WGU Professional Roles & Values CH 12 – Flashcards
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Important research is validating the contribution of RNs
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- improved patient outcomes - prevention of premature mortality - increased hospital profitability
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Overview
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- 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"
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Center for American Nurses (CAN)
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- 2003: CAN created as an independent national professional association and an associate organization member of the American Nurses Association (ANA) - addresses the needs of nurses not represented by collective bargaining
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CAN
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- embraces the Workforce Advocacy Ecosystem Model - workforce staffing - workflow design - personal/social factors - physical environment - organizational factors
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Opportunities and Challenges for Workforce Advocacy
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- identify mechanisms that provide opportunities for Rns to affect institutional policy - develop conflict resolution models that address RN's concerns about patient care - seek legislative solutions for workplace problems - develop legal centers for nurses - provide RNs with self-advocacy and patient advocacy information
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Examples of Workforce Advocacy
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- 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
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Examples of Workforce Advocacy
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- 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
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Issues in the Workplace
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- nursing shortage - appropriate staffing and mandatory overtime - patient advocacy and safety - workplace safety
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Nursing Shortage
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- 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 - by 2025 deficit will be near 500,000 with a 40% RN vacancy rate nationwide - positions for RNs expected to create more than half a million new jobs from 2006 to 2016, the second largest number of new jobs among all occupations - planning for an adequate nursing workforce one of the most critical challenges of this century
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Healthcare: no longer a favored employer
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- attractiveness of health careers declined in 1980's and 1990's - women's movement sparked greater opportunities beyond female-dominated professions - health care systems must redesign work and workplace environments to attract and retain RNs
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Areas of the work environment negatively affect nursing satisfaction as a preferred career choice
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- 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
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Decline in enrollments in 1990s resulted from
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- smaller numbers of individuals available to enter the workforce because birth cohorts born after 1955 are smaller in population size - career opportunities for women have expanded outside nursing - nursing schools unable to expand enrollments significantly because of a serious shortage of faculty
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Recruitment initiatives over the past decade
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- nurses for a Healthier Tomorrow: formed by 21 of the nation's leading nursing and health care organizations - nursing: The Ultimate Adventure: video produced by National Student Nurses' Association targeted at junior and senior high school students - Johnson & Johnson's Campaign for Nursing's Future
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Nursing school enrollments
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- recruitment efforts have resulted in increases in nursing school enrollments for 8 consecutive years (2001-2008) - increases continue to fall below projected need
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Education
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- 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 - 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
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Faculty Shortage
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- aging of nursing faculty is one of the most critical problems that faces nursing - faculty salaries are a major contributor to the faculty shortage
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Retention
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- depends on creating an environment conducive to professional autonomy 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
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Increased satisfaction predicted by
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- 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
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Decreased satisfaction predicted by
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- 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
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Aging Workforce and Retention
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- nurses older than 40 years represent nearly 60% of the workforce; almost all reached retirement age by 2010
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Strategies for retaining the older, expert nurse:
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- provide greater flexibility in scheduling - offer innovative positions such as mentor, research assistant, or safety officer - provide better ergonomics and health care design to decrease physical demands - improve introduction to technology - allow for greater participation in decision making
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Expectation of the 20-something generation
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- 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
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Emerging workforce recruitment and retention
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- four generations may be present in the workplace at one time with a resulting clash in ideas and goals
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Foreign Nurse Recruitment
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- long relied on as a remedy for nursing shortages - in 2006 15% of the RN workforce was foreign-born - problematic as a method of resolving U.S. shortage - current shortage is worldwide - foreign nurse recruitment is open to abuse - in 2008 a collaborative of nursing and other organizations endorsed a Code of Ethical Conduct for the Recruitment of Foreign Educated Nurses
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Compensation
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- during the 1990's, 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 - analysts believe further wage increases will be needed to bring about a new equilibrium in the RN labor market
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Work Environment: - Nine Elements of Healthful work Environemt
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- 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
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Factors contributing to nurse dissatisfaction within the workplace
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- 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
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Quantifying Appropriate Staffing: - Landmark study by Aiken et al. (2002) established links with appropriate staffing
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- 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
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Floating/Mandatory Overtime
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- increase in requirement in the 1990's led to increase in need to float to other patient care units - increase in mandatory overtime/mandatory on-call requirements by some employers
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Studies of mandatory overtime in other industries demonstrated
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- 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
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Floating/Mandatory Overtime
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- 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
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Advocating for Safe Staffing
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- 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: - 12 states enacted legislation restricting mandatory overtime - 3 states restrict mandatory overtime - the first state to pass legislation addressing nurse staffing levels through fixed minimum ratios was california in 1999
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Shared Governance
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- 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 - access to conflict resolution procedures is necessary
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Patient Advocacy and Safety
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- patients 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
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Errors in Health Care
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- Findings of two major studies: errors kill some 44,000 to 98,000 people in the 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 practice necessary for safety - unsafe workforce deployment - unsafe work and workspace design - punitive cultures that hinder the reporting and prevention of errors
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National center for Nursing Quality (NCNQ)
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- 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
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Errors in Healthcare - Transforming care at the bedside (TCAB)
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- 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
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Whistle-Blower protection
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- 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
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Workplace Safety
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- nurses' safety and health an ongoing concern - categories of health hazards in the healthcare workplace: - biologic - ergonomic - chemical - psychologic - physical
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Blood-borne pathogens
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- healthcare 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 non managerial employees in the selection of effective engineering and work practice controls - requires employers to maintain a sharps injury log
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Ergonomic Injuries
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- 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
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Barriers to reporting workplace injuries
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- fear of repercussions such as disciplinary action - stigmatization as a complainer - harassment by supervisors and coworkers - denial of opportunities for promotion - termination of employment
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Workplace Violence
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- a major societal issue - nurses must proactively advocate for safe workplaces - comprehensive organizational assessment to identify high-risk environments, psychologic 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
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Advocating for a Safer Workplace
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- ANA working with other nursing organizations to advocate for health care worker health and safety - ANA-affiliated CAN advocates 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 healthcare industry is a dangerous place to work, many risks are avoidable and dangerous exposures are preventable
