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Nurses work at the frontline of patient care. We collaborate and work with other healthcare professionals, but usually provide the most direct patient care. This extra time spent serving as an advocate, resource, and educator, while helping patients facilitate their healthcare journey has prompted the nursing profession to sometimes be thought of as the heart of healthcare. It’s also contributed to nurses earning the honor of being voted the most trusted profession for the 16th consecutive year in the Gallup honesty and ethics polls. Although, the nursing profession isn’t without its challenges.
The shift toward quality, value-based patient care with a heightened emphasis on population care that focuses on increased health promotion and holistic patient-centered care, requires a larger, more diverse, and highly educated nursing workforce. To continue to support patients, and manage their care, nurses must resolve to seek solutions for current issues within the nursing profession. Nurses are rising to the challenge, and efforts have already begun to tackle current issues and implement positive changes for the future of the nursing profession.
Issue - Nurse Staffing and Recruitment
Nurse staffing shortages are not a new issue. The challenge of maintaining adequate staffing to meet the increased demand for nurses remains ongoing. Insufficient staffing can contribute to additional issues that affect job satisfaction and the provision of quality care. As one of the fastest growing healthcare fields, nursing is anticipated to grow by 15 percent from 2016 through 2026. This is faster than average according to the Bureau of Labor and Statistics.
This age-old staffing problem, and present nursing shortage, challenges us to meet this need due to a combination of factors that are increasing the demand for nursing staff. These include:
The Affordable Care Act (ACA) has enabled more patients to acquire access to healthcare. Some patients may have never had healthcare before, and many patients may be more diverse or have complex healthcare needs.
The nursing shortage is aggravated by several. With an aging nursing workforce, and the pending retirement of baby boomers combined with an inadequate nursing faculty to educate future nurses, recruiting and retaining an adequate supply of nurses is even more challenging.
A shortage of nursing faculty. The wide gap between clinical and academic salaries, and the need for additional experience and education may have contributed to the lack of adequate nursing faculty. The nursing faculty shortage has forced some universities to limit the student capacity for their nursing programs.
Make a Resolution to Seek a Staffing Solution
Nurses are unique in that they can choose multiple education pathways. Although it’s felt that additional education can help nurses successfully navigate increasingly complex patient needs. Advanced education can also allow nurses to take on additional roles and responsibilities within the nursing profession.
The Affordable Care Act (ACA) was one of the prompts to inspire The Robert Wood Johnson Foundation and the Institute of Medicine (IOM) to begin working toward making nursing education a seamless academic progression with a goal of having 80% of nurses obtain a Bachelor of Science (BSN) by 2020. They recognized the need to rethink some of the roles of the nursing profession and increase their education, to meet the needs of an aging, more diverse, patient population.
This progress to transform the nursing profession continues, with the intent to improve effective care for the changing patient population. Having more BSN prepared nurses can also result in shorter hospital stays, lower healthcare costs, reduced patient mortality rates, and improved patient outcomes.
Issue - Struggling with Nurse Retention
Although once nurses obtain a position, the environment and culture of the organization must provide positive benefits to encourage them to stay. Organizations that focus more on recruiting nurses, and then not making efforts to make positive changes to retain them, often endure ongoing struggles to retain nurses and maintain adequate staffing levels. Retention issues that may occur due to the facility environment and culture can include:
Inadequate staffing levels
High staff turnover
A wage or benefit package that isn’t competitive
Inadequate time to provide patient care
Nurse bullying or incivility
Fear of workplace violence
Inability to achieve a satisfactory work and life balance
Lack of opportunities for advancement
Resolve to Work to Retain the Nursing Staff Gained
Poor retention affects more than the organization. Inadequate staffing can disrupt productivity, impact patient care, and decrease job satisfaction. Patient satisfaction is often linked to the quality and contentment of the nursing staff, so neglecting issues within the nursing environment can spur a vicious cycle of patient dissatisfaction and nurse turnover.
Issue - Overwhelming Stressors in the Workplace
The healthcare environment may be fast paced and ever changing, but it’s not normal for nurses to be constantly overwhelmed and exhausted. Passion isn’t always enough to sustain nurses through the physical and mental demands of the job, yet many neglect their own mental health and wellness. Some may even feel as if it’s a sign of weakness to admit to these feelings, or as if they should be able to handle everything on their own, get over it, or that it’s part of the job. But long shifts, working extended days in a row along with conflicting demands can lead to fatigue and burnout.
Many nurses overlook the signs to slow down, implement personal preventative care measures, or seek treatment. A negative or toxic work environment may be related to some of these issues. This can result in other mental or physical issues overlooked or unnoticed such as:
Burnout- The cause and the way the symptoms of burnout manifest can vary. This can lead to an increased risk of medical errors, may affect patient care, impact job satisfaction, and increase turnover.
Post-Traumatic Stress Disorder (PTSD)–Intense, ongoing stressors combined with staffing issues may leave little to no time to process a distressing event at work.
Bullying, harassment, and incivility- The RNnetwork survey indicates that 45 percent of nurses report being harassed or bullied by peers. Repeated, unwanted harmful actions intended to humiliate or offend the recipient can infect staff with fear and humiliation, decrease productivity, increase absenteeism and increase turnover.
Alarm fatigue- The multitude of devices meant to assist and alert staff to patient needs can result in sensory overload and desensitization. Their purpose is defeated when nurses ignore, overlook, or are unable to differentiate critical or routine alarms. Alarm fatigue can become counteractive to enhancing patient safety.
Resolve to Commit to a Supportive Environment
The way we treat each other is as important as the care provided. Nurses should respectfully support each other as professionals and encourage others to adhere to the advice they give to their patients and realize that mental health can be just as important as physical health to provide safe care. Nurses are less likely to encourage others to enter the nursing field if they aren’t engaged, or don’t feel supported, or appreciated, in the workforce.
Promote a professional environment that realizes value and shares goals and success to attract and maintain the best employees by:
Recognize and hold people accountable by rejecting negative behavior and reinforcing what behaviors are unacceptable and detrimental
Align a positive atmosphere to patient outcomes to attract and retain staff who support each other and the organization
Encourage and model clear, calm communication that’s mindful of volume and body language
Nurture a culture of mental and physical wellness and invest in individual health needs
Seek evidenced-based practice to develop an approach for alarms to perform appropriately and reduce false alarms and risks accompanying alarm fatigue
Issue - Increased Risks of Workplace Violence & Job Hazards
Performing procedures which can cause discomfort or pain for patients that may be fearful or confused can put nurses at risk for workplace violence. The risk of physical or verbal abuse from patients, or family members, can be exacerbated by inadequate staffing and can contribute to an undesirable, unsafe, work environment.
The Occupational Safety and Health Administration (OSHA) states that from 2002-2013 the rate of serious workplace violence was 4 times greater in healthcare than private industry. This may be even higher since many may not report because they don’t want to lose time, think reporting won’t make a difference, or that violence is part of the job.
The highest rates of violence usually occur in the emergency room and psychiatric units due to substance abuse, cognitive impairment, waking from anesthesia, fear or frustration. This risk for violence for nurses is in addition to the environmental and physical risks associated with the job due to injuries from patient care, exposure to bloodborne pathogens or needle sticks. The increased age of much of the nursing workforce, inadequate staffing hectic pace, fatigue and long hours, can result in decreased alertness and awareness and increase the risk of injury.
Resolve to Reduce the Risk
Education and awareness of situations with increased risk and incorporating a zero tolerance for violence can assist with proactively addressing these issues. Other methods to work to decrease the risk of violence and injury include:
Emphasize the importance of reporting and documenting
Report and gather data regarding incidents and risks
Set a zero-tolerance policy standard
Develop an expected code of conduct
Build awareness of the importance of ergonomics to reduce injuries
Educate on awareness and how to identify and address if there is a risk for performing safe care
Remove items in the patient care areas that could be used as a weapon
Ensure there is adequate lighting and an awareness of available exits in a crisis
Encourage clear patient communication on what to expect for their treatment, and wait times
Alert staff if patients have a history of violence
Issue - Meeting the Needs of Diverse Patient Populations
The patient population is becoming increasingly diverse. Striving to increase diversity in nursing staff, and education on cultural awareness can assist with improving cultural competency. Knowledge of cultural differences, expectations and how to identify personal assumptions, can assist nurses to reduce communication and cultural barriers to care.
This could potentially lead to better patient compliance and outcomes. Many patients are reassured to have a caregiver from the same ethnic or racial background. They may be able to better understand cultural preferences, communicate more effectively and appreciate the patient’s perspective. This can help in gaining patient trust and confidence in the care and increase patient satisfaction.
Resolve to Educate and Incorporate Cultural Awareness
Patients depend on nurses to adhere to their professional obligation to make healthcare decisions that balance treatment options and patient wishes. The nurse may not agree with the patient’s beliefs, or may struggle with conflicting personal values, but should still strive to provide care in the client’s best interest. Cultural awareness can help the nurse understand and support the patient’s unique care needs even if they conflict with the nurse’s personal beliefs.
Education and understanding on cultural diversity can increase awareness of personal attitudes, and beliefs, and allow nurses to provide fair treatment to patients regardless of their economic status, race, religion, ethnicity or gender identification.
Factors such as the changes in the economic environment, stable employment options, and the variety of settings and opportunities for advancement have played a role in increasing diversity in nursing: This has also influenced males and other minority groups to pursue nursing. This may help ensure the nursing profession can be sensitive to cultural specific needs while providing care for diverse populations.
Developing and supporting a more diverse, culturally aware, ethical environment may increase the nurse’s comfort in speaking up to act as a patient advocate and provide culturally appropriate care.
Issue - Blending Generations in the Workforce
Nurses delaying retirement, and an influx of new nurses, has resulted in blended nursing generations in the workforce. Generational differences and efforts to work coordinately can result in conflict and job dissatisfaction. Although individuals can’t be classified by their generation, since each person may have their own unique characteristics and expectations, most are influenced by the period they grew up in and experiences they’ve encountered. Generational differences can affect thoughts and perspectives and impact the ability to work coordinately. The generation we grew up in can also influence:
How we interact
Preferred work and life balance
Methods of communication
Values and beliefs
Significance of education and training
Desire, and preferred method, to be recognized for work performance
Preferred management style
Don’t Overlook Technological Challenges
Today’s nursing workforce must be both clinically skilled and technologically perceptive by balancing hands-on patient care with technology. This can prove challenging with blended workforce generations. Each generation, and individual may have varied comfort levels, and views, regarding technology. Some may be challenged to learn new processes, while others harbor fear and uncertainty.
Resolve to Work to Embrace Generational Differences
Incorporating technology into the workplace can provide opportunities for education and reverse mentoring between generations. If effective methods of learning are considered, opportunities can be created to develop leadership skills for new nurses.
New generations may be more accustomed to utilizing technology, while other generations may be accustomed to relying heavily on touch, sight and smell to gauge the patient’s medical condition. Both methods of patient care have positive benefits. The challenge is to create a balance that doesn’t completely rely on technology while maintaining the human element in nursing care. Ways to strive to embrace generational differences include:
Recognize the unique characteristics and expectations of each generation
Identify traits shared between nurses of all generations to foster teamwork and collaboration
Work toward a sense of purpose and overall goals
Focus on expectations, rather than outcomes, when approaching tasks
Technology and scheduling software can be beneficial to reduce paperwork and to work toward a better work-life balance, reduce overtime and the risk of short staffing. But quality, knowledgeable nursing staff must be available for technology to be effective.
Issue - Striving for Safe Staffing Levels
Staffing is one common element that can affect multiple nursing issues. Inadequate staffing contributes to more than nursing retention. As patients shift out of hospitals for better reimbursement, it can mean shorter stays with patients with more complex needs. Mandatory overtime, long shifts, or extended workday stretches can affect the ability to provide safe patient care. It can also contribute to:
Increased fatigue and rate of injury
Length of patient stay
Resolve to Seek and Support Staffing Solutions
Staffing issues have not gone unrecognized. The American Nurses Association (ANA)recognizes the significance of safe staffing and has implemented surveys, incorporated research and data collection to work toward positive legislative changes. This exploration of optimal staffing levels hopes to emphasize the importance of nurse and patio ratios and the effect on patient outcomes.
Hospital patient levels are constantly fluctuating. Staffing levels are dependent on patient acuity, complexity of care, the number of admissions, discharges, transfers, and the skill level and expertise required. Nurses have the best judgement on staffing levels and how to best manage flexible staffing while supporting each other. Working toward mandated staffing levels may help reduce the risk of patient harm and improve nurse job satisfaction.
Find Our Voice for Ourselves and Our Patients
The role of the nurse continues to grow to meet the complex demands of the healthcare system. Nurses need to become change agents and have a voice for themselves, and their patients, to work toward being full partners in redesigning healthcare. Nurse’s voices are important and can contribute the expertise acquired from education and experience across many healthcare settings and specialties.
Nurses Can Get Involved by:
Volunteering and participating in committees
Continuing with personal and professional growth and education
Becoming a mentor to:
Appreciate, and explain, the history of why tasks are done the way they are, and to take a critical look for areas for improvement
Share expertise, guide and educate
Inspire and empower future nurses and nurse leaders
Gain a feeling of ownership in the success of the organization
Bridge generational gaps by comprehending the strengths of different generations
Contribute toward a positive workplace culture
Display a willingness to embrace change
Acquire a fresh perspective on the newest and latest trends
Nurses Voices Carry
Nurses can make a difference by taking ownership of the nursing profession and committing to change the culture and status quo by getting involved within their organization, their community and contributing their voice to public policy. Nurses are generally underrepresented when major healthcare decisions occur. The Nurses on Boards Coalition is making strides to correct that with a goal of having 10,000 nurses on boards by 2020.
To begin acquiring a broader strategic mindset nurses can:
Start prepping mid-career to prepare
Work with a mentor, or other members of the board
Take courses on presentation skills and public speaking to build confidence
Recognize that nurses have valuable contributions
Serving on a board can be personally and professionally rewarding. It may also provide opportunities to enhance professional networks, impact public and community health, and be on the forefront of strategic planning. If nurses become a voting member in decision-making roles in healthcare they can:
Have a seat in decision making
Hold other board members accountable for decisions
Be the voice for nurses and patients
Bring the patient perspective
Resolutions for Future Change
The Robert Wood Johnson Foundation(RWJF) initiative, The Future of Nursing: Campaign for Action, emphasized improving access to care, collaboration, diversity, healthier communities, nurse leadership and education. We’ve made great strides toward these goals, but continue to have more work to do. Many of the issues in nursing are interrelated and ongoing. But by making small steps, and increasing involvement within, and outside, organizations, nurses can work to find their voice to make a better future for our patients and ourselves.
The public continues to place their trust in the nursing profession to provide compassionate, honest and ethical care, and nurses are honored to provide it. Recognizing the contributions and impact of nurses can help us realize that together we can lead positive changes for the nursing profession and lift each other up for future success.
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HealthLeaders Top 10 Nursing Stories of 2018
Low Nurse Staffing Increases Risk for Inpatient Death
Our Nation Needs More Nurses on Boards
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The Case for a Nurse Trustee
Update on Future of Nursing Report: Are We There Yet?