A new study on paid family and medical leave by the Pew Research Center shows American workers want access to paid time off for family or medical events. But even if they have access, many workers don’t a;ways feel secure to take the leave.
On the whole, Americans appreciate paid time off after a child is born or is adopted, if they have a medical issue that requires time off, or if they need time to care for an ill family member. But many study respondents disagreed on who should absorb the cost and just how reliable the system was.
Despite many calls to elevate the United States’ paid leave policy to that of other countries, respondents were divided over if the government should mandate access to paid leave. Only 51 percent thought that the government should mandate time off in those circumstances while the remaining 48 percent thought employers should be able to decide whether or not to offer employees that benefit.
In general, most people believe that paid family and medical leave is beneficial, with 82 percent believing the benefit should be available to new moms and 69 percent believing new dads should have the option. And if the government mandates the policy, 73 percent said they believed it should be available to both mothers and fathers (only 26 percent thought it should be for new moms only).
The United States stacks up woefully behind many other countries in offering paid parental leave to workers who have just had a child or adopted a child. According to another Pew study, the United States ranks last out of 41 countries in paid leave policy.
But industries are taking notice. Many respondents, while acknowledging that paid family leave was more beneficial to families and individuals than to businesses, said they thought offering the benefit would attract more quality works and also help retain them.
No matter where you work, according to a Henry J. Kaiser Family Foundation study, larger firms tend to offer more access to paid family and medical leave. But the Pew study asserts that many workers don’t take the time even if they are able to for reasons ranging from fear of losing their job to overwhelming job demands.
Those in lower income brackets were much less likely to receive or take paid family leave. Nearly one-third of those with household incomes of $30,000 or less said they were unable to take leave within the past two years although they wanted to, while only 14 percent of those with households of income above that level reported the same.
The study reveals that American workers, while they might support this leave, aren’t always able to, don’t always have access to it, or feel there might be career repercussions if they take the leave.
What do you think about paid family or medical leave for American workers?
Hospitals have dedicated tremendous resources to create an integrated clinical environment that results in better patient care and outcomes, reduces readmissions, and increases hospital utilization, in hopes of reducing the overall cost of health care.
Unfortunately, health IT projects either fall short of business and clinical goals or are completely abandoned at an astonishing rate. Studies vary, but failure-rate estimates range from 35% to 75%.
Overrun budgets and functionality problems are often cited as the primary culprits of doomed implementations. However, the failure to include direct-care clinical staff—including nurses—in the evaluation, implementation, and training of new technology should not be overlooked.
It’s easy to consider a new hardware or software solution and imagine its transformative potential. Health care trade shows brim with thousands of devices, enterprise systems, and software applications marketed as painless solutions for any clinical challenge facing a hospital or care unit. But a poorly implemented system that did not evaluate the impact to the clinical workflow can just as easily exacerbate inefficiencies and reduce the overall quality of patient care.
Equipment that doesn’t work properly or causes needless redundancies in daily tasks is enormously frustrating. The lack of sufficient training and vendor support increases the chances of mistakes or encourages direct-care staff to either work around a new solution or outright revolt at go-live.
A Shared Vision
Many of the doomsday scenarios associated with technology adoption and implementation can be mitigated with adequate planning, training, and collaboration. By listening to, engaging with, and educating front-line staff, hospitals can dramatically increase their chances of success with technology adoption.
For example, consider medical devices with alarm capabilities. Nursing staff are charged with the proper setting of the alarms and the prompt response when any of the devices send an alert. As the presence of alarm equipment continues to grow, nurses find their workflow and ability to engage with patients disrupted as they chase down hundreds of (often non-actionable) alarms. Without proper education and implementation of alarm devices, it’s all too easy to imagine clinical staff arbitrarily adjusting alarm settings—or even turning them off entirely.
Involving direct-care staff is critical to the success of any new technology. How will this new technology impact how nurses deliver patient care? What adjustments in workflow and practice need to be made—at go-live and beyond? Starting with these questions fosters buy-in from the staff who will be utilizing this equipment. If end-users are not involved in the selection, adoption, and implementation of a technology, then the likelihood that they will become owners of that product is significantly lower.
Environmental and Workflow Assessments
Hospitals each have their own unique characteristics, culture, and needs. Identifying and documenting those attributes are critical to any successful health IT implementation. To achieve measurable progress in health IT adoption requires that hospitals identify and support internal champions in all relevant departments.
For hospitals and health systems, especially those that are breaking ground on new technology integration, the first step is an assessment of needs and potential impact to workflow. The formidable task list that comes with any technology implementation requires the input and expertise of a project team, which ideally, should be comprised of leadership from myriad stakeholders, including IT networking, facilities, patient safety experts, educators, informatics nurses, laboratory staff, pharmacists, electrical engineers, biomedical engineers, quality improvement specialists, vendors, and direct-care clinical staff . This team will be responsible for every phase of deployment—evaluation, acquisition, rollout, implementation, and transition to live operations. They will determine the hospital’s objectives and integration goals, as well as vendor evaluations, business and clinical requirements, risk management concerns, patient safety goals, and costs.
The project team will also be charged with identifying the departments or units the integration will first impact. Big bang, enterprise integrations are not unprecedented, but a phased roll out in a single department or set of departments with the highest acuity, such as the surgical suite, allows more time and space for assessments, lessons learned, and best practices, which can be applied as the integration spreads to the rest of the enterprise.
One aspect of integration that is often overlooked is the value of clinical workflow, which can vary among hospitals and individual units. Workflow should not be minimized because it will largely define how data is collected, how it is displayed, and what is displayed. Hospitals should incorporate clinical workflow as quickly and as early as possible in the process.
Designating a nursing champion—or super-user—at the outset allows other nurses and direct-care clinical staff to receive information, training, and support during all phases of adoption. These super-users would be working closely with the interdisciplinary team assembled for the implementation project.
Health IT implementations can be expensive, complex, involve dozens of stakeholders, and are often up against aggressive deadlines. Technology can also be disruptive and bring new uncertainties to the entire organization. However, the quality of the relationship with the vendor supplying the solution can make a huge difference.
Any hospital or health system has business and clinical needs and cultures that make them different from other organizations. A partner with deep knowledge of the unique aspects of your organization not only will help you avoid common mistakes, but also keep you focused on detailed integration points and workflows.
A partner that knows your organization also helps other vendors get acclimated, provides guidance, and ensures everyone stays accountable. A positive and fruitful collaboration allows hospitals to establish benchmarks and ensure that configurations and interoperability are optimized and seamless.
An excellent vendor also acts as a consultant and educator, making hospital staff comfortable with new technology and uncovering strategies for optimizing workflow. The importance of evaluating the vendor as much as the product they are delivering cannot be stressed enough. Vendors that lack expertise, training capabilities and clear steps toward go-live and beyond are critical red flags.
Can the vendor explain their process? Can they share metrics? Do they offer continued training and support after the implementation is complete? Answers to these questions will give your project team keen insights into the potential challenges of a technology implementation.
If your vendor supplies references, ask their customers specifically about their specific challenges and the vendor resolved them. Setbacks are a natural part of any implementation, but the true difference maker is determining the level of support and collaboration provided to overcome it.
A team approach to health IT doesn’t guarantee that technology adoption and implementation will be a success—but it will significantly increase its chances of sustainability. Today’s nurses have neither the desire nor the option to be passive consumers of health care technology. The seamless integration of technology requires that direct-care clinical staff have influence in the design and testing of equipment and applications. Involving end-users in the early stages of system analysis and design specifications can lead to better adoption of new technology, as well as identifying how current technology can be adapted for greater user acceptance.
Nurses make up the largest segment of the health care workforce in the United States. There are more than 3.1 million registered nurses nationwide and about 85% of these RNs are employed in nursing. Yet, some states are predicted to experience a nursing shortage during the next decade as the result of changes in health care policy, an aging population, and nursing schools struggling to make space for more students.
A report from the Georgetown University Center on Education and the Workforce titled, “Nursing: Supply and Demand Through 2020,” predicts a shortage of approximately 193,000 professional nurses by 2020 based on the age of the current nursing workforce, the size of graduating nursing classes, and nurses’ career decisions. A 2012 report titled, “United States Registered Nurse Workforce Report Card and Shortage Forecast,” concurs. It predicts a nursing shortage by 2030 throughout the country, especially in the West and South, because of projected changes in population.
[email protected] online FNP program created the graphic below based on data from a 2014 HRSA report, “The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025,” to show which states will have a shortage of nurses and which will have a surplus.
To learn more about the nursing landscape, visit [email protected] website to read the original blog post.
Ever wonder why you might think about earning a certification? In honor of Certified Nurses Day, we asked Karen S. Kesten, DNP, RN, APRN, CCRN-K, CCNS, CNE, associate professor at George Washington University School of Nursing in Washington, DC, as well as the chair of the American Association of Critical-Care Nurses Certification Corporation board of directors her opinion on the matter.
What follows is an edited version of our Q&A.
How long have you been in the nursing field and what certifications do you hold?
I have been a nurse since 1974. My first certification was in 1980 as a CCRN. Now I hold these certifications:
- CCNS (Acute/Critical Care Clinical Nurse Specialist, Adult) – 2004 to present
- CCRN-K (Acute/Critical Care Knowledge Professional, Adult) – 2015 to present
- CNE (Certified Nurse Educator) – 2012 to 2017
Why do you think it’s important for nurses to get certifications? What does it do for them? For the field?
It is so important that nurses become certified because it demonstrates that they have the knowledge, skills, and attitudes to provide high quality care to patients and their families. A certified nurse is a lifelong learner who cares about the quality of care they deliver. Nurses who are certified feel more confident that the care they are delivering is based on the most up-to-date evidence. Certified nurses are proud of their achievement and are role models for nurses and other health care professionals. Certification shows that nursing is a profession that cares about safety, quality, and excellence of health care delivery.
What’s the difference between board certification and being certified in a specialty?
Board certification means that certification is required for licensure, such as in the example of advanced practice registered nurses (APRN). In this case, a board of experts at the state level in the field of nursing examines the credentials and qualifications of a nurse in order to determine eligibility for licensure. Certification in a specialty indicates that a nurse has acquired additional knowledge, skills, and expertise in a specialty area of nursing such as acute and critical care.
How do you know you’re ready to become certified?
Preparation for certification requires that the nurse meet the eligibility requirements such as gaining experience in providing direct care for a required period of time for the relevant patient population. It also involves setting certification as a specific target goal, studying, and acquiring the knowledge needed to pass the certification exam. There are courses, study materials, and practice tests that can help a nurse to prepare for certification. Progress on self-assessment practice exams can help nurses know if they are ready to sit for the exam to become certified.
Do you need additional education to become certified? What are the requirements to apply?
To become certified as a critical care nurse (CCRN) or progressive care nurse (PCCN), a nurse does not need additional formal education. However, it is helpful to prepare—and there are prep courses, study materials, and practice tests that can help prepare for certification. You do need additional education at the master’s or doctoral level in order to become certified as an advanced practice registered nurse (APRN), such as an adult-gerontology acute care nurse practitioner (ACNPC-AG) or adult-gerontology clinical nurse specialist (ACCNS-AG).
What does it take to maintain your certification?
Nurses who maintain their certifications must meet renewal criteria that involve continuing education and, in some cases, continuing practice experience and an unencumbered nursing license.
What have been the greatest rewards for you that happened because you earned your certification?
Earning my certification makes me feel proud of the care that I deliver; it makes me feel more confident and self-assured. Certification enables me to feel more satisfied with my career—that I’ve provided competent care. It’s also opened doors to opportunities that I might not have had otherwise. Certification has introduced me to knowledgeable compassionate nurse mentors and to a community of nurses who care about delivering excellent care to acutely and critically ill patients and their families.
What would you say to someone considering becoming certified in any field?
I would encourage anyone to seek certification in their field to demonstrate they have the competence, knowledge, and skills to excel in their profession.
Nurses often enter their profession to save lives. This is what nursing is most often advertised as to the average consumer. You show up and do whatever it takes to help your patients improve their health and discharge out of the hospital either to home or to rehabilitation. Unless you are working in hospice, it’s infrequent that the acute care nurse will experience a patient reaching the end of life without a fight. This does, however, occasionally happen. Perhaps a patient in the ICU has been terminally extubated. Perhaps treatment did not go well for an acute illness and the patient and family have decided they want to let things run their natural course. You, as the nurse, will be expected to know what to expect and how to explain it to the family.
Here are five signs that death will occur soon.
1. The patient stops eating and drinking.
This is often a gradual process, with appetite and thirst diminishing in the final weeks of life. Once a person stops eating and drinking completely, they will likely only survive between seven and ten days. This greatly depends on the previous hydration status of the patient. A person who suddenly stops eating and drinking may have a better amount of fluid reserved in their tissues to draw from, and therefore may survive longer. Alternatively, a patient who has been taking only sips of fluid and a bite or two of food for weeks prior may last less than a week once all intake stops. It is a very individual process for each patient, and the family often needs reassurance that it is normal and expected.
2. The patient is exhibiting increased amounts of sleep and periods of unresponsiveness.
As a person approaches end of life they have little energy to expend, and their sleep needs increase drastically. It is not uncommon that a person is only awake for a few hours per day in their last weeks of life, and they may choose to spend these awake times in the company of only certain family members and friends. It should not be taken personally by family and friends. The patient simply has little energy left and conserves it for the things they feel are most important to them at the time. A patient will most likely become completely unresponsive in the last few days of life, but reassure family that although they are witnessing these changes, the patient can often hear them until the very end of life.
3. The patient is having changes in mental status, perhaps seeing things that are not there, or having visions of people who have passed on before them.
This is all very common at the end of life and can be alarming for family and friends. There are medications, often benzodiazepines, that can be used if these visions or hallucinations become upsetting to the patient; however, patients often find peace and happiness in these visions. They may speak freely with visitors about family members who have come to visit them from “the other side.” Encourage family members and other visitors to try not to challenge the patient’s experience and to be accepting that what the patient is experiencing is real to them.
4. The patient is presenting with tachycardia and hypotension, or changes in breathing patterns.
The patient may also have some changes in body temperature regulation. Toward the last few days of life, there are often changes in vital signs and respiratory patterns. The blood pressure will often drop below the normal range and the pulse will speed up. This is a product of the regulatory functions of the autonomic nervous system shutting down, as well as one of the common sequelae of dehydration (related to not eating and drinking, as mentioned in number one). It is normal and expected, but can be very alarming to family members. The main goal of the nurse should be to assure that the patient feels comfortable and stays safe while these changes are occurring.
5. The patient is mottling.
Mottling is often a late sign of impending death, and happens when peripheral circulation, especially in capillaries, is poor. Blood flow tends to slow down and causes purplish or reddish patches on the lower extremities. The extremities may be cool to touch as well, but not always. Mottling sometimes can come and go, but more often progresses in nature as a patient approaches end of life. Reassure the family that this is a normal process and is not at all painful for the patient.
With the right knowledge of what to expect, the nurse can be a key player in helping a patient and their family approach the end of life with comfort and confidence.
On March 19, nurses everywhere can honor the extra work they have put into getting certified as the nation celebrates Certified Nurses Day.
Sponsored by the American Nurses Credentialing Center and the American Nurses Association, Certified Nurses Day offers a chance to acknowledge nurses’ extra efforts to gain the board certification that establishes advanced knowledge and specialization in specific areas.
Nurses can earn certification in everything from national healthcare disaster certification to cardiac rehabilitation to nursing case management, sharpening their skill set and therefore improving the patient care they provide. But certification takes work. Nurses must pass a credentialing exam and complete continuing education to maintain certification every few years.
Registered nurses are able to practice nursing, but nurses who earn certification status in various specialties are valuable to employers for additional reasons. Their extra motivation and willingness to become certified signals a dedication to nursing and to patient care. Earning certification shows they pursue their passions to advance their skills and go above and beyond typical job duties.
According to the ANCC, Certified Nurses Day is celebrated on “the birthday of Margretta ‘Gretta’ Madden Styles, the renowned expert of nurse credentialing. An accomplished advocate for nursing standards and certification, for more than two decades Styles advanced nursing practice and regulation worldwide.”
Nurses who are board certified in any specialty can help educate other nurses of the value of obtaining this extra designation. And the healthcare settings, patients, employers, and others for whom nurses form an invaluable part of the team can bolster the efforts and recognize the extra work it takes to earn and keep that certification.
If you don’t have certification in a specialty you’re particularly interested in or if you want to obtain another certification, the ANCC can help answer questions. Each certification has different testing and renewal requirements, so it’s best to check what you’ll need.
Many certified nurses appreciate the expertise recognition their certification confers. If you are especially interested in an area of nursing and have knowledge that people turn to you for, getting certified makes your knowledge and professionalism recognizable to others. Some nurses say they are reluctant to take the credentialing exam as they aren’t sure if they will pass. If that is your concern, take the extra time to study. If you don’t pass, you can take it again. Not everyone passes credentialing exams on the first try, but that doesn’t mean you shouldn’t refocus and take it again.
On Certified Nurses Day celebrate yourself and your colleagues who have obtained this extra education. Make plans to go out to lunch or just to say thanks to your colleagues who are making an effort to improve nursing care and their own professional skills. If you are thinking about getting certified in a specialty, take steps today to get the process started. You’ll advance your knowledge, your career, and your profession while providing the best possible patient care.