8 Problems Driving the Nurse Staffing Crisis

8 Problems Driving the Nurse Staffing Crisis

Today’s healthcare landscape has been riddled with hardship and systemic shifts. Large-scale downward trends were highlighted by the COVID-19 crisis, but originated beforehand and will require massive effort to reverse.

Unfortunately, the brunt of these inefficiencies and problems falls disproportionately on certain portions of the medical professional family. One primary example of this is the way problems in healthcare affect nurses. The rising stresses and demands on nursing professionals have initiated a drastic nurse staffing crisis, emptying the nursing ranks across the country, and creating significant employment shortages.

According to the Bureau of Labor Statistics, vacant nursing positions across the United States hover at almost 200,000 openings each year. A number of problems are contributing to this reality and need to be resolved.

1. Nurses Are Often Unreasonably Responsible for the Weight of Patient Advocacy

Historically, nurses have often taken the lion’s share of responsibility for patient advocacy. This can refer to calling for fair and adequate treatment, helping other medical professionals understand the particulars of patient cases and needs, mediating and safeguarding for vulnerable patients, and more.

However, this burden can cause a significant amount of stress, especially when a nurse feels that they are advocating for patients’ needs in the face of apathy or even resistance from fellow medical professionals who might have differing priorities.

2. COVID-19 Requirements Drove Many Nurses Out the Door

COVID-19 requirements and vaccine mandates created huge turbulence for nurses across the medical landscape. Many that disagreed with requirements or how they were put into effect left the workforce. This created another large drain on an already depleted nursing population.

3. Workplace Stress is Compounded for Nurses – It Comes from Both Sides

Nurses often liaise between patients (and their friends or families) and fellow medical staff. When tensions rise; stressful or difficult situations bring out the worst in people; or priorities differ between stakeholders in a patient’s care, nurses can find themselves caught in the middle.

They often have to diffuse the stress exuded by patients, family, partners, and friends as well as helping navigate the stress and difficulties their fellow medical personnel experience. It’s an incredibly difficult job.

4. Compensation is a Never-Ending Battle

Because nursing roles vary drastically by amount of compensation and type of contract, nurses don’t often enjoy the job security that other medical professionals do.

5. Current Inefficiencies of Healthcare System Fall More Heavily on Nurses

The nature of nursing roles means that when the medical field experiences turbulence or systemic problems, that uncertainty or strain inordinately affects nurses.

6. The Problem is Self-Propelling: Nurse Shortages Beget More Nursing Shortages

Burnout and the long-term stress of overwork is one of the most critical problems affecting the nursing population. When some nurses quit their jobs or leave a medical facility, or when open positions remain vacant for long periods of time, the existing workload falls on the nurses that remain.

This compounds the stress, overwork, and impossible expectations that remaining nurses experience, making it more likely that those remaining nurses will succumb to the stress as well and leave the workforce.

7. Pandemic’s Effects on Medical Training

COVID-19 created staggering difficulties for medical trainees across the board. Many nursing students that were in school during the height of the pandemic would have lost out on valuable class time or training weren’t able to complete parts of their coursework, or were called up early into the workforce to cover drastic needs and shortages. Many of these new nurses entered employment feeling unprepared and more susceptible to intense stress and burnout, thus ending up more likely to leave the field.

8. Average Nursing Age Looms Over Staffing Projections

The average age of nurses across the country was 50 years old in 2018. The current number of new nurses entering the workforce will not replace the large number of nursing professionals quickly reaching retirement age. If these trends do not change, projections are dire for how nursing shortages will increase over the next decade.

How to Correct These Issues

These large-scale realities are significant and systemic. It will take significant, intentional action to correct course and make the nursing profession more accessible and sustainable. If the healthcare system can take corrective action to lessen the stresses that fall on nurses, make their jobs more secure, and help spread the responsibilities nurses currently hold more collaboratively amongst other medical professionals, we can reverse these trends.

Polly Sheppard Delivers Some Home Truths About Hate in Video Address

Polly Sheppard Delivers Some Home Truths About Hate in Video Address

Polly Sheppard has been on a mission since surviving the 2015 Emmanuel AME church massacre in South Carolina. If the killer spared the retired prison nurse in the hope that she would spread his message of gun-toting white supremacy, though, he must be grievously disappointed.In fact, the indefatigable septuagenarian has been delivering her own messages – and like many nurses, she is a very good communicator.

Former nurse Polly Sheppard addresses the S Carolina senate.In the years following the notorious shooting, Sheppard crisscrossed the country to speak against gun violence. Then, once she accumulated enough speaker fees she poured her earnings into another passion and established her own Scholarship Foundation to support nursing students in Charleston. Now, as the seventh anniversary of the chilling church murders approaches, Sheppard is focusing on another initiative to reduce future bloodshed: this week she sent an eloquent appeal to South Carolina’s senate urging them to finally pass a hate crimes law.

“Being there, laying under the table with this gun to my head couldn’t be anything but hate.”

Like most hate crime laws, the proposed SC bill would add up to five years to prison sentences for any homicide or assault motivated by hatred of the victim’s race, sexual orientation, gender, religion, or disability. Aside from Wyoming, South Carolina is the only state that has failed to pass some form of law against hate crimes, but the current bill has faced a steep uphill battle. At present eight SC senators are determined to see it expire… which is a painful irony as Emmanuel pastor Clementa Pinckney, a victim of the massacre, had been a senator himself.  If the bill ends up on the table as a code blue, though, it won’t be due to inactivity on Sheppard’s part.

In a powerful two-minute video viewed by the senate on April 27, Sheppard addressed the recalcitrant senators. She mused on other ironies, asking some acute questions: “I really can’t understand them standing against a [hate] law, but they can pass a law to kill somebody a firing squad. They can take that to the floor, but they can’t bring the hate crime law to the floor… What’s the problem?” Sheppard also wondered “why South Carolina has to be the last, almost the last to get a hate crime law?  Because we didn’t have it. We had to go to the federal government for (the AME killer) to be charged with a hate crime. It makes no sense.”

Sheppard reminded her audience: “Eight members of the South Carolina Senate are giving a safe haven to hate. Every time you look at senator Pinckney’s photograph, you should be reminded that hate killed him.”

Community Health Pioneer Gloria McNeal Tapped for AACN Award

Community Health Pioneer Gloria McNeal Tapped for AACN Award

Having spent her career “truly on the front lines making a difference,” Gloria McNeal, PhD, MSN, ACNS-BC, FAAN, will receive an AACN Pioneering Spirit Award at the American Association of Critical-Care Nurses (AACN) 2022 National Teaching Institute & Critical Care Exposition in Houston, May 16-18.

McNeal’s award recognizes her efforts to bring healthcare directly to those most in need and introduce telehealth and remote monitoring to critical care. The AACN Pioneering Spirit Award, one of AACN’s Visionary Leadership awards, recognizes significant contributions that influence progressive and critical care nursing and relate to the association’s mission, vision and values.

Gloria McNeal, PhD, MSN, ACNS-BC, FAANThe health equity trailblazer is associate vice president for community affairs in health at National University headquartered in San Diego, the flagship institution of the National University System, which comprises three nonprofit universities serving more than 45,000 students nationwide, both on-site and online. In this role, she leads the university’s comprehensive community and global outreach strategies efforts related to healthcare services and education. She previously served as dean for the university’s School of Health and Human Services for six years.

“Dr. McNeal has a passion for healthcare and serving those who are underserved,” said AACN President Beth Wathen. “Her community service efforts and nurse-led clinic model sponsored by the university bring healthcare directly to those most in need. She is truly on the front lines making a difference.”

At National University, McNeal has worked with community-based organizations to establish nurse-managed clinics at churches, community centers and shelters in South Los Angeles. The initiative was expanded to offer telehealth services for patient-provider interactions that do not require in-person visits.

Among her academic appointments, she has held the administrative positions of director, assistant dean, associate dean, dean and founding dean at various research-intensive public and private universities. As dean, McNeal has led several academic nursing programs on their journey to acquire national accreditation for both graduate and undergraduate curricula of study.

Her interprofessional, nurse-led and other projects, totaling more than $12 million in extramural funding, have been continuously funded for over 20 years. She currently serves as project director for the Health Resources and Services Administration Nurse Education, Practice, Quality and Retention (NEPQR) Simulation Education Training (SET) Program, a highly competitive grant-funded project initially awarded to a cohort of only five nursing programs nationwide. With this latest project, she is spearheading the use of virtual reality and immersive technologies to better prepare nursing students to practice in real-world settings through simulation.

Developing the protocols of care, she helped lead the transition of critical care nursing practice beyond the traditional walls of the intensive care unit, and was among the first to publish work on the remote monitoring and electronic transmission of ambulatory electrocardiographic data, revolutionizing the manner by which critical care nurses could remotely monitor their patients.

As a result of her work, she was invited to author “AACN Guide to Acute Care Procedures in the Home,” which describes over 100 complex nursing home-care procedures written in collaboration with 20 nursing expert contributors.

Her nursing career began as a critical care nurse in the U.S. Navy Nurse Corps at Philadelphia Naval Hospital, where she received two medals of commendation and three promotions leading to the rank of Lieutenant.

She obtained her bachelor’s degree from Villanova University Fitzpatrick College of Nursing, where she currently sits on the Board of Consultors, and her master’s degree at University of Pennsylvania (Penn) School of Nursing, later receiving the Outstanding Alumna Award. She returned to Penn for doctoral studies in the Graduate School of Education. For her PhD, which was awarded with meritorious distinction, she investigated the scholarly productivity of minority nurse academicians.

The American Academy of Nursing awarded her the coveted Media Award in 1994, inducted her into the Academy in 2006, and most recently named her a 2020 Edge Runner Award recipient.

She served as an invited co-contributor for the IOM (now National Academy of Medicine [NAM]) text on “The Future of Nursing: Leading Change Advancing Health” and is a featured speaker for the current NAM podcast on “The Future of Nursing 2020-2030,” Episode 2 – Health Equity.

Minority Nurses Describe Struggles with Moral Distress on Covid Frontlines

Minority Nurses Describe Struggles with Moral Distress on Covid Frontlines

Nurses inevitably encounter situations that cause moral distress. At the height of the Covid-19 pandemic, though—when there was no vaccine, and it was still assumed that for at least two years there would be no protection beyond masking and social distancing—moral distress became a daily ordeal for many frontline nurses.

Among those hardest hit by moral distress were the nurses of color working through a pandemic that exacted a disproportionate toll on Black, Filipino, Latino, and Native American minorities. Their experiences during the early days of Covid are at the core of a new study from researchers at DePaul University’s School of Nursing.  In interviews with a diverse group of nurses located across the US, investigators found that moral distress was an almost inevitable affliction when lack of support made it impossible for nurses to provide high-quality care based on their training.

Nurses on the frontlines faced unrivaled psychological and physical demands during the pandemic, noted researchers. Voices of nurses from this moment in history could help inform policies and laws to improve retention and reduce burnout among nurses in the U.S. “People need to listen to nurses more, and nurses need to feel empowered to share their experiences at every level of leadership,” said principal investigator Shannon Simonovich, PhD, RN, an assistant professor of nursing at DePaul.

“Diverse nurses caring for a diverse patient population”

In 2020, many news stories about health care heroes featured white, female nurses, Simonovich said. In reality, nurses from many personal, ethnic and geographic backgrounds with a varying levels of education were caring for COVID-19 patients.

Researchers Shannon Simonovich, PhD, RN and Kashica Webber-Ritchey, PhD, RN.Simonovich recruited a diverse group of DePaul nurse researchers to conduct the study, which in turn helped recruit a diverse group of 100 nurses to be interviewed, according to assistant professor and coauthor Kashica Webber-Ritchey. “We captured the voices of diverse nurses caring for a diverse patient population that was being disproportionately impacted by COVID-19,” Webber-Ritchey said. In the DePaul sample, 65% of the nurses identified as a member of a racial, ethnic, or gender minority group.

Many nurses from these represented populations have lost their lives to COVID-19. Researchers at DePaul cite a tally that more than 3,300 U.S. nurses, doctors, social workers and physical therapists died of COVID-19 between February 2020 and February 2021.

DePaul researchers conducted interviews between May and September 2020, asking nurses to describe their emotions. Nurses reported moral distress related to knowing how to treat patients and protect themselves, but not having the staff, equipment or information they needed. As a result, they reported feeling fear, frustration, powerlessness and guilt.

The toll of frustration, stress, and guilt

This qualitative study is believed to be the largest of its kind from this period—a time of great uncertainty about the virus that causes COVID-19 before the development of vaccines. Highlights include:

  • Study participants described many forms of frustration while providing patient care, including frustration with healthcare leadership being out of touch with those on the frontlines.
  • Nurses felt powerless to protect themselves and others from contracting COVID-19.
  • Nurses described being placed in difficult patient care experiences that resulted in guilt around letting down patients and their families, as well as fellow members of the healthcare team.

““We are a largely female profession, and we don’t complain enough when things are tough.”

The burden nurses have shouldered during the COVID-19 global pandemic calls for research that describes and examines the emotional well-being of nurses during this unprecedented time in contemporary history, write the researchers. As the media coverage of nurse heroes fades, the narratives in this study should be a call to action, says Kim Amer, an associate professor with 40 years of nursing experience.

“Nurses need to come together as a profession and make our standards and our demands clear,” Amer said. “We are a largely female profession, and we don’t complain enough when things are tough. As a faculty member, we teach students that it’s OK to refuse an assignment if it’s not safe. We need to stand by that.”

The DePaul research team calls for clear, safe standards for nurses that will be legally binding and hold hospitals and health care agencies accountable. “We go into nursing with the intention of saving lives and helping people to be healthy,” said Simonovich. “Ultimately, nurses want to feel good about the work they do for individuals, families and communities.”

Investments by healthcare organizations and policymakers in mental health resources could help promote psychological resilience in nurses, noted Webber-Ritchey. “Taking time to speak to nurses to understand their needs and provide support would help with addressing moral distress,” she said.

 

 

What is Alopecia? It is No Joke for Millions of Black Women

What is Alopecia? It is No Joke for Millions of Black Women

The Oscar slap that overshadowed the Academy Awards ceremony was sparked by a joke about Jada Pinkett Smith’s lack of hair – with husband Will Smith objecting violently to comedian Chris Rock mocking the actress’s shaved head.

Away from the recriminations over what could be perceived as a mean-spirited jibe and a disproportionate response, many people will sympathize with Pinkett Smith. As millions of women in the U.S. will attest, hair loss is no laughing matter.

Originally published in The Conversation.The Conversation asked dermatologist Danita Peoples of Wayne State University’s School of Medicine about alopecia and why certain forms of it can disproportionately affect Black women.

1. What is alopecia?

Alopecia is a medical word that refers to hair loss generally. And there are descriptors added which can refer to where the hair loss is occurring, or to the cause of it. Traction alopecia, for example, is hair loss from trauma or chronic inflammatory changes to the hair follicles.

2. What causes it?

Traction alopecia happens when there is trauma to the scalp, where the hair is being pulled or rubbed on a regular basis, causing inflammation around the hair follicles. This can lead to hair loss or thinning.

Alopecia areata describes hair loss to a particular area. It has different levels of severity, so there might be just a coin-sized area of hair loss on the scalp, or it could affect large areas. It can occur any place on the body.

Or it might result in complete hair loss on the scalp, alopecia totalis. Some people lose eyebrows or see a thinning of their eyelashes.

People can even have alopecia universalis, which is a loss of hair on the entire body.

Alopecia areata is considered an “immune-mediated” type of hair loss. The immune system is attacking the hair follicles. It has to do with T cells, the important white blood cells in the immune system.

And then other autoimmune disorders can have alopecia associated with them. This is the form of alopecia that Jada Pinkett Smith has said she has.

Lupus is an autoimmune disorder that can lead to hair loss. One type is systemic lupus erythematosus. Another type, discoid lupus erythematosus, primarily affects the skin and can cause hair loss with scarring on the scalp.

Thyroid abnormalities can be related to hair loss as well. In fact, when patients come to me with hair loss, the first test that I may order is a thyroid study.

3. Who does alopecia affect?

Anyone can get alopecia. Alopecia areata can show up at any age, from children to adults, and both men and women. But it’s more likely to affect African Americans than white or Asian Americans. About 1 million people in the U.S. have alopecia areata.

Traction alopecia can affect people in certain professions, like ballerinas, who wear their hair up in buns all the time. The pressure and friction from sports headgear, like helmets or baseball caps, can also cause hair loss. And in some parts of northern Europe, where it is common for people to pull their hair back tight on a regular basis, there are higher rates of traction alopecia. Traction alopecia affects one-third of women of African descent, making it the most common type of alopecia affecting Black women.

4. Why is traction alopecia so common among Black women?

That is due to certain hair styling practices that Black women use on their hair – wearing tight weaves or extensions, straightening with heat, that sort of thing. Hair is a big deal among African American women in a way that it isn’t for others. When I was growing up, my older relatives told us girls that our hair was our “crowning glory.” And they made a big deal about us keeping our hair looking stylish and well groomed, and that usually meant straightening it.

But I believe there’s less pressure than there used to be for Black women to keep our hair straightened, in the workplace or elsewhere.

5. How is it treated?

It depends on the cause. There are injected or topical corticosteroids for alopecia areata. If it’s due to a nutritional deficiency, like iron or protein, obviously you simply need to correct the deficiencies with supplements or by changing the diet. When it is caused by traction or discoid lupus, if you don’t treat the inflammation on the scalp soon enough, the hair loss can become permanent.

[Over 150,000 readers rely on The Conversation’s newsletters to understand the world. Sign up today.]

When it comes to traction, though, it’s much more about eliminating the practices that cause the problem in the first place. What’s happening now is more people are aware of the downsides of chemical or heat applications to straighten the hair and are using those damaging processes less.

One thing that may help is the CROWN Act, legislation introduced last year, which the U.S. House passed on March 18, 2022. That would make it illegal to discriminate against people wearing natural styles, such as afros and braids, so I am hopeful that it will contribute to a lot less traction alopecia in the future.

Nurse Researchers’ Study Suggests that Microaggressions Can be Hazardous to Your Health

Nurse Researchers’ Study Suggests that Microaggressions Can be Hazardous to Your Health

Two recent papers by UIC College of Nursing faculty found that microaggressions – common, subtle indignities – can be just as harmful as a major discriminatory event, contributing to negative mental and physical health outcomes in bisexual women.

Two recent papers by UIC College of Nursing faculty found that microaggressions – common, subtle indignities – can be just as harmful as a major discriminatory event, contributing to negative mental and physical health outcomes in bisexual women. Associate professor Wendy Bostwick, PhD, MPH, and assistant professor Ariel U. Smith, PhD, RN, were co-authors on both papers, one published in the Journal of Bisexuality and the other in Psychology of Sexual Orientation Gender Diversity, a publication of the American Psychological Association. Both relied on findings from the Women’s Daily Experience Study of 112 ethnically and racially-diverse bisexual women. Bostwick is principal investigator on a National Institute on Minority Health and Health Disparities grant which funded the Women’s Daily Experience Study, one of the first ever to focus on bi-identified women and mental health. Participants completed a baseline survey, followed by 28 days of e-diaries to capture microaggressions that they may have experienced during the previous 24 hours. “The old saying goes, ‘sticks and stones may break your bones, but words can never hurt you,” Smith says. “But you look at the data and realize that’s simply not true. Microaggressions that someone has experienced over a lifetime are correlated with mental and physical ailments they experience even today.” The researchers looked at microaggressions related to sexual orientation, race and gender. Microaggressions could include denying a person’s bisexuality—suggesting it’s “just a phase”—or a rude or insulting comment about lesbian or gay individuals. A comment minimizing or denying the existence of racial discrimination is an example of a racial microaggression. Participants reported an average of eight microaggressions of any type in the previous month, with almost all women—97%—reporting at least one microaggression throughout the duration of the study. Gender-based microaggressions were reported the most frequently. Women reported being sexually objectified on more than 15% of the days recorded. The papers also found microaggressions were associated with poor mental health and binge drinking, smoking and marijuana use. The most consistent finding was an association between microaggressions and anxiety. “Our findings suggest that for bisexual women, the weight of denigrating comments about their sexual identity, gender and race can contribute to poor health outcomes—whether such comments happened last year or yesterday,” Bostwick says. “Of course, these comments are situated in a larger context of systemic inequities, which may render bisexual women with fewer resources to cope when confronted with dismissive and disparaging comments about core aspects of who they are and their own lived experiences.” Bisexual women of color were a majority in the study—57%—a group that is notably absent in the literature, the researchers say. Latina bisexual women reported worse health outcomes than Black and White bisexual women in their daily diaries. Smith says the impact of microaggressions on bisexual women of color is an area where further research is needed. “So often we focus on the large discriminatory events, like being denied housing or being fired from a job,” Smith says. “These subtle comments and slights can be just as harmful. That’s why it’s important to address it through education – understanding and recognizing what a microaggression is and then adapting policies to raise awareness.” Co-authors included UIC Nursing visiting research specialist Larisa Burke, MPH, Amy L. Hequembourg, Alecia Santuzzi and UIC Nursing professor emerita Tonda Hughes, PhD ’89, RN, FAAN.Associate professor Wendy Bostwick, PhD, MPH, and assistant professor Ariel U. Smith, PhD, RN, were co-authors on both papers, one published in the Journal of Bisexuality and the other in Psychology of Sexual Orientation Gender Diversity, a publication of the American Psychological Association. Both relied on findings from the Women’s Daily Experience Study of 112 ethnically and racially-diverse bisexual women.

Bostwick is principal investigator on a National Institute on Minority Health and Health Disparities grant which funded the Women’s Daily Experience Study, one of the first ever to focus on bi-identified women and mental health. Participants completed a baseline survey, followed by 28 days of e-diaries to capture microaggressions that they may have experienced during the previous 24 hours.

“The old saying goes, ‘sticks and stones may break your bones, but words can never hurt you,” Smith says. “But you look at the data and realize that’s simply not true. Microaggressions that someone has experienced over a lifetime are correlated with mental and physical ailments they experience even today.”

The researchers looked at microaggressions related to sexual orientation, race and gender. Microaggressions could include denying a person’s bisexuality—suggesting it’s “just a phase”—or a rude or insulting comment about lesbian or gay individuals. A comment minimizing or denying the existence of racial discrimination is an example of a racial microaggression.

Participants reported an average of eight microaggressions of any type in the previous month, with almost all women—97%—reporting at least one microaggression throughout the duration of the study.

Gender-based microaggressions were reported the most frequently. Women reported being sexually objectified on more than 15% of the days recorded.

The papers also found microaggressions were associated with poor mental health and binge drinking, smoking and marijuana use. The most consistent finding was an association between microaggressions and anxiety.

“Our findings suggest that for bisexual women, the weight of denigrating comments about their sexual identity, gender and race can contribute to poor health outcomes—whether such comments happened last year or yesterday,” Bostwick says. “Of course, these comments are situated in a larger context of systemic inequities, which may render bisexual women with fewer resources to cope when confronted with dismissive and disparaging comments about core aspects of who they are and their own lived experiences.”

Bisexual women of color were a majority in the study—57%—a group that is notably absent in the literature, the researchers say. Latina bisexual women reported worse health outcomes than Black and White bisexual women in their daily diaries. Smith says the impact of microaggressions on bisexual women of color is an area where further research is needed.

“So often we focus on the large discriminatory events, like being denied housing or being fired from a job,” Smith says. “These subtle comments and slights can be just as harmful. That’s why it’s important to address it through education – understanding and recognizing what a microaggression is and then adapting policies to raise awareness.”

Co-authors included UIC Nursing visiting research specialist Larisa Burke, MPH, Amy L. Hequembourg, Alecia Santuzzi and UIC Nursing professor emerita Tonda Hughes, PhD ’89, RN, FAAN.

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