There’s no denying the correlation between nurse staffing levels and patient outcomes. As the Baby Boomer generation continues to retire, the need for additional medical attention increases (hospitals, aging facilities, etc). But because the nurse population mirrors the overall population, this means we also face a bubble of nurses entering retirement, reducing the number of experienced health care staff available to serve patients and creating new stresses on health care teams and health care facilities. A recent article in the Wall Street Journal stated that the United States is in the midst of a nurse retirement epidemic. These and other trends are creating exposures nurses are facing today and into the foreseeable future.
Risk experts at Nurses Service Organization (NSO) identified key risks for nurses as a result of staffing shortages:
1. Higher patient loads.
The Affordable Care Act has impacted the volume of individuals with health insurance, including individuals with complicated issues who once used to only seek treatment when necessary through the ER. This larger and more complex patient load places additional pressures on nurses. When care suffers, positive outcomes are negatively impacted, which only strikes down hospital reimbursement rates, making it all the more difficult for hospitals to be able to afford additional highly qualified nurses. It’s a vicious cycle.
2. Extended hours.
As shifts stretch (often last minute), fatigue becomes more of a factor, mental acuity may suffer, and the opportunity for an incident increases. When combined with increased patient ratios, nurses have more opportunities to, inadvertently, make mistakes and injure those they serve or themselves. These added hours also can create job dissatisfaction, which stresses health care teams and staffs.
3. Increased responsibilities.
Nurses are at the center of patient care, acting as an advocate between patients and physicians, and patients and family and friends. More and more, nurses are becoming accountable for the coordination of care and providing informed discharge notes for patients, which extend the potential to impact outcomes and the nurse’s exposure beyond the facility walls.
4. Greater likelihood of “floating.”
The nursing shortage creates gaps in coverage and the need for additional nurses to ‘float.’ Unfortunately, when nurses are assigned to an area they are unfamiliar with, or when a team of nurses has a professional from another department entering their zone, it can create confusion and issues. In fact, the most recent NSO claims report shows agency nurses (who often are sent to help facilities fill gaps in coverage) were involved in nearly 25% of the closed claims in the study. We can expect these workplace dynamics will continue to evolve as facilities move nurses as needed to address shortages on the fly.
5. New nurses entering the workforce.
The next eight years will see a steady stream of new nurses entering the workforce to replace those retiring. Much like nurses who float, these new nurses will need experience, on-the-floor training, and mentoring to acquire the skills needed to master their environment.
As the country continues to see an increase in the number of people ages 65 and up as well as more patients entering the health care marketplace, the nursing shortage will continue to be a concern. This rising concern has the potential to place all nurses into higher risk working conditions they need to protect themselves, and their careers, against.
As Black History Month draws to a close, now is an excellent time to reflect on all the nurses who paved the way for today’s increasingly diverse nursing workforce.
The numbers still don’t reflect the levels of diversity in the country as a whole, or even necessarily in the settings where they work, but African-American and black nurses are entering the nursing profession and earning advanced nursing degrees in greater numbers than ever before.
According to the Bureau of Labor Statistics, the nursing workforce is achieving greater diversity, but there’s still a long way to go. While the 2015 National Nursing Workforce Study stated 19.5 percent of nursing respondents reported a racial or ethnic minority background, the rate was even higher among newly registered nurses.
With a nod to early black nurses like Sojourner Truth or Harriet Tubman, who each paved the way for minority nurses to follow, nurses are expanding into many specializations and gaining higher degrees. With the current push to have 80 percent of nurses educated with a completed bachelor of science in nursing by 2020, higher ed and advanced degrees are an important part of getting ahead in nursing. Of the 176,000 nurse practitioners, 8.5 percent are African-American. And of the 3,102,000 registered nurses, 11.9 percent are African-American.
Minority nurses continue to make big strides in increasing the diversity of the overall nursing population. According to American Association of Colleges of Nursing (AACN) figures, the percentages of black or African- American nurses earning master’s or doctoral degrees has increased significantly in the past 10 years.
In 2006, 10.6 percent of those earning doctoral degrees were African American. In 2016, that percentage jumped to 16.2. And in those same years, the number of those earning master’s degrees also saw a percentage jump. In 2006, 11.3 percent of those going for a master’s degree were black. Ten years later, the percentage was 14.3. Overall, the percentage of minority nurses seeing nursing degrees hovers at about 30 percent of the total.
All that good news helps patients who say they want to see a diverse workforce in the healthcare professions. Many patients feel comfortable with someone who looks like them, but, more importantly, a diverse workforce helps spread culturally competent nursing practices. The entire nursing staff may not represent the ethnic diversity in a given setting, but they can learn from those who might understand certain cultural traditions, languages, or practices. All that understanding makes for better patient care and outcomes and an especially effective nursing staff.
So as Black History Month draws to a close, take a few moments to reflect on how far African-American and black nurses have come and the essential care and understanding they provide to the public. And take a moment to take pride in being part of that.
From February 6 to 12, Perianesthesia Nurse Awareness Week will be celebrated and honored by perianesthesia nurses and the colleagues they work with.
According to Armi Holcomb, RN, BSN, CPAN, and immediate past president of the American Society of PeriAnesthesia Nurses (ASPAN) perianesthesia nursing is one of the most well-rounded areas of nursing. For that reason, she sees the field as exciting and satisfying for both personal and professional reasons.
Perianesthesia nurses always have to weigh several different factors when treating each individual patient.
“We see people before surgery and have to know about their preexisting conditions or any medical conditions they have to make sure the surgery is safe,” she says. “We are the patient’s first line of defense.”
Perianesthesia nurses, who administer care during the transition times of pre- and post-surgery, are especially aware of the recovery room care.
Holcomb, who has practiced in many settings including med-surge and ICU, says perianesthesia nursing is her niche. “We see the whole patient,” she says. And then, she says, the perianesthesia nurses are there to help patients transition safely after surgery. “We make sure they can transfer to home, to inpatient, or to the ICU,” she says.
Perianesthesia nurses undergo a certification process through the American Board of Perianesthesia Nursing Certification, Inc. Certification must be renewed every three years.
As medical care becomes more advanced and complex, the patients nurses see are also generally more acute. Many have coexisting conditions that can have a big impact on surgery and anesthesia. Because of that, these nurses have to always be on top of trends and research. “We have to be life-long learners,” she says, noting that perianesthesia nurses have to keep current with physical health, pharmacology, and surgical needs.
“All of that weighs in and it’s critical thinking,” says Holcomb. Perianesthesia nurses never back away from asking questions and will always advocate for patients, says Holcomb. And they are a tight bunch. ASPAN emphasizes mentoring and sharing knowledge among members.
If you are a perianesthesia nurse or work with one, take time this week to reflect on all you do. Celebrate with colleagues and do something to honor your own work (Holcomb says her organization will celebrate nurses with goody bags and a luncheon among other things).
And if your state doesn’t have a proclamation for this week, you can always advocate for one. ASPAN even offers a sample proclamation to guide your efforts.
Congratulations to all the perianesthesia nurses!
Health care professionals and organizations all recognize the importance of paying attention to our health. Every day we witness the negative consequences of neglecting to cultivate and maintain healthy routines. Sickness loves to seek out the overburdened mind and body. With today’s frantic pace of life and the speed at which we all must make decisions about where and how to invest our time and energy, it is not surprising but yet ironic that health care professionals often fail to properly nurture their own careers.
The Big Picture
Professionals in the health care field now more than ever face an amazing number of enticing career options, if they are mindful of them. In an effort to meet the rising needs of aging boomers, rising “at-risk” patients, and many other challenges, the health care industry is using the latest technologies into all workplaces and seeking the most talented and passionate minds available. Prospective health care candidates, particularly those willing to relocate, have an enviable number of rewarding career paths to pursue. Recognizing and navigating those options, however, can be intimidating.
You should know that great recruiters should be keenly aware of how a job change affects not only the individual but also their families, friends and communities. Career navigation should be guided by a well-planned and thoughtful strategy that addresses both a candidate’s goals and their individual personality and strengths. As a recruiter for ThinkingAhead, I invest my time and effort into truly understanding the sensibilities and nuances of candidates I represent. My goal is to match their talents and skills not just with a position but with a work culture and environment that will encourage their professional growth and personal happiness, making the change an overwhelmingly successful one, both for the professional and their intimate circle.
We’re all well beyond busy — we need to accept this as the new normal. It can seem as if there is never an opportunity to sit and contemplate who we are professionally and what we want long-term from our careers. But if candidates don’t take the time to think about their lives’ direction, they’ll end up following someone else’s lead or agenda. I personally focus on working to impress upon candidates the value of exploring the positives and negatives of their career decisions and the need to be proactive about reaching their professional objectives. This process needs to begin with an assessment of their professional achievements to date – what tangible positive imprints they have made professionally that are rewarding to them in retrospect and keep them excited about going to their offices daily.
When I’m working with candidates, I often hear that they are uncomfortable with “bragging” about what they have accomplished. When discussing professional backgrounds, candidates have a tendency to shift to discussing their roles and responsibilities, rather than highlighting the projects/programs they headed that added significant value to their organization. This supposed “humility” impedes a candidate’s ability to see the true trajectory of their careers and personal strengths and weaknesses and conceals their own truths. Careers, like lives, are defined by actions and deeds, not titles and roles. An honest evaluation of an individual’s accomplishments—and how we feel about those successes— can provide a detailed career profile for candidates who have difficulty defining what about their job fulfills and frustrates them.
Embrace Synergy via Technology
Adeptly using technology is part of the new bedside manner. Candidates and clients in the health care industry are at the forefront of figuring how technology can change the way we work, heal and live. The data garnered through devices and systems throughout the health care industry can often improve everything from patient care and satisfaction to the financial performance of an organization. Data is becoming increasingly integrated into every health care job and organization. Data drives decisions from how hospitals invest money to what demographics and geographic areas are most in need of proactive care.
Technology is the catalyst behind the synergy that is morphing traditional health care jobs into dynamic, modern positions that require an appreciation for data. Technical and operational responsibilities are no longer siloed. As an example, my clients value IT professionals with a clinical or operational background as well as clinical experts with technical acumen. This merging of duties can often means that a chief nursing officer is most valued if they have informatics and optimization skills or that a CIO must show a strong success in working with the clinicians at their organizations. Candidates who are willing to embrace technology and understand how it impacts health care from every angle are poised to lead the industry into a new and inspiring era of care for everyone.
So be true to yourself and understand your passion and strengths to lead you to continued success in your profession!
Of all the professions available, nursing offers one of the most flexible and diverse set of opportunities to people with similar training. One of the reasons so many people stay in nursing the because they are able to stretch their professional skills and try new roles. With additional training or certification, a nurse can move into a specific cardiac specialty or try something as broad as travel nursing.
Even with so many options, nurses can easily get into a job rut. There are a few ways to tell if you’ve reached a point where you feel like you’re stagnating. If any of these signs feel familiar, it’s time to take a step back to reassess what you’re doing in your current role. You might be able to change things up by talking to your supervisor about taking on new responsibility or it might just be time to seek out something else.
How can you tell if you’re in a job rut?
1. Are you happy to go to work?
You don’t have to leap out of bed ready to get right to work with a smile on your face. It’s not that kind of happy. But if you genuinely dread going to work or, worse, if you are feeling real physical symptoms from job stress, it’s time to reconsider what you’re doing. Your job shouldn’t give you headaches, stomach aches, feelings of panic, or an overall sense of hopelessness.
2. Do you feel challenged?
If work feels like you’re just biding your time, then your time is probably best spent in some other role. Your job should offer you enough new tasks or put you in different roles so you’re learning new skills. Whether it is a new technology at your organization or a new management skill, adding to your skill set is important for your overall job growth. If you aren’t getting that, you’re missing out and also hurting your long-term job prospects.
3. Do you feel your skills are being used well?
If you have expertise, it should be highlighted and used to your and your organization’s advantage. Your skills should help every professional around you do a better job and do it more efficiently and safely. You might have to point it out and find ways to make sure your expertise is used to its full advantage, but don’t let it stagnate.
4. Are you satisfied with your work environment?
Working with people isn’t always easy, but it can bring about life changing results. If your work environment feels toxic, whether from a bullying situation or from management that doesn’t support nurses, then it’s time to move on. And, of course, if you don’t feel safe in your environment, that’s a red flag that it’s time to move on immediately.
5. Are you always reading job boards?
Everyone looks, but if you’re looking and thinking how much a new job would improve your life, you might be right. If you want a bigger salary or better benefits and you can get that somewhere else, it’s time to polish up that resume.
Honest job dissatisfaction shouldn’t be ignored. If your current role is holding you back, eating away at your spirit, or preventing you from learning new skills, then it’s time to reassess and consider moving on. You shouldn’t be stuck in a job rut.
From January 22 to 28, the American Association of Nurse Anesthetists (AANA) is sponsoring National CRNA Week to honor nurse anesthetists.
John Bing, BSN, CRNA, AANA Region 6 director, and national AANA board of directors member, says most people don’t quite understand what a nurse anesthetist does and, in fact, there are not very many of them.
Many people believe a nurse anesthetist puts them to sleep, leaves, and then returns to wake them. Far from it, says Bing. “The job of a nurse anesthetist is always assessing,” he says. They are with the patient all the time, from the moment they greet the patient, through the entire procedure or surgery, and when they are brought out of anesthesia.
The job, says Bing, is like no other. “We are there pre-, inter-, and post-op,” he says. But he understands why the job is mysterious to some. Even Bing’s mom thought he just gave people a pill to make them go to sleep, he says with a laugh.
But nurse anesthetists appear happy with their jobs. On the just-released 2017 U.S. News and World Report Best Jobs list, a nurse anesthetist’s job placed fifth on best health care jobs and placed sixth on the best jobs overall. The reported salary median salary is $157,140.
Bing says he appreciates being able to develop a relationship with a patient in such a short amount of time. Being present through the entire procedure gives nurse anesthetists the ability to monitor every nuance of the patient’s reactions and behavior, he says. And the interactions before the anesthesia is administered means nurse anesthetists have the chance to build up trust and get to know a patient as a person. The patients remember that, says Bing, and you get to know them as a person.
And this field rarely gets stale, he says. CRNAs have to be recertified every four years, so continued learning is mandatory. One of the special draws for nurse anesthetists is the ability to work with people from the moment they are born until the day they die, says Bing. These nurses work with all ages and have to know the intricacies of how the human body reacts to the anesthesia at each age and with virtually any condition. “We get everybody,” says Bing. “And it is all acute.”
As a group, nurse anesthetists stick together, says Bing. With as high as 89 percent reporting approval for their job satisfaction, he says, they enjoy the work. And the AANA doesn’t encourage sub groups, he says. The group acts as one. “Eighty-five percent of our professional nurse anesthetists belong to our parent professional organization,” says Bing. “We don’t want to go out and have splinter groups. We are better together.”
The AANA is urging nurses to spread the word during National CRNA Week and suggests things like career days in schools, inviting legislators to a breakfast or coffee gathering, or even casual and formal public speaking opportunities to let people know about the profession. And use #crnaweek to spread the word o a wider audience.
It’s also a good time to celebrate what nurse anesthetists do. “In this country 100,000 people give anesthesia,” he says. “That means there are 3.5 million people per anesthetist. That makes [them] pretty special.”