Intro to Prof. Nursing Ch.12: Workforce Advocacy and the Nursing Shortage – Flashcards

Nurse and nursing profession's powerful voice at the local, state, and national levels in supporting policies that protect consumers and enhance accountability for quality by promoting safer health care systems. Patient advocacy is a cornerstone of the nursing profession, and patients depend on nurses to ensure that they receive quality care. Workforce advocacy is a competent of patient advocacy.

An array of services and tools designed to help nurses promote an optimal professional work environment. Elements of workforce advocacy include staffing, workflow design, personal and social factors, physical environment, and organizational factors.

An array of complex issues nurses face in the workplace on a daily basis. These complex issues affect the nurse, the patient, the organization and the profession. Examples include the nursing shortage, adequate staffing levels, errors in health care delivery, and violence in the workplace.

Identify mechanisms within healthcare systems that opportunity's for Rn's to affect institutional policies... Shared governance Participatory management models Magnet hospital recognition statewide staffing regulations. Professor Approach - If you see the facilities and the policy's are not up to date then it doesn't cover. Sometimes it doesn't what going on. Do something about it. Develop conflict resolution models for use within organizations that address RNs' concerns about patient care delivery issues.... Identification of the reporting loop Appointment of a final arbiter in disputes * Arbiter (a person who settles a dispute or has ultimate authority in a matter). Seek legislative solutions for a workplace problems by reviewing issues of concern to nurses in employment settings and introducting appropriate legislation, such as.... Whistle-blower protection Safe harbor peer review Support for rules outlining strong nursing practice standards. Develop legal centers for nurses that could provide legal support and decision-making advice as a last recourse to resolve workplace issues... Provide fast legal assistance to nurses Earmark precedent-setting cases that could affect case law and health care policy. Professor Approach - Nurses have legal rights Provide RNS with self-advocacy and patient advocacy information, such as the following... Laws and regulations governing practice Use of applicable nursing practice standards Conflict resolution and negotiation techniques State and national reporting mechanisms that allow RNs to report concerns about health care organizations and or Professionals

Promoting and protecting occupational safety and health of nurses. - Always use nurse practice act Using nurse practice act and other legislative and regulatory protections. - Protect yourself cause you will get blamed for it. Know your rights. Using the political process to influence legislative and regulatory agencies for the protection of nurses and patients. - Your and advocate for yourself and your patients. Providing education regarding employment rights and responsibilities. - Look at your job description. Developing skills related to public relations, media presentations, and conflict resolution. Building alliance and support groups to enable nurses to speak and advocate for their professional practices. Participating in the organizations committee structure to ensure a nursing voice in safety and workplace issues. - Be apart of the governors

Interventions by these key groups that affected the shortage, resulting in growth in RN employment and school enrollment includes.... state and federal policymaker and leaders in education, healthcare, and manufacturing. Cause of nursing shortage was due to.... Too many retired nurses re-entering the workforce due to economic pressures, Nurse who planned to retire who are holding on, Part-time nurses who take full time positions, hospitals treating fewer patients cause hospital are delaying procedures or not seeking care cause of loss of insurance. Professor Approach - 2009, older nurses came back to the workforce cause they couldn't afford to retire. Companies ask them to come back.

Nursing employment are expected to grow 22% by 2018. Thousands of job openings will result from... Need to replace experienced nurses who leave the occupation. Technologic advances in patient care that result in more patients accessing the health care system and needing more specialized care. Increasing emphasis on preventive care Rapid growth in older population who are more likely to need care than younger people. Hospitals employment will grow more slowly cause many procedures and care setting are shifting to outpatient and home settings because procedures can safely be done out the hospital. employment growth are going to be in long term and home health care due to aging population. Professor Approach - People are Living longer and they are sicker.

Areas identified as negatively affecting nursing satisfaction were ... Opportunities to influence decisions about workplace organization recognition of accomplishments and work well done Opportunities for professional development and advancement. - How would you work with my schedule? What do you offer for me to continue my education? Opportunities to influence decisions about patient care. - Ask there any organizations I can be apart of that can benefit the facility? Nursing job satisfaction declines 24%. Nurses will seek for better employment as the economy improves. Half will switch to less demanding positions, Travel nurse, part-time, or retire.

Johnson and Johnson campaign helps to enhance the image of nursing profession, recruit new nurses and faculty, and help retain nurses. Most schools and are not able to expand their nursing programs cause of the lack of nursing faculty. Essentials to introduce and retain new nurses... Adequate orientation, Mentoring Preceptor programs Professor Approach - Student are willing to go, but Faculty are lacking cause of little pay.

Demand for BSN nursing with critical thinking, Leadership quality improvement, case management, and health promotion skills, who can deliver care across a variety of health care settings. Also looking for Master and Doctoral degrees Nurses. Professor Approach - LVN & ADN are being Phased out.

Low unsatisfied salaries. Average age 60.6, 57.1, and 51.5.

Ability to retain nurses depends on the creation of an environment conductive to professional autonomy. Nurses prefer to work in a place that supports decision making and effective nurse-physician relationships, which are important to patient safety. *Autonomy - independence, ability to think outside the box. The increase in job satisfaction was predicted by several factors... Organizations that emphasized quality of patient care, Management that recognized importance of their personal and family lives, Satisfaction with salary and benefits, Job security Positive relationships with nurses and management. The decreased in job satisfaction... Stress and burnout Feeling burdened (too many task) increasing number of patients overall negative view of the health care system.

One of the most successful nurse retention models focuses on.... Promoting and recognizing quality Excellence Service. Magnet Hospitals -attract and retain professional nurses in their employment. This landmark study titled "Magnet Hospitals: Attraction and Retention of Professional Nurses," Identified workplace factors, such as... management style, nursing autonomy quality of leadership, organizational structure, professional practice, career development, and quality of patient care. The Qualitative Factors of Nursing... referred to as the 14 forces of Magnetism Provided conceptual framework for the appraisal process. 2005 Magnet Recognition Program Application manual yielded an empirical model for the magnet recognition program. Magnet Hospital nurses have higher levels of autonomy, Practice setting control, and better relationships with physicians that increases quality care for patients.

Texas Nurses Association wanted to improve workplace for nurses and establish Nurse-friendly program for rural areas. The goal of the program... To improve both quality of patient care and professional satisfaction of nurses working in small and rural hospitals.

Ways to keep older nurses practicing cite in following suggestions for employers in creating positive environments.... Work place enhancements (Physical layout, Tech improvements, Teamwork opportunities. Staffing enhancements (consistent nurse and patient ratios, having an admission and discharge nurse, Patients assignments based on acuity. Work redesign ideas (take out semiprivate rooms, more work space to decrease standing, locked med drawers in patient rooms, bedside computers.

Younger nurses identified their needs as... stability flexible work schedules recognition opportunities for professional development adequate supervision

Philippines has dominated the nurse ,migration pipeline to the US and to other recruiting countries. International nurse coming to work in the US find supportive resources through the Commission on Graduates of Foreign Nursing Schools including verification of the foreign Nurses Knowledge-based practice competency. Professor Approach - Back then it was alot of hostility cause the foreign nurse was getting paid more than American Nurses including houses and etc. They must retake the NCLEX

Salary compression has long plagued the nursing profession, with little opportunity for extended growth of salary as nurses gain experience.

One of the Primary factors for increasing nurse turnover rate was identified as workload and staffing patterns. Other issues was insufficient supply of qualified managers and staff, increased market demand, Inappropriate staffing. Nursing Organization Alliance developed and presented its Principles and Elements of a Healthful Practice/Work Environment.... Provides framework for organizations to improve nurses' work environments.

Nursing Organizations Alliance believe that a healthful practice and work environment is supported by the presence of.... Collaborative (Pharmacy, RT, etc) Communication-rich culture (Make sure you communicate) A culture of Accountability The presence of adequate number of qualified nurses The presence of expert, competent, credible, visible, leadership Shared decision making at all levels Encouragement of professional practice and continued growth and development. Recognition of the value of nursing contributions Recognition by nurses for their meaningful contribution practice.

Fewer nurses per patient, surgical patients were more likely to experience higher death rates from failure to rescue (insufficient nursing care) and death from complications. Nurses working in places with insufficient staffing and shortages were more likely to experience emotional exhaustion and greater job dissatisfaction.

Shortage results in... Professional nurses being required to float to other care units with little to no experience or orientation and Implementation of mandatory on call requirements by some employers. Increasing work time increased time lost to absenteeism and injuries. Also adverse events and errors. Professor Approach - If you have to go a another unit and you have no experience on that unit. Say your not comfortable and ask for training. Because if you go there your are held responsible. Don't go somewhere without having training for that floor.

Some Questions to ask about safe staffing before accepting employment...(Page 232, Box 12-5) Who is chief nursing officer, to whom does she or he report, and does she or he have authority over staffing? Who controls the staffing budget? Does the organization have a shared governance? What is the content and length of orientation for new nurses? 3 Resources to help professional nurse decision making relative to adequate staffing and mandatory overtime.... Utilization Guide for the ANA principles for Nurse Staffing... focuses on patient acuity systems, patient classification, role of professional judgement; directs RN on how to determine the level of nurse staffing for any setting. ANA's Principles for delegation... Provides principles and guidelines for delegation to tasks to others. Define relevant principles and provide RNs with practice strategies delegating patient care to nursing assistive personnel. Principles for Nursing Documentation.... Managing the increasingly complex requirements of documenting patient care activities in both paper and electronic formats. 3 models of staffing are informing policymakers in the current environment... Fixed minimum ratios, Patient classification systems, Pay-for-perfomance The ANA endorses this approach through its Principles for nurse staffing which.... provides recommendation on appropriate staffing requires nurses to be an integral part of the nurse staffing plan development and decision-making process. Helps establish staffing levels that are flexible and account for changes including... Intensity of patient needs, Number of admission, discharges and transfers, level of experience of nursing staff, layout of the unit availability of resources. 3 General approaches to assure suffiecient nurse staffing have been utilized at the state level... 1st approach is to require hospitals to have a nurse-driven staffing committee, create staffing plans that reflect the needs of the patient population, Match the skills and experience of the staff. 2nd Approach - Legislators to mandate specific nurse to patient ratios in legislation of regulation 3rd - require facilities to disclose staffing levels to the public and or a regulatory body. P4P (Pay for Performance) model... Provide greater payments to hospitals that meet quality standards. Payments are linked to outcomes; providing incentives to boost staffing.

identified as key indicator of excellence in nursing practice. Concept of shared governance... Maintain job satisfaction, quality care, fiscal viability. Importance of shared governance.. models provide an organizational framework for nurse in direct care to become committed to nursing practice within their organization. Implementation of models... Allow nurses to be active in decision making by providing participation and accountability for outcomes. Empowers staff to make care decisions. Results in more than job satisfaction for nurses; includes as equally important increased efficiency and better patient outcomes.

Patients depends on nurses to ensure that they receive proper care. Nurse has a powerful voice in the role of patient advocate by supporting public policies that protect consumers and enhance accountability for quality by promoting safer healthcare systems.

44,000 -98000 patient die a year from med errors. ANAs national center for nursing quality was created to address patient safety and quality in nursing care and nurses work lives. NCNQ advocates for nursing quality through quality measurement, novel research, and collaborative learning. National Database for nursing quality Indicators.. Program of the NCNQ, only database containing data collected at the nursing unit level and allows for empirical linkages between nursing care and patient outcomes. Transforming care at the bedside was a joint effort between Robert woord Johnson foundation and Institute for healthcare improvement to.... create a framework for change on hospital medical surgical unit by engaging front line nurses and leaders to... Improve quality and safety patient care Increase the vitality and retention of nurses Engage and improve the patients and family members experience of care Improve the effectiveness of the entire care team. Safety and quality of patient care is dependent on teamwork communication Collaborative work environment. To ensure quality and promote safety, health care organizations must address the problem of behaviors that threaten performance of health care team.

Acting within the scope of practice; Speaking up for their patients without fear of retaliation.

Biologic Hazards... Bacteria, virus, fungi that can transmit by contact with infected patients. Ergonomic Hazards... Musculoskeletal injury to the back and extremities from lifting standing for long periods, repeated hand motions. Chemical Hazards... Meds, solutions, gases, formaldehyde, cytotoxic agents,PVC, Mercury Psychologic Harzards... Stress, shift work, mandatory overtime, verbal abuse by patients and other health care providers. Physical Hazards... Radiation, lasers, noise, electricity, violence

The needlestick and safety and prevention act.... require the use of safer needle devices to protect from sharps injuries. Also required employers to solicit the input of non-managerial employers responsible for direct patient care who are potentially exposed to sharps injuries in the identification, evaluation, and selection of effective engineering and work practice controls. Law also requires employers to maintain a sharps injury log brand of device involve Department or work area where it happen Explanation how it happen. Professor Approach - Never Recap a needle

Professor Approach Lifting a patient incorrectly hurting your back.

Being bullied in the workplace

American Association of Occupational Health Nurses, Association of periOperative Registered Nurses Emergency Nurse Association Labor unions representing coworkers.... These organizations advocate administrative controls such as... adequate staffing health safety committees; engineering controls (ventilation, safer needle sticks) personal protection equipment (gloves, respirators)