Category Archives: Evaluation
Twelve-hour nursing shifts cause higher levels of burnout and negatively affect patient care, according to a study published this month in Health Affairs.
Researchers from the University of Pennsylvania found that more than 80 percent of nurses working shifts of eight or more hours were satisfied with the scheduling practices at their hospitals, but “the percentages of nurses reporting burnout and an intention to leave the job increased incrementally as shift length increased.” Nurses who worked shifts longer than 8-9 hours were up to 2.5 times more likely to have burnout and job dissatisfaction.
Long nursing shifts also have consequences for patients. In hospitals with high proportions of nurses working long shifts, patients perceived worse care, both overall and in nursing-specific factors. Patients in these hospitals reported that nurses didn’t communicate well or respond quickly, and said their pain was not well controlled. For many patient outcomes, dissatisfaction increased as the proportion of nurses working longer shifts increased, the study says.
The researchers hypothesize that nurses may underestimate the impact of working long shifts because long shifts mean working fewer days a week, which may be appealing.
Accrediting bodies should consider policies for nurses—like those already in place for medical residents—limiting the number of hours they can work a week, the research team suggests, and boards of nursing and nursing management should monitor nurses’ hours and overtime, and promote a workplace culture that facilitates manageable work hours.
What do you think? Are long shifts good for nurses or patients? Is there a way to help nurses keep flexible schedules without compromising their job satisfaction and patient care? Register below to leave a comment.
Sarah Burgard, PhD, MS, MA, is an alumna of the RWJF Health & Society Scholars program, and an associate professor of sociology and epidemiology and research associate professor at the Population Studies Center at the University of Michigan. Burgard recently co-authored a study that finds perceived job insecurity is linked with significantly higher odds of fair or poor self-reported health, symptoms of depression, and anxiety attacks.
Human Capital Blog: What got you interested in researching the working lives and health outcomes of adults? Was there anything in particular that sparked your curiosity about job insecurity?
Sarah Burgard: I was interested in the excellent research being done by health disparities researchers that focused on socioeconomic position and its strong and persistent relationship with health. My dissertation looked at race and socioeconomic position and how they shaped children's health in different societies. When I started looking at the lives of adults in wealthy economies and focusing on health disparities in these groups, it struck me that most scholars were focused on education and income as stratifying factors, but not looking deeply at what connected them: paid employment.
Careers characterized by stimulating and satisfying work versus dangerous, monotonous or insecure work are of considerable interest in their own right to sociologists of stratification, but they could also be important for understanding divergence in health, as considerable research in occupational psychology and epidemiology has suggested. Many of the projects I've done have been aimed at bringing together the strong work in each of these fields to build even stronger explanations of the way work (or lack of work) influence health. I've been interested in less explored aspects of work, such as perceptions of job insecurity among those still employed, and in taking better account of the multitude of psychosocial aspects of work that affect individuals at a given point in time and the ways these could change over the career.
Samir Soneji, PhD, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program, and an assistant professor at the Dartmouth College Institute for Health Policy and Clinical Practice and the Norris Cotton Cancer Center. His study on the statistical security for Social Security was published in the August 2012 issue of Demography. Read the study.
Human Capital Blog: This study is a follow-up to your previous research. Can you briefly describe what you’ve studied up to this point?
Samir Soneji: Previously we studied the impact of historical smoking and obesity patterns on future mortality and life expectancy trends. For men there’s been a steady decline in cigarette smoking, and so also a gain in life expectancy. Women have also experienced a decline in cigarette smoking, but not as quickly. The rise in obesity has been much more recent than the historic decline in smoking, and we don’t know yet the impact of that rise. There’s a lag—the effect of today’s obesity may affect the population in 15-20 years, or later. One possibility may be that the rise in obesity may partially offset what’s been achieved by the historic reductions in smoking. Taking these factors into account, we found that both men and women will have an increase in life expectancy in the next 25 to 30 years.
HCB: Your new study looks at the solvency of Social Security. Tell us more about what you were analyzing.
Soneji: The Social Security Administration and Medicare use the same mortality and demographic forecasts to determine the number of beneficiaries, and the number of working age adults who are contributing payroll taxes to support those retirees.
In a month when national employment data were largely unchanged, the U.S. Bureau of Labor Statistics reports that the health care industry added nearly 33,000 jobs in May, continuing as a strong and growing field. Over the year, health care employment has risen by 340,000 jobs.
Employment in ambulatory care services accounted for the majority of the new jobs in the industry (23,000). That growth was seen mostly in physicians’ offices (9,900), home care services (6,900) and outpatient care centers (4,600).
Demand for health care employees remains strong. Nurse.com reports that data from Wanted Analytics finds that employers posted more than 620,000 online job ads for health care careers in May, an increase of 5 percent from a year prior.
An appendectomy in California could cost anywhere from $1,500 to more than $180,000, even at the same hospital or within the same county, according to a study led by RWJF Physician Faculty Scholar Renee Y. Hsia, MD, MSc. The study, published this week in the Archives of Internal Medicine, found wide variations in fees for the routine procedure, about one-third of which could not be explained even after reviewing all the cases and accounting for individual health variations.
“We expected to see variations of two or three times the amount, but this is ridiculous,” Hsia told the New York Times. “There’s no rhyme or reason for how patients are charged or how hospitals come up with charges… There’s no other industry where you get charged 100 times the same amount, or 121 times, for the same product.”
Read a post Hsia wrote for the RWJF Human Capital Blog about ambulance diversion and emergency department crowding.
A newly released ranking of the nation’s “top 100 hospitals” concludes that if every U.S. hospital had performed as well over the last 30 months as the hospitals that earned spots on the list, nearly 180,000 Medicare patients would still be alive today.
That calculation and the list itself come from HealthGrades, an independent hospital- and doctor-rating company based in Denver. Researchers analyzed approximately 150 million Medicare patient records dating back to 1998, looking at specific medical procedures and conditions. Collectively, the hospitals registered a 30-percent lower risk-adjusted mortality rate across 17 specific procedures and diagnoses during 2008 and 2010. The company calculates that if all hospitals delivered care as effective, some 179,593 Medicare patients’ lives would have been saved.
NurseZone.com checked in with a number of the hospitals on the list, and found that many “credit their nursing staffs with helping them achieve the best safety records and high rankings.”
“Nurses are most important and are very much a part of the team,” says Victoria King, MHA, MSN, RN, CNOR, NEA-BC, chief nursing officer at Memorial Hermann The Woodlands in Texas. “Nurses contribute, because they are at the bedside and are the captain of the ship every single day, watching those patients.” She notes that an important element of the hospital’s “culture of safety” is that nurses are encouraged to speak up if an error seems imminent. “That makes our nurses feel free, safe and protected to do the right thing and speak up when they need to,” she says.
Jan Mauck, RN, BSN, MSN, NEA-BC, chief nursing officer of Sarasota Memorial Hospital in Florida, also on the top 100 list, highlights the importance of interprofessional collaboration, according to NurseZone.
It's Spring and Allergy Season is Upon Us. Is our Primary Care Workforce Ready to Meet Patient Needs?
By Nancy Fishman, BSN, MPH and Maryjoan Ladden, PhD, RN, FAAN. Fishman and Ladden are senior program offers at the Robert Wood Johnson Foundation
Spring is blooming all around us here in central New Jersey and that means nice weather, flowers and a constant search for allergy solutions! For those of us on the Robert Wood Johnson Foundation (RWJF) Human Capital team, this brings up several questions about how to use the primary care workforce more creatively. In this scenario, who in the primary care office could help us with our common allergy symptoms? How would we feel if we went in for a visit and didn’t see a health professional but were instead counseled about common over-the-counter treatments by the medical assistant according to standard protocol?
These are questions that seem practical and every day, but tie back to some basic questions about the primary care workforce and how we could be more creative in using all members of that workforce to improve patient access to care and the value of that care.
At the Robert Wood Johnson Foundation, we are all aware of the shortage of primary care providers – but short of producing a large number of physicians, nurse practitioners and physician assistants this instant – we need to get creative with what we have.
To that end, we are thrilled to be launching a new program to identify those practices that are already creatively using their whole office teams in new ways. This program “The Primary Care Team: Learning from Effective Ambulatory Practices” (LEAP) will first identify and then study sites that have succeeded in providing high quality health care and involving all staff in new and creative ways.
We believe that studying these sites will provide us with insights that we can share with other practices that would like to make changes.
The Robert Wood Johnson Foundation (RWJF) yesterday announced the launch of a new program designed to make primary care more accessible and effective by identifying practices that maximize the services of the primary care workforce.
The Primary Care Team: Learning from Effective Ambulatory Practices (the LEAP Project) will identify primary care practices that use health professionals and other staff in ways that maximize access to their services, so these workforce models can be replicated and adopted more widely. Its goal is to identify and then study the innovative staffing arrangements of up to 30 high-functioning primary care practices.
With millions more Americans poised to enter the health system as the Affordable Care Act is implemented, the new program will identify changes in policy, workforce, culture, education and training related to primary care that can improve the way practices function. “The nation will not be able to train new primary care providers quickly enough to meet the need, so part of the solution must be to use the workforce we have more effectively. This new program will identify ways to do that,” said John Lumpkin, MD, MPH, RWJF senior vice president and director of the Health Care Group.
The LEAP Project will be directed by Ed Wagner, MD, MPH, and Margaret Flinter, PhD, APRN, and the MacColl Center for Health Care Innovation at Group Health Research Institute in Seattle will serve as its national program office. Wagner is director of the MacColl Center and Flinter, a family nurse practitioner by clinical background, is senior vice president and clinical director of the Community Health Center, Inc., a statewide Federally Qualified Health Center in Connecticut and director of its Weitzman Center for Innovation. She is an alumna of the RWJF Executive Nurse Fellows program.
Learn more about the new program here.
By Jennifer Doering, PhD, RN, Assistant Professor at the University of Wisconsin-Milwaukee College of Nursing and Robert Wood Johnson Foundation Nurse Faculty Scholar
The first time I took the Myers Briggs Type Indicator Instrument (MBTII) I was 18 and just starting the Air Force ROTC. It seemed rather obvious to my young mind there was a ‘right way’ and a ‘wrong way’ to answer the questions. I’ll admit that I outright lied and selected answers that suggested I was bold, aggressive and outspoken, thinking I knew the type of personality the military wanted officers to possess. However, even with such effort to appear extraverted, I only came out in the middle of the Introvert-Extravert (I-E) spectrum.
Fast forward 15 years. I am again sitting down to take the MBTII, this time as a new Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar. Out of curiosity more than anything, I decide to be as honest as possible. It’s no surprise, then, to discover I am about as introverted as it gets. Threaded through my cohort’s week together at Outward Bound is the running joke that awareness of our I-E type allows the group’s extraverts to know better than to keep asking, ‘What’s wrong?’ when we introverts get grumpy. The MBTII exercise tells them our grumpiness means we need some alone time to ‘re-charge our batteries,’ but don’t possess the straightforwardness to simply say so.
Over the next three years, RWJF provided us with incredible leadership training. We heard words of advice, wisdom and passion from the premier leaders of our discipline and of health care. These leaders took huge risks at great personal cost and sacrifice to push forward the edge of what was possible for the betterment of nursing and humanity. They made no apology for breaking the rules in order to re-invent those rules in their image. It was a gift to learn from such bold leaders.
But as I sat through each training session, one nagging question loomed in the back of my mind: How could I harness the leadership potential RWJF saw in me if I was most happy and energized when working alone?
By Raina Merchant, MD, MSHP, Robert Wood Johnson Foundation Clinical Scholars program alumna and assistant professor, University of Pennsylvania Department of Emergency Medicine
If the person next to you went into cardiac arrest, would you know what to do? Would you know where to find an automated external defibrillator (AED) to shock and restart their heart? Millions of public places across the United States have AEDs that can save lives – airports, casinos, churches, gyms and schools, among them – but most people don’t know where they’re located. Every second counts when someone’s heart stops beating, and time spent searching for an AED is time wasted in increasing the chances of survival.
Surprisingly, no one knows where all of the country’s AEDs are located. Requirements for AED reporting and registration vary widely by state, and no comprehensive map of their locations has ever been compiled. As a result, 911 dispatchers aren’t always able to direct callers to an AED in an emergency, and callers have no good way of quickly locating one on their own.
This week, I launched the MyHeartMap Challenge with a multidisciplinary team from the University of Pennsylvania. This pilot study will use social media and social networking tools to gather this critical public health data and create searchable maps of Philadelphia’s AEDs that can be used by health professionals and the general public.
The first step of our challenge is a Philadelphia-based community-wide contest. We’re asking Philadelphians to find and photograph AEDs over the next six weeks, and submit the photo and location to us via a mobile app or our website. You can also participate if you don’t live in Philadelphia by finding a creative way to use your social network or harness crowdsourcing.