Nursing Perspectives Chapter 12 PowerPoint.ppt

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Chapter 12Workforce Advocacy

and the Nursing Shortage

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Promoting a Professional Practice Environment

3Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Important research is validating the contribution of RNs Improved patient outcomes (Kane et al, 2007) Prevention of premature mortality (Cho, Hwang, and

Kim, 2008) Increased hospital profitability (Needleman et al.,

2006; Unruh, 2008)

Overview


Nurses struggle to deliver patient care against many barriers and with dwindling resources

Commitment to patient care often places nurses in direct conflict with administrators

The power the nurse can call on to resolve conflict and improve care is called “workforce advocacy”

Overview (cont'd)


How a nurse reacts to challenges within the workplace and continues to advocate to improve patient care is a necessary focus for the profession

Workforce Advocacy


Identify mechanisms that provide opportunities for RNs to affect institutional policy

Develop conflict resolution models that address RNs’ concerns about patient care

Seek legislative solutions for workplace problems

Develop legal centers for nurses Provide RNs with self-advocacy and patient

advocacy information

Opportunities and Challenges for Workforce Advocacy


Promote occupational safety and health of nurses

Use nurse practice acts and other legislative and regulatory protections

Use the political process to influence legislative and regulatory agencies for the protection of nurses and patients

Examples of Workforce Advocacy


Provide education regarding employment rights and responsibilities

Develop skills related to public relations, media presentations, and conflict resolution

Build coalitions and support groups to enable nurses to speak and advocate for their practices

Participate in committee structures to ensure a nursing voice in safety and workplace issues

Examples of Workforce Advocacy (cont'd)


Nursing shortage Appropriate staffing and mandatory overtime Patient advocacy and safety Workplace safety

Issues in the Workplace


Nursing Shortage

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 11

History of cyclic shortages documented since World War II

The current shortage is more complex and long-lasting and will dwarf all shortages to date

Downturn in the U.S. economy in 2009 led to an easing of the nursing shortage in some parts of the country

Despite positive signs, analysts warn there is no long-term resolution of the nursing shortage

Planning for an adequate nursing workforce is one of the most critical challenges of this century

Overview


Employment of RNs is expected to grow by 22% from 2008 to 2018, much faster than the average for all occupations

Job openings will result from: Need to replace experienced nurses who leave the

occupation Median age of RN’s is 46 years Technological advances in patient care Increasing emphasis on preventive care Rapid growth in the older population

Future RN Employment Opportunities


Comparison of three national random sample surveys of RNs, areas identified as affecting nursing satisfaction were: Opportunities to influence decisions about workplace

organization Recognition of accomplishments and work well done Opportunities for professional development and

advancement Opportunities to influence decisions about patient

care

Health Care as a Challenging Work Environment


Efforts to recruit more students into nursing have been successful

Unfortunately, most schools and universities find themselves unable to expand their nursing programs because of a serious shortage of nursing faculty

National and statewide efforts have resulted in increases in nursing school enrollments for 11 consecutive years

Increases will not balance out the impending wave of RN retirements or employment changes as the economy recovers

Nursing School Enrollments


Demands require not simply more RNs, but more RNs with the right education and skill Baccalaureate-prepared nurses with critical thinking,

leadership, case management, and health promotion skills, IOM calls for 80% of nurses to be BS prepared by 2020.

Experienced RNs in critical care, emergency department, operating room, and neonatal intensive care

Master’s and doctorate-prepared RNs in advanced clinical specialties, teaching, and research

Education


Aging of nursing faculty is one of the most critical problems that faces nursing

Faculty salaries are a major contributor to the faculty shortage

Faculty Shortage


Depends on creating an environment conducive to professional autonomy that supports decision making and effective nurse-physician relationships

Magnet hospitals: successful retention program; promotes standards for professional nursing practice and recognizes quality, excellence, and service

Nurses in magnet hospitals have higher levels of autonomy, greater control over the practice setting, and better relationships with physicians

Pathway to Excellence designation emerging as another model to improve retention

Retention


In national survey, RNs were generally satisfied with their jobs, and satisfaction had increased over time

Increased satisfaction predicted by: Organizations who emphasized the quality of patient care Management that recognized the importance of nurses' personal

and family lives Satisfaction with salary and benefits High job security Positive relationships with other nurses and with management

Decreased satisfaction predicted by: Feeling stressed to the point of burnout Feeling burdened by too many non-nursing tasks Experiencing an increase in the number of patients assigned Having a general, negative overall view of the health care

system

Retention (cont'd)


Nurses older than 40 years represent nearly 70% of the workforce;

Strategies for retaining the older, expert nurse: Provide greater flexibility in scheduling Provide better ergonomics and health care design to

decrease physical demands Allow for greater participation in decision making

Aging Workforce and Retention


Health care challenged to become the employer of choice for the younger generation

Expectations of the 20-something generation: Opportunities to gain advanced training, education,

and certification Ongoing coaching and feedback about performance Manager to take a personal interest in them Assistance to build a competitive portfolio Comfortable with technology and excel at multitasking

Emerging Workforce Recruitment and Retention


Long relied on as a remedy for nursing shortages 5.1% of RNs licensed before 2004 and 8.1% of

RNs licensed since that time are foreign trained International nurses coming to work in the U.S.

find supportive resources through the Commission on Graduates of Foreign Nursing Schools (CGFNS), including verification of the foreign nurse’s knowledge-based practice competency

Foreign Nurse Recruitment


1. During a public talk, a nurse is asked, “Who ensures that foreign nurses are properly trained and competent to practice as an RN?” The nurse responds that monitoring of foreign nurses’ knowledge base and competencies is the jurisdiction of the: A. Commission of Graduates of Foreign Nursing

Schools B. Employment and Training Administration C. Center for American Nurses D. U.S. Department of Labor


During the 1990s, nursing salaries remained flat and contributed to the current shortage

Salary compression has plagued the profession Sharp increase in RN wages in 2002 and 2003 Not clear if future wage increases will be needed

to bring about a new equilibrium in the RN labor market

Nursing Salaries


Most common reasons for turnover Insufficient supply of qualified managers and

experienced staff Other career prospects Workload and inappropriate staffing

Work Environment


Nine elements of healthful work environment Collaborative practice culture Communication-rich culture Culture of accountability Presence of adequate numbers of qualified nurses Presence of expert, competent, credible, visible leadership Shared decision making at all levels Encouragement of professional practice and continued

growth/development Recognition of the value of nursing’s contribution Recognition of nurses for their contribution to practice

Work Environment


Appropriate Staffing and Mandatory Overtime


Factors contributing to nurse dissatisfaction within the workplace Inappropriate staffing levels Increased requirement for mandatory overtime

Research has reinforced the importance of appropriate nurse staffing to affect nurse satisfaction and positive patient outcomes

Overview


Landmark study by Aiken et al. (2002) established links with appropriate staffing Surgical patients more likely to experience higher

death rates from failure to rescue (insufficient nursing care) and from complications in hospital, with fewer nurses per patient

Nurses working in institutions plagued by insufficient staffing were more likely to experience emotional exhaustion and greater job dissatisfaction

Quantifying Appropriate Staffing


Increase in requirement in the 1990s led to increase in need to float to other patient care units

Increase in mandatory overtime/mandatory on-call requirements by some employers

Floating/Mandatory Overtime


Studies of mandatory overtime in other industries demonstrated: Increased time lost to absenteeism Increased injuries in absolute numbers and rate of

incidence Required 3 hours of work to produce an additional 2

hours of productivity

Floating/Mandatory Overtime (cont'd)


Mandatory overtime may alleviate employer’s sense of urgency to find safer and more appropriate staffing

Nurses may feel resentment that they bear the personal, professional, and legal burden for the staffing problem

Nursing efforts to address mandatory overtime and inadequate staffing through professional practice advocacy have begun

Floating/Mandatory Overtime (cont'd)


Nurses across the country are concerned about inadequate staffing and excessive overtime

Mandatory overtime and adequate staffing levels have become federal and state legislative issues As of 2012, 16 states enacted legislation restricting

mandatory overtime The first state to pass legislation addressing nurse

staffing levels through fixed minimum ratios was California in 1999

Advocating for Safe Staffing


Chapter resources to guide decision making Questions about safe staffing to ask before accepting

a position in a health care organization (Box 12-5) Resources to help decision making regarding

adequate staffing and mandatory overtime (Box 12-6) Questions to guide decision making regarding

accepting or refusing an assignment (Box 12-7)

Advocating for Safe Staffing (cont'd)


Gives nurses an active role in decision making Provides maximal participation and accountability for

nursing practice Attributes include independence, accountability, and

autonomy over nursing practice Results in increased job satisfaction and better patient

outcomes Goes beyond participatory management to governance

of nursing practice Questions should be asked about shared governance or

participatory management models (Box 12-8) Access to conflict resolution procedures is necessary

Shared Governance


Patient Advocacy and Safety


Patient advocacy is the cornerstone of nursing Patients depend on nurses to ensure that they

receive proper care Complex systems and complicated uses of

technology lead to errors and adverse events

Overview


Findings of two major studies: errors kill some 44,000 to 98,000 people in U.S. hospitals annually

2004 IOM report examines safety from the perspective of the nurses’ work environment Provides evidence of the critical role nurses have in health care Work environment characterized by serious threats to patient

safety • Frequent failure to follow management practices necessary

for safety• Unsafe workforce deployment • Unsafe work and workspace design• Punitive cultures that hinder the reporting and prevention of

errors

Patient Safety


National Center for Nursing Quality (NCNQ) Created to address patient safety and quality in

nursing care and nurses’ work lives Advocates for nursing quality through quality

measurement, novel research, collaborative learning National Database for Nursing Quality Indicators

(NDNQI), a program of NCNQ, is the only database containing data collected at the nursing unit level to allow for empirical linkages between nursing care and patient outcomes

Patient Safety (cont'd)


Transforming care at the bedside (TCAB) Initiative to create a framework for change on hospital

medical/surgical units by engaging front-line nurses and leaders to:

• Improve the quality and safety of patient care• Increase the vitality and retention of nurses• Engage and improve the patient’s and family members’

experience of care• Improve the effectiveness of the entire care team

Ideas for transforming the way care is delivered come from nurses and others who are engaged in direct patient care

Errors in Health Care (cont'd)


Protects nurses who speak out about unsafe situations from being fired or subjected to other disciplinary actions by their employers

Nurses want to be able to speak up for their patients without fear of retaliation

Advocated for at the federal level and has passed in some states

See Box 12-9 for an overview of whistle blowing

Whistle-Blower Protection


2. An RN suspects that an employer hires nursing students at a higher rate of pay and allows them to perform certain procedures that require the skills of an RN. The nursing students enjoy the autonomy and extra pay. Before the RN participates in whistle-blowing, he or she should:

A. File a formal complaint to The Joint Commission to initiate an investigation and receive protection from retaliation by the employer.

B. Collect adequate documentation and, if possible, consult with the state nurses association before reporting to the state agency responsible for regulation of the employer.

C. Remember that protection from retaliation by the employer is provided until unethical or illegal actions are reported in writing.

D. Confront the individual suspected of wrongdoing and request that he or she stop the behavior.


Workplace Safety


Nurses’ safety and health an ongoing concern Categories of health hazards in the health care

workplace Biologic Ergonomic Chemical Psychological Physical

Overview


Health care professionals at risk for exposure to hepatitis B and C, and HIV/AIDS

Use of needlestick devices reduces worker injuries Needlestick Safety and Prevention Act signed into law in

2000 Requires the use of safer devices to protect from sharps injuries Requires employers to involve nonmanagerial employees in the

selection of effective engineering and work practice controls Requires employers to maintain a sharps injury log including the

brand of device being used

Blood-Borne Pathogens


Nursing is ranked second after industrial work for physical workload intensity

ANA’s lifting initiative—Handle With Care—seeks to prevent back and other musculoskeletal injuries through education and increased use of assistive equipment and patient-handling devices

Ergonomic Injuries


Fear of repercussions such as disciplinary action Stigmatization as a complainer Harassment by supervisors and coworkers Denial of opportunities for promotion Termination of employment

Barriers to Reporting Workplace Injuries


A major societal issue Nurses must proactively advocate for safe workplaces

Comprehensive organizational assessment to identify high-risk environments, psychological conditions, and populations that threaten workplace safety

Zero tolerance policy for workplace violence, verbal and nonverbal threats, and related actions

No employee who reports workplace violence faces reprisals Develop plans for maintaining security in the workplace Staff education to proactively address identification of and

response to high-risk behaviors that can lead to violence

Workplace Violence


ANA working with other nursing organizations to advocate for health care worker health and safety

Advocate for administrative controls Adequate staffing Health and safety committees Engineering controls—ventilation and safer needlestick devices Personal protective equipment—respirators and synthetic gloves

Although the health care industry is a dangerous place to work, many risks are avoidable and dangerous exposures are preventable

Advocating for a Safer Workplace


Nursing Perspectives Chapter 12 PowerPoint.ppt

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