The Nursing Workforce in an Era of Health Care Reform

ArticleinNew England Journal of Medicine 368(16):1470-2 · April 2013with20 Reads
DOI: 10.1056/NEJMp1301694 · Source: PubMed
    • "Graduations from U.S. nursing schools have doubled from 75,000 to 150,000 a year in the past 15 years [16], and thousands of qualified applicants to nursing schools are being turned away. As pointed out by Auerbach et al. [16], several factors may have contributed to this remarkable growth, including a national media campaign to promote nursing, increased growth in overall healthcare spending, and dynamic growth in the number and type of nursing education programs. There has been a substantial increase in the number of second degree students entering nursing, with BAs and higher degrees in other fields. "
    [Show abstract] [Hide abstract] ABSTRACT: Many countries, including Israel, face health workforce challenges to meet the needs of their citizens, as chronic conditions increase. Provider shortages and geographical maldistribution are common. Increasing the contribution of nurse practitioners and other advanced practice nursing roles through task-shifting and expansion of scope-of-practice can improve access to care and result in greater workforce efficiency. Israel and many other countries are introducing reforms to expand nurses’ scope-of-practice. Recent international research offers three policy lessons for how countries just beginning to implement reforms could bypass policy barriers to implementation. First, there is substantial evidence on the equivalence in quality of care, patient safety and high consumer acceptance which should move policy debates from if to how to effectively implement new roles in practice. Second, regulatory and finance policies as well as accessible advanced education are essential to facilitate realignment of roles. Third, country experience suggests that advanced practice roles for nurses improve the attractiveness of nursing as a career thus contributing to solving nursing shortages rather than exacerbating them. Designing enabling policy environments and removing barriers will gain in relevance in the future as the demand for high-quality, patient-centered care is increasing.
    Full-text · Article · Dec 2016
    • "This change may have contributed to the increase in job satisfaction through more consistent staffing, where there is increased opportunity for interaction, continuity of care for patients and a familiarity of colleague skills and strengths, making for a more consistent workplace (Siow et al. 2012, Cabana & Jee 2004). Alternatively, the increase in full-time employment may be attributed to RNs working additional hours and the re-entry of many RNs back into the workforce following the GFC in 2007-2009 (Auerbach et al. 2013 ). Consistency of staff and the presence of more fulltime employees can assist in creating a more stable work environment, where skill and experience can be better utilized and nurse unit managers given the opportunity to interact and support nursing staff (Duffield et al. 2009a, Schmalenberg & Kramer 2009). "
    [Show abstract] [Hide abstract] ABSTRACT: Aims: To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013. Background: Positive nurse practice environments have been linked to nurse retention and care quality outcomes. Methods: The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared. Results: On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period. Conclusions: The decline in nurses' perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline. Implication for nursing management: Managers need to apply existing evidence to improve nurse practice environments and manage instability.
    Article · Mar 2016
    • "According to the Bureau of Labor Statistics, unfilled positions for RNs are projected to reach 1.2 million by 2020 [1]. A shrinking economy appears to have eased the nursing shortage, but with an anticipated 32 million Americans gaining access to healthcare services as a result of the Patient Protection and Affordable Care Act, the need for nurses will become even more pressing and is projected to outstrip nurse availability [2,3]. How the shortage of nurses affects patient care A 2002 survey reported in the New England Journal of Medicine found that 53% of physicians and 65% of the public believe that a shortage of nurses increases the risk of medical errors [4]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: A nursing shortage in the United States has resulted in increased workloads, potentially affecting the quality of care. This situation is particularly concerning in long-term care (LTC) facilities, where residents are older, frailer, and may be receiving multiple medications for comorbidities, thus requiring a greater commitment of nurse time. We conducted a survey of LTC nurses to determine how much of their time each week is spent managing newly started and stable warfarin-treated residents. Methods: Forty LTC nurses validated the questionnaire to determine what protocols/procedures are involved in warfarin management. Twenty LTC nurses completed the survey, quantifying the time they spend on procedures related to warfarin management, and how often they performed each procedure for each resident each week. Results: The nurses reported that 26% of their residents were receiving warfarin; the majority (approximately 75%) of these residents began warfarin after admission to the facility. On average, the nurses spent 4.6 hours per week for treatment procedures and monitoring patients initiating warfarin therapy and 2.35 hours per week for each resident who was stable on warfarin therapy on admission. Overall, to care for an average number of newly initiated and stable warfarin patients in a medium-size LTC facility, staff nurses are estimated to spend 68 hours per week. Study limitations include the potential for bias because of the small sample size, representativeness of the sample, and the possibility of inaccuracies in respondents' self-reported time estimation of warfarin-related procedures. Conclusions: In the context of a well-documented and expanding nursing shortage in the United States, the substantial use of time and resources necessary to initiate, monitor, and manage warfarin treatment in elderly LTC patients is of concern. Until the problem of understaffing is resolved, implementation of therapies that are simpler and require less nursing time-e.g. the use of new oral anticoagulants in the place of warfarin-may be a way to free up nursing time for other essential care tasks.
    Full-text · Article · Dec 2015
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