While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Short-Term Contract Nurses Could Play Key Role in Offsetting Nursing Shortage
Registered nurses (RNs) who work on short-term contracts through external staffing agencies or through supplemental nursing services have similar education levels and, on average, only slightly less work experience than permanent RNs, according to a study published in the November issue of Health Affairs.
A research team led by Ying Xue, DNSc, RN, associate professor at the University of Rochester School of Nursing, conducted the study. Xue is a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar, and her work on the project was funded by RWJF in that capacity.
Researchers compared data from the National Sample Survey of Registered Nurses from 1984 to 2008 for supplemental and permanent nurses, and found that supplemental RNs are keeping pace with permanent nurses in the trend toward baccalaureate-degree preparation. Researchers found that the proportion of RNs in both groups holding bachelor’s degrees in nursing (BSNs) increased during that period from 34 percent to 46 percent for supplemental nurses and 33 percent to 50 percent for permanent nurses. In addition, supplemental nurses averaged only three years less experience than permanent nurses, averaging 15 years in 2008 compared with 18 years for permanent RNs.
The data also revealed that supplemental nurses tended to be younger, more diverse and more flexible when it came to relocating. Together, the findings prompted researchers to conclude that supplemental nurses could be one key to meeting the challenges posed by an aging nursing workforce, the projected nursing shortage, and an increasingly diverse U.S. population.
“Our study shows that supplemental nurses have roughly the same education and experience qualifications as permanent nurses,” said Xue. “Especially important is that they are increasingly earning bachelor’s degrees, and there is growing evidence that higher proportions of nurses with bachelor’s degrees or higher are associated with better outcomes for patients. The nursing shortage is now projected to return in 2018. We would expect to see the demand for these nurses increase in the future.”
Lower Mortality Rates for Surgery Patients at 'Magnet' Hospitals
Surgery patients at hospitals that have earned recognition from the American Nurses Credentialing Center (ANCC) Magnet program have a 14-percent lower mortality rate, according to a study published in October in Medical Care.
The research team included Matthew McHugh, PhD, JD, MPH, RN, CRNP, an RWJF Nurse Faculty Scholar, and Linda Aiken, PhD, RN, FRCN, FAAN, a 1998 recipient of an RWJF Investigator Award in Health Policy Research. Aiken is a professor of nursing and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing; McHugh is an assistant professor of nursing at the center.
About 8 percent of hospitals nationwide have been recognized as Magnet hospitals, meaning that they meet a set of criteria for quality patient care, nursing excellence, and innovation in nursing practice.
McHugh and Aiken's team examined two years of data from hospitals in four states—56 Magnet hospitals and 508 non-Magnet hospitals. The Magnet hospitals were found to have "14 percent lower odds of mortality…and 12 percent lower odds of failure-to-rescue."
“The lower mortality we found in Magnet hospitals is largely attributable to measured nursing characteristics, such as significantly better work environments, investments in a more highly qualified and educated nursing workforce, and practice settings supportive of high-quality nursing care,” Aiken said in an ANCC news release. “But there is a mortality advantage above and beyond what we could measure, which suggests that the process of applying for and retaining Magnet recognition identifies existing quality and stimulates further positive organizational behavior and innovation that improve patient outcomes."
Longer Shifts Linked to Nurses Dropping Out of Profession and to Patient Dissatisfaction
Hospital nurses who work long shifts are more likely to leave the profession, according to new research, and the patients they care for are more likely to be dissatisfied.
The research team included Amy Witkoski Stimpfel, PhD, RN, and Linda Aiken of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Stimpfel is a research fellow at the center; Aiken is its director. They examined three years of data on 23,000 RNs in several states.
Their conclusion: "As the proportion of hospital nurses working shifts of more than 13 hours increased, patients’ dissatisfaction with care increased. Furthermore, nurses working shifts of 10 hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction and to intend to leave the job. Extended shifts undermine nurses’ well-being, may result in expensive job turnover, and can negatively affect patient care. Policies regulating work hours for nurses, similar to those set for resident physicians, may be warranted. Nursing leaders should also encourage workplace cultures that respect nurses’ days off and vacation time, promote nurses’ prompt departure at the end of a shift, and allow nurses to refuse to work overtime without retribution."
The study appears in the November issue of Health Affairs.
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