Category Archives: Workforce supply and demand
A new report from the Institute of Medicine (IOM) criticizes an absence of transparency and accountability in the nation’s graduate medical education (GME) financing system, which was created in conjunction with the Medicare and Medicaid programs nearly five decades ago. The 21-member IOM committee behind the report says there is “an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME,” and it recommends “significant changes to GME financing and governance to address current deficiencies and better shape the physician workforce for the future.”
Because the majority of public financing for GME comes from Medicare and is rooted in statutes and regulations from 1965 that don’t reflect the state of health care today, the committee’s recommendations include a modernization of payment methods to “reward performance, ensure accountability, and incentivize innovation in the content and financing of GME,” with a gradual phase-out of the current Medicare GME payment system.
Peter Buerhaus, PhD, RN, is the Valere Potter Distinguished Professor of Nursing, director of the Center for Interdisciplinary Health Workforce Studies, and professor of health policy at Vanderbilt University Medical Center. He co-authored a new study in Health Affairs that found more nurses are delaying retirement, which is adding to the supply of nurses at a time when shortages had been projected.
Human Capital Blog: A decade ago, you forecast large shortages of nurses by the middle of this decade. That isn’t panning out yet. Why?
Peter Buerhaus: When we did the original research, which was published in 2000 in the Journal of the American Medical Association, we were using data that was available at that time, which was up to about 1997 or 1998. At the time, we observed that enrollment in nursing schools had dropped nearly 5 percent each year over the previous five years. Based on that and some other factors, our projections suggested that unless something big happened—namely that we would get a lot of new people to enter nursing to replace the aging and large number of retiring Baby Boomer registered nurses (RNs)—we would run into large shortages and the RN workforce would stop growing by around 2014 or 2015.
Now we’re seeing two new phenomena: First, there has been a great surge of interest in nursing since the mid-2000s, and this has been reflected in a dramatic increase in the number of graduates from associate- and baccalaureate-degree nursing programs. And second, RNs are, on average, spending more time in the workforce—about 2.5 more years than did their peers back in the 1980s and 1990s.
This is part of the August 2014 issue of Sharing Nursing’s Knowledge.
The TV is a funhouse mirror—at least when it comes to its portrayals of nurses.
That’s the view of Leah Binder, MA, MGA, president and CEO of the Leapfrog Group, a national organization that promotes quality and safety in hospitals, and a member of the Future of Nursing: Campaign for Action’s Champion Nursing Coalition.
In a recent essay in the Wall Street Journal’s The Experts blog, Binder says television medical shows badly distort everyday life in hospitals and health care facilities. “Tune to your favorite hospital drama and count how many characters are nurses and how many are doctors,” she writes. “More likely than not, you will find about 10 doctors for every one nurse. The reality is roughly the opposite: There are about 10 times more nurses than physicians in the hospital down the street from you. Most of what hospitals do is deliver expert nursing care.”
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.
The federal government announced on July 7 it had awarded more than $83 million to expand access to care by training hundreds of new primary care providers.
The money will be used to support primary care residency programs in family medicine, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, geriatrics, and general dentistry at 60 health centers across the country. The expanded residency programs will help train more than 550 residents in coming academic year—about 200 more than were trained in the previous academic year, according to the U.S. Department of Health and Human Services (HHS). The funds will also be used to boost the number of states with teaching health centers from 21 to 24.
“This program not only provides training to primary care medical and dental residents, but also galvanizes communities,” said Mary K. Wakefield, PhD, RN, head of the Health Resources and Services Administration, a division of HHS. “It brings hospitals, academic centers, health centers, and community organizations together to provide top-notch medical education and services in areas of the country that need them most.”
A growing demand for acute care nurse practitioners (ACNPs) has created significant opportunity in this field, as well as a significant need for postgraduate residency programs, according to an article in the Journal for Nurse Practitioners.
Faced with issues such as the mandated reduction of work hours for residents, hospitals are turning to ACNPs to boost patient safety and satisfaction, writes Catherine Harris, PhD, MBA, CRNP, director of the ACNP program at Thomas Jefferson University in Philadelphia. Yet ACNP education emphasizes care across the life span instead of focusing on specialties—such as trauma, critical care, and cardiology—that hospital patients count on.
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.
Nearly 40 percent of the country’s 100 most promising employment opportunities are in health care, according to the Best Jobs of 2014 list recently published by U.S. News & World Report.
Although the health care sector dominates the list, it did lose the No. 1 spot (to technology) for the first time since U.S. News launched the annual rankings in 2012. The top 10 jobs include dentist (at No. 3), nurse practitioner (4), pharmacist (5), registered nurse (6), physical therapist (7), physician (8), and dental hygienist (10).
Other health care jobs on the list include occupational therapist, phlebotomist, physical therapy assistant, diagnostic medical sonographer, respiratory therapist, licensed practical and licensed vocational nurse, optician, home health aide, and paramedic.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published nearly 400 posts in 2013. Which were your favorites? Today and tomorrow, as the year comes to an end, we’re taking another look at the posts published on this Blog in 2013 that attracted the most traffic.
A Closer, More Dispassionate Look at Obesity RWJF Scholar in Health Policy Research alumna Abigail Saguy, PhD, discusses how fatness went from being considered a fashion problem to a social problem, a medical problem, and finally the public health crisis we see it as today. She says social perceptions of weight have affected medical interpretations, and shares her concern that some efforts to promote healthy lifestyles will exacerbate weight-based discrimination. Saguy’s interview was also the post most-shared on social media this year, generating more than 2,200 “likes” on Facebook.
A Chief Nursing Officer Who Does Not Have a BSN-Only Hiring Policy in Place In a blog that is both personal and provocative, RWJF Executive Nurse Fellow alumnus Jerry Mansfield, PhD, RN, shares his journey to become a nurse, the setbacks he overcame, and how he has fulfilled his commitment to lifelong learning. He also addresses how he reconciled his support for the Institute of Medicine’s future of nursing education recommendations with the steps he had to take to meet demand for nurses at his institution. Mansfield is chief nursing officer at University Hospital and Richard M. Ross Heart Hospital, and a clinical professor at Ohio State University College of Nursing.
Efforts to increase the percentage of baccalaureate-educated nurses in West Virginia are getting a boost from a new online RN-to-BSN program at the University of Charleston (UC) in the state capital. The program, which will begin in the spring, will allow registered nurses (RNs) to complete requirements for a bachelor of science in nursing (BSN) degree in as little as 18 months.
The university’s president, Ed Welch, PhD, said in a news release that the program “answers an immediate need of West Virginia’s health care facilities. By completing their bachelor’s degree at UC in just 18 months, and continuing to work full time, nurses are able to advance their careers and better serve patients in the field.”
Robert Wood Johnson Foundation Executive Nurse Fellows program alumnus Duane Napier, MSN, RN-BC, formerly executive director of the West Virginia Center for Nursing, is the UC RN-BSN program coordinator. “We’ve had a great response since announcing the program,” Napier said in an interview. “It's the state's first online program that doesn't require any campus sessions, so it's truly designed for the working nurse.”