports professional nursing practice
Slide 22: Strategies to Improve Nurse Staffing Educational Preparation  Emphasize baccalaureate (BSN) level preparation rather than associate degree nursing (ADN) programs; two-thirds of the nurses entering practice hold Associate Degrees  Of 2.1 million nurses in the US:      500,000 with diplomas (24%) 732,000 with ADN (35%) 675,000 with BS/BSN (32%) 195,000 with MS/MSN (9%) 14,500 with PhD/DNS/ND (<1%)  ADN programs receive the bulk of federal funding  Only 15% of ADN graduates move on to advanced practice or faculty levels
Slide 23: Strategies to Improve Nurse Staffing Education Increased funds for nurses Loan repayment programs ,scholarships , tuition tax credits Target students seeking BSN, MSN, and PhD degrees States  reclassify nursing education programs as high cost States  Allocate funding based on performance standards Employers  allow for paid time off Federal Government/Medicare  restore funding to education programs
Slide 24: Strategies to Improve Nurse Staffing Distribution  Acute nursing shortages in key areas  Underserved geographic regions, such as rural areas and inner cities.  Financial incentives for nurses to work in underserved areas  Fully fund the National Nurse Corps established under the Nurse Reinvestment Act of 2002
Slide 25: Strategies to Improve Nurse Staffing Utilization  Expand the availability of services rendered by all types of health providers, especially APNs  Improve overall access to health services  Address barriers within current scopes of practice to foster equitable reimbursement  Amend Medicaid law so that all advanced practice registered nurses are recognized as primary case managers
Slide 26: Strategies to Improve Nurse Staffing Utilization  JCAHO policy recommendation -- link reimbursement to the quality of nursing services and patient outcomes  This, in effect, would move nurses “...from the cost side of the balance sheet to the asset side”.  Need data that supports nurse staffing objectives  National Database of Nursing Quality Indicators (NDNQI) established by ANA
Slide 27: The final word…. “As I travel around the world on behalf of ANA, I often state that “In many cities and states, there’s not a nurse shortage, but a shortage of good places to work.” ANA President Rebecca M. Patton, MSN, RN, CNOR
Slide 28: Resources to Share Healthy Work Places – Best Practice Guidelines available at http://www.rnao.org/ (from the Registered Nurses Association of Ontario - includes topics such as Healthy Work Environments, Collaborative Practice, Sustaining Effective Staffing and Workload practices, and Professionalism in Nursing Quality Worklife – Quality Health Care available at http://www.qwqhc.ca American Nurses Association (ANA) www.SafeStaffingSavesLives.org www.nursingadvocacy.org; Center for Nursing Advocacy, a site that monitors the media's portrayal of nursing The Center for Health Outcomes and Policy Research at the University of Pennsylvania is a research and research training enterprise focusing on the outcomes of health care and health workforce policy. http://www.nursing.upenn.edu/chopr/ www.PartnersInNursing.org.
Slide 29: Resources to Share The National Database of Nursing Quality IndicatorsTM (NDNQI®) is the only national nursing database that provides quarterly and annual reporting of structure, process, and outcome indicators to evaluate nursing care at the unit level. Linkages between nurse staffing levels and patient outcomes have already been demonstrated through the use of this database. http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursi ng/PatientSafetyQuality.aspx Nurses Needed Now Video (about 25 minutes long): available at http://www.pbs.org/now/shows/442/index.html
Slide 30: Newspaper Articles to consider 1. Going to the Hospital? Don't Forget to Pack a Nurse New York Times. (Late Edition (East Coast)). New York, N.Y.: Sep 17, 2005. pg. C.9 2. Nursing Shortage: How It May Affect You Family Awarded $2.7 Million over Alleged Nursing Neglect at Kansas Hospital, Available at http://abcnews.go.com/WNT/Health/story?id=1529546
Slide 31: References Agency for Healthcare Research and Quality. (2007). Nurse staffing and quality of pa-tient care (AHRQ Publication No. 07-E005). Rockville, MD: Author. Retrieved October 15, 2007, from http://www.ahrq.gov/clinic/tp/nursesttp.htm Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288 (16), 1987 1993. American Association of Colleges of Nursing (2007-2008) Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Retrieved February 10, 2009 at www.aacn.nche.edu/IDS American Nurse’s Association (ANA) (2008). ANA’s Health System Reform Agenda 2008. Retrieved February 10, 2009 from http://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues /Reports/ANAsHealthSystemReformAgenda.aspx Buerhaus, P. (2008). The future of the nursing workforce in the United States: Data, trends, & implications. Retrieved February 20, 2009 at www.jbpub.com/catalog /9780763756840. Buerhaus, P. I., Donelan, K., Ulrich B. T., Norman, L., DesRoches, C., & Dittus, R. (2007). Impact of the nurse shortage on hospital patient care: Comparative perspectives. Health Affairs, 26, 3853–3862.
Slide 32: References Donelan, K., Buerhaus, P., DesRoches, C., Dittus, R., Dutwin, D. (2008). Public perceptions of nursing careers: The Influence of the media and Nursing Shortages. Nursing Economics, 26, 3, 143-165. Government Accounting Office (GAO) 2001. Nursing workforce emerging nurse shortages due to multiple factors. Retrieved February 20, 2009 at http://www.gao.gov/new.items/ d01944.pdf. Health Resources and Services Administration (HRSA) (2009). Behind the RN Projections. Retrieved February 20, 2009 at http://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/index.htm Institute of Medicine. (1999). To err is human: Building a safer health system. Com-mittee on Good Quality of Health Care in America. Washington, DC: National Academy Press. Retrieved October 30, 2007, from http://books.nap.edu/cata-log.php?record_id=9728 Institute of Medicine. (2004). Keeping patients safe: Transforming the work environ-ment of nurses. Committee on the Work Environment for Nurses and Patient Safety. Washington, DC: National Academy Press. Retrieved October 30, 2007, from http://books.nap.edu/catalog.php? record_id=10851
Slide 33: References Malone, B.L. & Marullo, G. (1997). Workforce Trends among U.S. Registered Nurses, A Report for the International Council of Nurses ICN Workforce Forum Stockholm, Sweden September 21-October 1, 1997. Retrieved February 12, 2009 at www.nursingworld.org/mainmenucategories/healthcareandpolicyissues/reports/workforcetrends.aspx McClure, M. L., & Hinshaw, A. S. (2002). Magnet hospitals revisited: Attraction and retention of professional nurses. Washington, DC: American Nurses Publishing. Nursing Institute at the University of Illinois College of Nursing (May 2001). Who Will Care for Each of Us?: America’s Coming HealthCare Crisis, Retrieved February 16, 2009 at www.uic.edu/nursing. PricewaterhouseCoopers’ Health Research Institute (July 2007). What Works: Healing the Healthcare Staffing Shortage. Retrieved March 1, 2009 from http://www.pwc.com. Robert Wood Johnson Foundation (2006). Wisdom at work: The importance of the older and experienced nurse in the workplace. Princeton, New Jersey: Author. Stanton, M. W., & Rutherford, M. K. (2004). Hospital nurse staffing and quality of care. Rockville, MD: Agency for Healthcare Research and Quality. The Council on Physician and Nurse Supply (2008). Retrieved February 20, 2009 at www.physiciannursesupply.com U.S. Bureau of Labor Statistics (2007). Monthly Labor Review. Retrieved February 15, 2009 at www.bls.gov/opub/mlr/2007/11/art5full.pdf West, E.A., Griffith, W.P., & Iphofen, R. (2007). A historical perspective of the nursing shortage. MedSurg Nursing, 16(2), 124-131.