Category Archives: Work environment
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the August issue.
More Nursing Schools Preparing Students to Provide Team-Based Care
Several of the nation’s top nursing schools now require students to participate in at least one interprofessional education course or activity, reports the Future of Nursing: Campaign for Action. Experts have called for interprofessional education for decades, but more health professions schools are responding now because requirements are being written into health professions accreditation standards, says Barbara Brandt, PhD, head of the National Center for Interprofessional Practice and Education, a public-private partnership supported by RWJF, the U.S. Health Resources and Services Administration, and other organizations.
Physical Work Environment in Hospitals Affects Nurses’ Job Satisfaction, With Implications for Patient Outcomes, Health Care Costs
A study conducted by RWJF’s RN Work Project finds that a physical work environment that facilitates registered nurses’ efficiency, teamwork and interprofessional communication relates to higher job satisfaction. The study revealed that physical environment affected whether nurses could complete tasks without interruptions, communicate easily with other nurses and physicians, and/or do their jobs efficiently.
This is part of the August 2014 issue of Sharing Nursing’s Knowledge.
Violence Against Emergency Nurses
For many nurses working in emergency departments, physical violence and verbal abuse is a common occurrence. One survey found that more than half of emergency nurses had experienced such incidents within the previous week. Research suggests a number of contributing factors, including long wait times and patients who have psychiatric problems or are under the influence of drugs or alcohol. According to a study published in the July 2014 issue of The Journal of Emergency Nursing, while data on the frequency of such incidents is readily available, less study has been devoted to nurses’ personal experiences with assaults, including the circumstances and consequences of the incidents.
With that in mind, a research team led by Lisa A. Wolf, PhD, RN, CEN, conducted a qualitative analysis of 46 nurses’ personal accounts of assaults. Several common themes stood out:
- A number of nurses talked about what the researchers described as a “culture of acceptance” of an “unsafe workplace.” For example, hospitals discouraged nurses from pressing charges or prosecutors declined to pursue cases. Some nurses said safety measures such as security or panic buttons were not maintained. Others noted that despite signs being posted that warned that anyone who committed violence, made threats, or acted out in other ways would be ejected from the hospital, such behavior was tolerated.
- Many nurses described the impact of assaults in personal terms, saying they had “lingering psychological trauma that continues to impede their ability to work in the emergency setting.” Some reported chronic pain from injuries sustained during violent incidents, but said they continued to work full time. Others reported having to leave the profession because of the extent of injuries.
- Nurses described what researchers identified as missed cues that violence was about to occur, usually from patients from whom such behavior might have been anticipated. One example is a patient taken to the emergency room for ingesting multiple drugs and placed only in soft restraints. Another example involved individual nurses being left alone with patients brought in for psychiatric evaluation who had been verbally abusive to paramedics.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
RWJF Clinical Scholar Chileshe Nkonde-Price, MD, shared her experiences with the medical system during the last week of her recent pregnancy in a video featured on Nasdaq.com. Despite have given birth via Cesarean section earlier, Nkonde-Price wished to deliver vaginally with this pregnancy if she could do so safely. C-section has become the nation’s most common major surgery, the piece says. It examines some of the factors behind the sharp increase in the number of women delivering via C-section in the United States.
In a Health Affairs Blog, José Pagán, PhD, analyzes Medicare’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excessive 30-day readmissions for conditions such as pneumonia and heart failure. While Pagán says that not all readmissions can be avoided, hospitals can improve their performance through effective discharge planning and care coordination. With more incentive programs on the horizon, Pagán suggests that health care organizations “seek and monitor collaborative partnerships and, more importantly, strategically invest in sustaining these partnerships” so they can survive and thrive. He is an RWJF Health & Society Scholars program alumnus and recipient of an RWJF Investigator Award in Health Policy Research.
A study led by RWJF Nurse Faculty Scholar Lusine Poghosyan, PhD, RN, looks at how Nurse Practitioners (NPs) rate their work environments. It finds that those working in Massachusetts fared better that those working in New York on every topic in the survey: support and resources, relations with physicians, relations with administration, visibility and comprehension of their role, and independence of practice. The survey also found that NPs working in community health clinics and physicians’ offices rated their work experiences better than NPs working in hospital-affiliated clinics. Poghosyan told Science Codex the findings suggest “the practice environment for NPs in New York can improve once the state’s NP Modernization Act,” which will expand NPs’ scope of practice, takes effect.
This is part of the July 2014 issue of Sharing Nursing's Knowledge.
ABC’s NY Med, a documentary series about hospital life, has a lesson for nurses in the digital age: Think before you post.
Katie Duke, RN, an emergency room nurse at NewYork-Presbyterian Hospital who is featured in the series, learned that lesson the hard way.
During the show’s season premiere on June 26, Duke was summarily fired after posting a photo of a messy trauma room on a social media website. She was hired soon after at a different hospital, according to an article about the episode on AOL.com.
“I’ve been in that emergency room for six years ... in a matter of ten minutes, I am no longer,” Duke said, according to the AOL article. “This post that has gotten me fired was a picture of an empty trauma room with a comment underneath.”
The health care industry is not in the healthiest state when it comes to weight, according to a study published in the American Journal of Preventive Medicine. Analyzing data from the 2010 National Health Interview Survey and adjusting for confounding factors such as race, gender, and smoking, researchers identified two industries—public administration (36%) and health care and social assistance (32%)—as having significantly higher-than-average obesity rates.
Long work hours and hostile work environments were among factors that contributed to higher obesity rates, researchers found. Within the health care industry, obesity rates were lower for health care practitioners and for workers in technical occupations than they were for health care support occupations (such as home health aides and nursing assistants), “suggesting that the impact of working conditions on obesity may be especially harmful for lower-income workers,” the researchers wrote.
Out of 20 industries in the study, real estate workers had the lowest obesity rate, at just under 20 percent.
Has a push for increased efficiency in health care come at the expense of physicians’ happiness? That’s a big question explored recently in a Becker’s Hospital Review article.
Molly Gamble writes:
Physician stress and engagement issues were not born from reform.... But now other factors—such as increased workloads, electronic medical records and physicians’ apprehension to work for hospitals—add another layer of complexity. Healthcare’s pursuit of efficiency seems to be making the adoption of other values it endorses, such as patient-centeredness and continuity of care, more difficult.
Physicians’ interactions with coworkers and patients are changing, according to the article—and the learning curve for electronic medical records and other technological advances has left many physicians looking at screens more and patients less.
Ten years ago, a report from the Institute of Medicine (IOM) proposed a transformation of nurses’ workplaces, warning that “The typical work environment of nurses is characterized by many serious threats to patient safety.” The latest issue of the Charting Nursing’s Future policy brief series from the Robert Wood Johnson Foundation (RWJF) focuses on how much has changed in the intervening years, and how much remains to be done.
The new brief identifies a series of initiatives designed by and for nurses that have “spurred the creation of work environments that foster health care quality and patient safety.” Among them:
- The RWJF-backed Transforming Care at the Bedside (TCAB) initiative, developed in collaboration with the Institute for Healthcare Improvement, which seeks to empower frontline nurses to address quality and safety issues on their units, in contrast with more common, top-down improvement efforts. TCAB is now integrated with Aligning Forces for Quality (AF4Q), RWJF’s signature effort to improve the quality of health care and reduce disparities in targeted communities.
- Another RWJF-backed project, Quality and Safety Education for Nurses (QSEN), focuses on nursing school faculty, and has helped prepare thousands teaching in graduate and undergraduate programs to integrate quality and safety competencies into nursing school curricula.
- On the policy side, efforts have been made to further examine and improve the adequacy of nurse staffing. For example, a number of jurisdictions, including California, Illinois, Washington state, and Minnesota, have adopted standards that either require or encourage limits on how many patients a given nurse may be assigned to care for in acute care hospitals. Subsequent research has demonstrated an impact on hospital policies, but evidence of improvements in cost, quality, and safety is mixed so far.
- A number of institutions, including Vanderbilt University Medical Center in Nashville and The Johns Hopkins Hospital in Baltimore, have taken aim at disruptive behavior and professional discourtesy in the workplace, noting that, given the growing importance of teamwork and collaboration, the consequences of such misbehavior can be “monumental when patients’ lives are at stake.”
Health care may have some of the nation’s most promising career opportunities. But it also promises a lot of stress to go along with those jobs, according to a survey from CareerBuilder and its health-care-focused website.
Health care workers topped the list of most stressed workers in the United States, with 69 percent reporting that they feel stress in their current jobs. Next are workers in professional and business services, retail, financial services, information technology, leisure and hospitality, and manufacturing. Health care also had the highest percentage (17) of workers reporting that they are “highly stressed.”
“Stress is part of the environment in many health care settings, but high levels sustained over a long period of time can be a major detriment to employee health and ultimately stand in the way of providing quality care to patients,” CareerBuilder Healthcare President Jason Lovelace said in a news release.
Human Capital Blog: How does your study differ from previous research exploring the link between adverse working conditions and depression?
Sarah Burgard: The main contribution of this study was in the way we measured working conditions. Most studies that have looked at adverse working conditions and depression, or other measures of health, have looked at one adverse working condition at a time, such as job strain, job insecurity, or job dissatisfaction. But every job comes with a whole package of working conditions. We felt that capturing multiple indicators at the same time might give us a truer sense of the size, the magnitude, and the power of the association between work and depression.
Also, while some previous studies relied on longitudinal data that included multiple interviews with workers over time, they often excluded workers who did not participate in every interview because those workers didn’t have a measure of the focal working condition at every possible interview. That’s a problem because people who have worse jobs are probably more likely to drop out of longitudinal studies or leave work. Our approach was different; we analyzed data from everyone who participated in at least one interview, using all possible working conditions measure collected at each wave. We created an “overall working conditions score” at each wave using item response theory models. As a result, were able to get a more representative picture.
In a survey of more than 31,000 U.S. physicians for Medscape’s 2014 Physician Lifestyle Report, dermatologists emerged as the specialists who are happiest both at home and at work. Seventy percent of dermatologists said they are very to extremely happy at home, slightly behind ophthalmologists. But at 53 percent, dermatologists topped the list by a considerable margin in reporting a high level of happiness at work.
Among the least happy specialists are family and emergency medicine physicians, with only 36 percent reporting great happiness at work, followed at 37 percent by internists and radiologists.