Employee Well-Being Becomes Patient Safety Issue
Many years of research has shown that depression among registered nurses is extremely common. One study published last year showed that RNs suffer from depression at almost twice the rate of people in other professions.
Now, new research is linking depression among nurses to a significant uptick in medical errors.
The study, published in the Journal of Occupational and Environmental Medicine, analyzed survey responses of 1,790 U.S. nurses. It found that 54% reported poor physical and mental health. About one-third said they had some degree of depression, anxiety, or stress, and less than half said they had a good professional quality of life.
Researchers also found that about half the nurses reported medical errors in the past five years. When researchers compared the wellness data to the medical error data, they saw a significant link between poor health, particularly depression, and medical errors. In fact, nurses in poorer health had a 26% to 71% higher likelihood of reporting medical errors than did their healthier peers.
Depression stood out as a major concern and the key predictor of medical errors, the researchers said.
“Hospital administrators should build a culture of well-being and implement strategies to better support good physical and mental health in their employees,” lead author Bernadette Melnyk, dean of The Ohio State University’s College of Nursing and chief wellness officer for the university, said in a statement. “It’s good for nurses, and it’s good for their patients.”
Melnyk noted several steps hospitals and health systems could take toward creating “wellness cultures for their clinicians,” including limiting long shifts and providing easy-to-access, evidence-based resources for physical and mental health, including depression screenings.
The issue of clinician wellness has gotten increasing attention recently. For instance, the National Academy of Medicine just launched an effort to combat clinician burnout and mental health issues called the “Action Collaborative on Clinician Well-Being and Resilience.”
However, there’s a stigma around mental healthcare among clinicians, as evidenced by studies and research into physician mental health. One study in the Society of Teachers of Family Medicine found that state medical boards ask physicians much more extensive and intrusive questions about mental health conditions than for physical health conditions, and many of those questions violated the Americans with Disabilities Act.
Fearing stigma, punishment, and loss of their license, physicians often don’t report their mental health struggles and don’t seek treatment. In addition, up to 15% of physician suicide victims did not receive mental healthcare.
This story was originally posted on MedPage Today.
The United States is facing a critical shortage in all health care professions. With the nation’s baby boomer population approaching retirement age, the issue is twofold: the aging population requires more care, and the nation’s physicians, nurses, and other health professionals are retiring.
Too Many Students, Not Enough Options
The solution to filling this gap is replacing the departing health care professionals with nursing graduates of all academic levels. However, many higher education institutions are turning away suitable candidates in droves. In 2016, nursing degree programs in the U.S. rejected 64,067 qualified applicants from baccalaureate and graduate nursing programs alike citing a lack of budget, faculty, clinical sites and preceptors, and classroom space.
Currently, there is a serious shortage of physicians, which continues to grow. By 2025, there will be a projected deficit of nearly 35,600 primary care doctors alone. Nursing schools are facing the struggle and strain to increase the capacity of existing nursing programs, and explore other avenues like online courses and accreditation.
Higher Education Means Higher Pay
Enrollment is increasing in nursing masters and doctoral programs across the country, and it’s no wonder that nurses are applying to graduate schools en masse. RNs realize there are significant perks to training and becoming an advanced practice registered nurse. Evidence shows that the quality of care by an advanced practice nurse is comparable to physicians, while often more affordable.
The full-time annual salary for a Nurse Practitioner (NP) averages $105,546. The high pay range of the NP may be partly to blame for the faculty shortage—higher compensation in the clinical setting is luring potential educators away from teaching.
Most vacant faculty positions require a terminal nursing degree. If more nurses pursue a doctoral degree, the faculty shortage will be alleviated. What will the outcomes of the nursing shortage be? Only time will tell.
Caitlin Goodwin MSN, RN, CNM is a Board Certified Nurse-Midwife and freelance writer. She has ten years of nursing experience and graduated with a MSN from Frontier Nursing University.
When the first nurse practitioner residency programs began, the term “residency” left many in the nursing community unsettled.
“One of the concerns of residency programs and that terminology is the suggestion that nurse practitioners are not prepared upon graduation, which is not accurate at all,” Kitty Werner, MPA, executive director for the National Organization of Nurse Practitioner Faculties (NONPF), told MedPage Today.
In considering the language debate, Werner said, “[I]f people look at them [residencies or fellowships] closely they see how they are specific to their practice site, it’s much more like an intensive on-boarding experience for new graduates. Or it might be for existing nurse practitioners who transition to that particular practice environment, but they don’t replace formal educational preparation.”
The NONPF, as part of a broader statement on post-graduate education, declared that the term “residency” is “not an optimal description for NP post-graduate support” because it may be confused with medical residencies which are required for physicians to gain licensure. Four other major nursing groups signed the statement, which was later endorsed by the largest, the American Nurses Association.
“The residency in medicine fulfills the required clinical focus of a particular specialty. In NP preparation that clinical focus is embedded in the NP educational program centering on the population focus that is the center of NP practice emphasis (e.g., family, pediatrics, women’s health, etc.),” the statement read.
Even more confusing, some nursing programs use “residency” specifically for the clinical hours already included in their programs. The statement urged post-graduate support programs to keep things simple and call themselves “fellowships” instead.
Britney Broyhill, DNP, ACNP-BC, the director of the nurse practitioner program at Carolinas Healthcare in Charlotte, N.C., said she prefers the term “fellowship” since the programs are voluntary and offer advanced practice clinicians a chance “to go above and beyond their formal education and training in a subspecialty.”
But there are dissenters, among them Margaret Flinter, PhD, APRN, senior vice president and clinical director of the Community Health Center in Middletown, Conn., who founded the first nurse practitioner residency program and still prefers that name.
“My feeling is still — though I’m always open to the conversation — that this kind of broad-based, very intensive clinical training across the full gamut of primary care is best described as residency.”
She noted that the Department of Veterans Affairs also uses the term “residency.”
This story was originally posted on MedPage Today.
Often the leading factor in nurses’ decisions about academic progression
Students are graduating from college with significant amounts of educational debt — in 2015 the average student borrower had $30,100 in loans upon graduation — and a recently published study finds that nurses are no different.
When Jan Jones-Schenk, DHSc, RN, NE-BC, national director for the college of health professions at Western Governors University, surveyed 1,299 working nurses for the study, 62% of the respondents reported they had prior college debt.
More than 39% of those with debt said their debt ranged from $1 to $24,999 while 23.5% reported debt greater than $25,000. Approximately one-third of the respondents said they had no prior college debt.
“Some had debt as high as $100,000, and 7% reported debt greater than $50,000. That’s a lifetime of debt,” Jones-Schenk said.
The study also found that educational debt influences nurses’ decisions about academic progression.
“The data showed that most of the people who have an education plan are going to go on, and they have debt,” she said. “But if they have more than $10,000 in college debt they’re going to delay their educational advancement so they’re not going to go on as quickly.”
Debt’s Influence on Education Decisions
When the National Academy of Medicine’s (formerly the Institute of Medicine) report, “The Future of Nursing: Leading Change, Advancing Health,” was released in 2010, it had very specific recommendations on the educational preparation of RNs.
The report called for 80% of nurses to hold a baccalaureate degree by 2020, and for the number of nurses with doctorate degrees to double during that time as well. It also called upon healthcare organizations to encourage nurses with associate’s and diploma degrees to enter baccalaureate nursing programs within 5 years of graduation, and for accredited nursing schools to ensure that at least 10% of all baccalaureate graduates enrolled in master’s or doctoral program within 5 years of graduation.
“We all understand the basis of that,” Jones-Schenk said. “But I do think that nurse leaders may not understand that while they may offer tuition reimbursement or other incentives for their staff, they may not be aware of the current level of debt those people have already.”
While nurses with ADNs may want to obtain BSNs, they may already carry a large amount of educational debt from their associate’s degree program.
“Because I do have students in all 50 states, I was seeing programs where students were coming to me with an associate degree and it seemed like their college debt was already pretty high,” she said of her inspiration for the study. “Some of the associate degree programs were at $60,000.”
The Need for Financial Knowledge
Jones-Schenk said that good financial mentoring is one way to help nurses keep their educational debt in check.
“If [students] are eligible for federal financial aid or state financial aid, without good counseling they may take the maximum amount of eligibility. But they may not need all that,” she said.
“In our university, we have a specific initiative called ‘the responsible borrowing initiative.’ We counsel students about how much borrowing they really need and not to over-borrow … so they’re going to be able to go on without that debt as a barrier.”
Nurses should also look at the overall cost of a program, even if a college or university is offering a discount to their employer.
“‘If you’re saying, ‘Well, I’m going to go to the school that offers the 20% tuition discount versus one that offers a 5% discount,’ that percentage of discount is meaningless. What matters is the ultimate cost to the student,” Jones-Schenk said. “That’s where I think a lot of people get hung up. They think they’re going to go to a school because they offer a 20% discount, but the ultimate cost to the student is still $30,000 versus $10,000 [with a smaller discount].”
Responsibility for minimizing debt shouldn’t be placed entirely on the student. Jones-Schenk said that low-interest rate loans and loan forgiveness programs are tools that could help defray educational debt.
“Nurse leaders, people in higher education, the government, and other individuals who have an interest in healthcare are all worried about healthcare costs,” she said. “This is part of it as well. I would hope that we would take a serious look at the cost of higher education and its value and contribution to the health of the nation.”
This story was originally posted on MedPage Today.
Healthcare workforce gains seen with Medicare-funded test program
An increase in government funding for clinical training opportunities for advanced practice registered nursing (APRN) is a feasible and affordable way to grow the primary care workforce, according to a Report to Congress on the Centers for Medicare and Medicaid Services (CMS) Graduate Nurse Education Demonstration.
The $200 million initiative was started in 2012 to determine if Medicare funding for graduate clinical education for APRNs, similar to residency training for physicians, could help meet meet the health needs of the U.S. population.
“There is a shortage of primary care providers in this country and the education of more APRNs can be part of the solution to increasing access to care,” Barbara A. Todd, DNP, director of Graduate Nurse Education (GNE) Demonstration at the Hospital University of Pennsylvania in Philadelphia, told MedPage Today.
CMS awarded funding for clinical training programs to five hospitals, which then partnered with accredited schools of nursing and non-hospital community-based care settings to deliver primary, preventive, and transitional care to Medicare beneficiaries.
The five hospitals are Duke University Hospital in Durham, North Carolina; Hospital of the University of Pennsylvania, Memorial Hermann-Texas Medical Center in Houston, Rush University Medical Center in Chicago, and HonorHealth Scottsdale Osborn Medical Center in Arizona.
Lori Hull-Grommesh, director of demonstration at Memorial Hermann-Texas Medical Center, commented on program results in the Texas Gulf Coast area, noting that 95% of APRN graduates are employed in the community setting and are helping meet critical access needs. She said she believes that national funding would allow these results to be replicated in other states.
Linda H. Aiken, PhD, coordinator of the GNE Demonstration Consortium of University of Pennsylvania, agreed. “If permanent Medicare funding were available for the clinical training of advanced practice nurses in all states, the national shortage of primary care could be solved and Americans would be able to get timely healthcare where ever they live.”
The report stated that demonstration schools had significantly greater APRN enrollment and graduation growth than comparison schools. It also touched on financial incentives: clinical training for an APRN came to a total of $30,000 compared with $150,000 for just 1 year of community-based residency training for primary care physicians.
Although the GNE demonstration is slated to conclude at the end of June 2018, the five hospitals are currently collaborating with major national stakeholders in order to promote permanent funding to roll out the program nationally.
“All five sites are working together to promote efforts for ongoing funding, along with major stakeholders AARP and [American Association of Critical-Care Nurses], who were instrumental from the beginning,” explained Hull-Grommesh. This is being done through publications, meetings, presentations and discussions with our legislators, she added.
Aiken noted that various types of healthcare organizations, including physician practices and retail clinics, are hiring nurse practitioners in larger numbers and supporting efforts like the demonstration to increase the supply for advanced practice nurses. Also, healthcare settings are working to recruit more advanced practice nurses, especially for their valuable role in ending the opioid epidemic and addressing unmet mental healthcare needs, she pointed out.
This story was originally posted on MedPage Today.
Jeffrey Ballard, R.N. and Army Veteran, began his medical career as an emergency medical technician (EMT). After gaining experience as a paramedic and a licensed practical nurse (LPN), he became a registered nurse in the Emergency Department at a Level 1 Trauma Center. He was deployed to Afghanistan two years later as an infantry medic, where he sustained injuries in combat. Following a year and a half of surgeries and physical therapy back home, Ballard returned to emergency nursing, but his struggle with PTSD prompted his departure within a year.
Ballard received care at the Manchester VA Medical Center, and he decided to continue his nursing career there. “I wanted other Veterans to have the same comfort I experienced,” he said.
Today, Ballard has been working with the VA for nearly five years and serves in a program that helps elderly Veterans maintain their independence. Working alongside compassionate nurses and caring for combat Veterans like himself has helped Ballard rediscover his passion and flourish in his career. With his experience, he’s been able to better understand and build trust with Veterans in a way that generates comfort and healing for both parties. Recently, Ballard won the title “Red Sox Nurse Hero of 2018” and was invited to throw a game-opening pitch at the historic Fenway Park.
VA offers Veterans not only life-changing care but also life-changing careers. Join our team and discover the unique rewards that come from serving our nation’s heroes. To get started, search for opportunities near you and apply today.
This story was originally posted on VAntage Point.