Category Archives: Medical, dental and nursing workforce
This is part of the April 2014 issue of Sharing Nursing’s Knowledge.
ICU Staffing’s Impact on Patient Outcomes
A nurse-led study from the United Kingdom has found that higher numbers of doctors and nurses in intensive care units (ICUs) have a positive effect on survival rates for high-risk patients.
A research team led by Elizabeth West, PhD, MSc, RN, Director of Research in the School of Health and Social Care at the University of Greenwich, used data on 38,000 patients in 65 ICUs in the United Kingdom, correlating patient outcomes with staffing levels for doctors, nurses, and support staff. They found that “higher numbers of nurses per bed ... and higher numbers of ‘consultants’ [senior hospital-based physicians or surgeons] were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death.”
“It seems reasonable to argue,” the researchers conclude, “that skilled nurses, who have the time to observe patients closely, to intervene or mobilise the team if they begin to deteriorate, would be most important to patients who are at the greatest risk. This study is the first to produce evidence that this is the case.” Their findings are published in the May 2014 issue of the International Journal of Nursing Studies.
Nurses are “the backbone of efforts” to expand New Mexico’s primary care workforce, according to Gov. Susana Martinez, and they help ensure that people living in the state’s rural and underserved communities can get the high quality care they need and deserve. A video from the governor helped open the Robert Wood Johnson Foundation Academic Progression in Nursing meeting in Washington, D.C., this week, which brought together nurse leaders from around the country. In her remarks, Governor Martinez explains why New Mexico has implemented a common statewide nursing curriculum, made it easier for nurses in the state to further their education, and placed “a strong emphasis on nurses.”
This is part of the March 2014 issue of Sharing Nursing’s Knowledge.
It took Arnold S. Relman, MD, one of the nation’s foremost medical thinkers, nine decades and a full-blown medical catastrophe to fully appreciate the value of nurses, according to an essay he penned in the Feb. 6 edition of the New York Review of Books.
Relman, 90, a doctor, a professor emeritus at Harvard Medical School, and a former editor of the New England Journal of Medicine, learned this lesson the hard way: as a patient. Last summer, Relman fell down the stairs and suffered life-threatening injuries—and discovered the critical role nurses play in health and health care during his lengthy recovery.
He shared his late-in-life epiphany in his recent essay: “I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled,” he wrote. “This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.”
Relman’s remarks spawned a surprise reaction from Lawrence K. Altman, MD, who begged the following question in a post on the New York Times Well Blog: “How is it that a leading medical professor like Dr. Relman—who has taught hundreds of young doctors at Boston University, the University of Pennsylvania (where he was chairman of the department of medicine) and Harvard—might not have known about the value of modern-day Florence Nightingales?”
What do you think? Do medical educators and scholars fully appreciate the contributions nurses make? Register and leave a comment.
This is part of the March 2014 issue of Sharing Nursing’s Knowledge.
Comparing Nurse and Physician Performance on Colonoscopies
A new study finds that colonoscopies performed by nurse and physician endoscopy trainees are comparable in terms of quality and safety.
Researchers in The Netherlands studied 15 endoscopy trainees—seven nurses and eight physicians—at two medical centers over the course of three-and-a-half years. At the beginning of the study, none had experience in endoscopy. All were trained according to the applicable regulations of the Dutch Society of Gastroenterology, performing a minimum of 100 colonoscopies. After completing their training, each performed 135 consecutive colonoscopies under the supervision of a gastroenterologist, with their work evaluated for safety and quality.
The nurse group and the physician group had comparable results on both measures, with the nurse group producing marginally better scores in some areas. Each group detected the same percentage of adenomas (benign polyps), and had the same low rate of complications. The nurses had slightly higher rates of cecal intubation (successfully passing the colonoscope to a key part of the colon), and slightly higher rates of completing the procedure without assistance.
This is part of the February 2014 issue of Sharing Nursing’s Knowledge.
Nurses’ Perceptions of Their Workplaces
A new survey offers insights into how hospital nurses perceive their workplace and profession. Jackson Healthcare, a health care staffing company, surveyed 1,333 hospital nurses. Among the findings:
- Nearly two-thirds of surveyed nurses (64 percent) say they are satisfied or very satisfied with their jobs.
- Sixty-seven percent say they have less time at patients’ bedsides than they wish because they must perform activities that other hospital personnel could be doing, including looking for equipment and supplies, and restocking supply areas.
- Sixty-six percent cite inadequate staffing levels in their hospitals, saying that limited coverage and clinical support force nurses to divide their time between more patients.
- Almost half of nurses surveyed reported a nursing shortage at one or more of the units in their hospitals, with 35 percent citing the medical-surgical department as short-staffed, 18 percent pointing to critical care, and 17 percent to the emergency department.
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.
Enrollment in registered nurse (RN) programs has increased for the 13th consecutive year, according to preliminary data from the fall 2013 nursing school enrollment survey conducted by the American Association of Colleges of Nursing (AACN). But with a 2.6 percent enrollment increase from 2012 to 2013, entry-level baccalaureate nursing programs saw their lowest growth rate in five years.
Though interest in nursing careers remains strong, AACN said in a news release, many qualified individuals seeking to enter the profession can’t be accommodated in nursing programs. The preliminary data show that 53,667 qualified applications were turned away from 610 entry-level baccalaureate programs in 2013, and AACN expects that number to increase when final data are released in March.
The primary barriers to accepting all qualified nursing school applicants continue to be a shortage of faculty, clinical placement sites, and funding, AACN reports.
The 2013 survey shows stronger growth rates for RN-to-BSN programs, at 12.4 percent, as well as master’s programs (4.4 percent) and doctor of nursing practice programs (21.6 percent).
More than 1,000 veterans will obtain undergraduate degrees in nursing over the next four years with the help of a grant from the Health Resources and Services Administration. The grant was announced earlier this fall.
The multi-million-dollar effort, known as the Veterans’ Bachelor of Science in Nursing (VBSN) program, will allow veterans to build on their combat medical skills and experience and receive academic credit for prior military training and experience. The program provides funding to nine institutions to recruit veterans and prepare VBSN undergraduates for practice and employment in local communities, and also develop career ladders that include academic and social supports, career counseling, mentors, and linkages with veteran service organizations and community health systems.
Participating institutions include three in Florida: Jacksonville University, Florida International University, and the University of South Florida; two in Virginia: Hampton University and Shenandoah University; as well as the University of Texas at Arlington, the State University of New York at Stony Brook, Davenport University in Michigan, and the University of Alabama at Birmingham (UAB).
Staffing company AMN Healthcare has released the results of its 2013 Survey of Registered Nurses, highlighting generational differences that have implications for the imminent nursing shortage and the shape of the profession in years to come.
Among key findings, nearly 190,000 nurses may leave nursing or retire now that the economy is recovering, and nearly one in four nurses age 55 and older (23 percent) say they will change their work dramatically by retiring or pursuing work in another field.
Fewer than half the RNs with an associate degree or diploma who were surveyed say they will pursue additional education in nursing. However, younger and mid-career nurses are more likely to do so. The landmark Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health, recommends that 80 percent of the nation’s nurses have BSN or higher degrees by the year 2020.
While nurses of all ages say they are very satisfied with their career choice, younger nurses (19-39) are much more positive than nurses 55 and older about the quality of nursing today. Sixty-six percent of nurses 55 and older say they believe that nursing care has generally declined.
“The younger generation is more optimistic about the profession and more receptive to the changes the industry is experiencing,” Marcia Faller, PhD, RN, chief financial officer of AMN Healthcare, told Advance for Nurses. “These are differences that health systems must understand as they work with multiple generations of nurses.”
This was the fourth annual RN survey conducted by AMN Healthcare, which emailed 101,431 surveys in April to opted-in members of NurseZone.com and RN.com. The company received 3,413 responses, reflecting a response rate of 3.36 percent. Statistical analyses were run with a 95 percent confidence threshold.
What do you think about the survey findings? Do they reflect your views about the future of nursing? Register below to leave a comment.
Michael Hochman, MD, MPH, is medical director for Innovation at AltaMed Health Services, a 43-site federally qualified health center in Southern California. He completed the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program at the University of California, Los Angeles, and the U.S. Department of Veterans Affairs in 2012. While a Clinical Scholar, Hochman co-led a primary care demonstration that was published last month in JAMA Internal Medicine. He recently published, 50 Studies Every Doctor Should Know.
Primary care in the United States is at a crossroads. As health care becomes increasingly disjointed and costs continue to rise, primary care providers face increasing pressure to take charge of the health system. Indeed, we know that health care systems with more developed primary care infrastructures are more efficient and of higher quality than those with a weaker primary care foundation.
But at the same time, more and more health care professionals are shying away from careers in primary care. Not only is the work challenging (late-night phone calls, numerous tests and studies to follow up on, ever-increasing regulatory requirements), but the pay is lower than in other fields of medicine.