A generational gap is showing in nurses’ views of the practice, with younger RNs more likely to have a positive opinion of the nurse supply and use of electronic medical records, according to a survey.
The fourth annual survey was conducted by AMN Healthcare, a healthcare workforce and staffing company. Results were based on 3,413 responses from questionnaires emailed to 101,431 RNs during April 2013.
“In a time of unprecedented change in the healthcare industry, it becomes even more important to study how the nursing workforce is responding to the myriad new systems, requirements and quality measurements that accompany healthcare reform,” Marcia Faller, RN, PhD, chief clinical officer of AMN Healthcare, said in a news release.
“While the vast majority of nurses remain satisfied with career choice, the younger generation is more optimistic about the profession and more receptive to the changes the industry is experiencing. These are differences that health systems must understand as they work with multiple generations of nurses.”
Despite existing shortages, RNs ages 19-39 are more confident about the supply of nurses and their ability to meet the demands of healthcare reform, according to the survey. Findings show 45% of younger RNs believe the shortage has improved during the past five years, compared with 41% of RNs ages 40-54 and 34% of RNs ages 55 and older.
The generational differences widened when nurses were asked whether healthcare reform will ensure an adequate supply of quality nurses, with 38% of younger nurses saying they were “very confident” or “somewhat confident,” compared with 29% and 27% of nurses 40-54 and 55 and older, respectively.
Generational differences also appeared in answers about the use of electronic medical records, a requirement of the Affordable Care Act. Younger RNs were more likely to believe their use positively influenced job satisfaction, efficiency and patient care. While 67% of younger nurses agreed or strongly agreed EMRs were a positive influence on job satisfaction, that number fell to 51% for nurses 40-54 and 45% for RNs 55 and older.
Similarly, more young RNs (60%) agreed EMRs positively influence productivity and time management compared with older RNs (38%), the survey found.
• Almost 90% of nurses, regardless of age, are satisfied with their career choice, and 73% are satisfied with their current jobs.
• With the improving economy, approximately 23% of nurses age 55 and older plan to dramatically change their work life, citing retirement, taking a non-nursing job or working part-time as very near-term possibilities.
• Less than half of RNs with an associate’s degree or a diploma plan to pursue any additional education in nursing. However, RNs ages 19-39 are more likely to pursue higher education, with nearly 25% saying they expect to pursue a BSN and 34% planning to obtain an MSN, compared with 22% of RNs ages 40-54 planning to pursue a BSN and 22% eying an MSN.
• Of younger nurses, 21% are certified in their specialty, but 59% expect to seek certification.
• RNs ages 19-39 were less likely to believe the quality of care has generally declined (37%), compared with RNs 40-54 (56%) and RNs 55 and older (66%).
“The potential departure of a significant number of older nurses from the workforce can be concerning, given the unclear supply and demand for nurses in the coming years, but is to be expected as nurses approach retirement age,” Faller said in the news release.
“Healthcare systems must use innovative approaches to attract and retain their workforce while keeping them effective and satisfied. Innovative workforce solutions could help maintain high standards of patient care and efficiency in the era of dramatic change in the healthcare industry.”
Report (registration required): www.amnhealthcare.com/industry-research/2147484433/1033/
Despite “measurable progress” in the three years since the release of the Institute of Medicine’s landmark report on the future of nursing, more work remains “to fully realize the potential of qualified nurses to improve health and provide care to people who need it.”
That assessment is part of a commentary by Harvey V. Fineberg, MD, PhD, president of the IOM, and Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation, on the aftermath of the report.
“The Future of Nursing: Leading Change, Advancing Health” was released Oct. 5, 2010, by the IOM with the support of RWJF. It provided a blueprint for transforming the nursing profession to “respond effectively to rapidly changing healthcare settings and an evolving healthcare system,” according to a report brief.
The key recommendations: allow nurses to practice to the full scope of their education and training, provide opportunities for nurses to serve as healthcare leaders and increase the proportion of nurses with a BSN to 80% by 2020. Following the report, RWJF and AARP formed the Campaign for Action to implement the report’s recommendations at the state level.
Regarding scope of practice for advanced practice registered nurses, Fineberg and Lavizzo-Mourey wrote that 43 state action coalitions have prioritized initiatives to remove scope-of-practice regulations that prevent APRNs from delivering care to the full extent of their education and training. Iowa, Kentucky, Maryland , Nevada, North Dakota, Oregon and Rhode Island have removed barriers to APRN practice and care, and 15 states introduced bills this year to remove physician supervision requirements that can hinder APRN care.
Regarding education and training, the proportion of employed nurses with a BSN or higher degree was 49% in 2010 and 50% in 2011. “Progress is likely to accelerate in the years to come,” Fineberg and Lavizzo-Mourey wrote, “because between 2011 and 2012 along there was a 22.2% increase in enrollment in RN-to-BSN programs and a 3.5% increase in enrollment in entry-level BSN programs.” The authors also noted a recent increase in the number of students enrolled in nursing doctorate programs. Of the 51 action coalitions, 48 have worked to enable seamless academic progression in nursing.
The authors noted that the influence of the campaign has paid off with a $200 million Medicare initiative to support the training of APRNs at hospital systems in Arizona, Illinois, North Carolina, Pennsylvania and Texas.
Regarding nurse leadership, Fineberg and Lavizzo-Mourey wrote, the “Campaign for Action has tapped established and emerging nurse leaders across the nation and is working to provide them with opportunities for networking, skills development and mentoring. A key strategy is to advocate for more nurses to serve on hospital boards.”
Full commentary: http://bit.ly/176XyZs
Campaign for Action: http://www.rwjf.org/en/topics/rwjf-topic-areas/nursing/action-coalitions.html
“Future of Nursing” report: www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
Graduate Nurse Education Demonstration: http://innovation.cms.gov/initiatives/gne/.
By Debra Wood, RN
To achieve the national goal of improved health outcomes, many researchers and health advocates agree that patients must assume a greater role in managing their health
care. But how can facilities and health systems accomplish this kind of patient engagement? The answer may rest with nurses and nurse leaders, who have long overseen patient education about how to care for chronic conditions and make lifestyle changes to improve health.
“Promoting patient education has always been a part of our nursing role and obligation to the
patient,” said Debi Sampsel, DNP, MSN, BA, RN, chief officer of innovation and entrepreneurship at the University of Cincinnati’s College of Nursing in Ohio. “It has been a long-standing practice that nurses involve the patient across the life span in their own care.”
Sampsel finds nurses strive to and take great pride in promoting healthy lifestyles. And research has demonstrated that active, engaged individuals have far better health outcomes. The University of Cincinnati includes health promotion in the nursing curriculum and gives students an opportunity gain patient-engagement experience while working with the homeless and elementary and secondary school age youth.
“What’s new is old,” added Patrick R. Coonan, EdD, RN, NEA-BC, FACHE, dean and professor at the College of Nursing and Public Health at Adelphi University in Garden City, N.Y. “I went to nursing school 35, 40 years ago and what did they teach but to be the patient advocate, to teach the patient. But we got away from that in the last few decades.”
Coonan pointed out that today’s consumers and patients, particularly baby boomers, are better informed. They often turn to the Internet for facts, but he called it a nursing professional’s obligation to verify whether the online information is accurate. Boomers are not going to settle for a paternalistic “Just take this pill” without knowing why and how it will benefit them. And that often falls to the nurse.”
“We have to get away from the patient-doctor or patient–nurse relationship that is almost like a parent–child relationship, in existence for many years, to a more informed and empowered [consumer] who will take responsibility for their health,” said Rosemary Glavan, RN, MPA, CCM, senior vice president of clinical operations at AMC Health, a telehealth provider based in New York. “Baby boomers have been go-getters and always wanted to be in charge. They want to be empowered.”
Advocating with a personal connection
“As patient advocates, nurses and nurse leaders play a key role in promoting patient engagement,” said Cynthia M. Friis, MEd, BSN, RN-BC, associate association executive for SmithBucklin’s healthcare and scientific industry practice in Chicago. “Nurses are privileged with having the opportunity to spend more time with the patients to assess, plan, implement and then help clarify the plan of care with the patient and his/her family or caregivers. Nurse leaders are key in helping to ensure this role is realized. Nurses can do their jobs better with the full support of our nurse leaders.”
Nurses ask questions, she added, and draw patients into thoughtful discussions about their care, helping them move forward when they feel overwhelmed and understand how to best care for themselves.
Establishing principles of engagement
Patewood Memorial Hospital in Greenville, S.C., participated in a national study by the Agency for Healthcare Research and Quality (AHRQ) and in the development of theGuide to Patient and Family Engagement in Hospital Quality and Safety.
Recommendations in the AHRQ guide include:
• Working with patients as advisors;
• Communicating effectively;
• Giving bedside shift reports, where nurses do not talk with each other but involve the patient and family members he or she wants to participate; and
• Engaging patients in transitions to home.
The hospital has experienced improvements to its HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey since implementing the program.
“The patients and families are much happier,” said Kerrie Roberson, MBA, MSN, RN-BC, CMS, nurse educator at Patewood. “Patient engagement is a partnership with the patient and families, and they trust you more when they see you are open about their care.”
Nurses at Patewood are leading discussions about patient engagement across the Greenville Health System and have begun sharing their experiences with others.
Other nurses gathered to develop Guiding Principles for Patient Engagement, released last year by the Nursing Alliance for Quality Care (NAQC), which was supported by the Robert Wood Johnson Foundation.
Principles in the NAQC guide include:
• Having a dynamic partnership with patients and their families;
• Respecting boundaries;
• Maintaining confidentiality;
• Adhering to responsibilities and accountabilities;
• Recognizing patients able to engage;
• Appreciating patient rights;
• Sharing information and decision making; and
• Advocating for the patient.
“Patient-centered care and engaging patients is very important to improving quality outcomes, which includes reducing cost and better health of populations in the community, but also reductions in disparities of care,” said Maureen Dailey, PhD, RN, CWOCN, senior policy fellow for nursing practice and policy at the American Nurses Association (ANA), a member organization of the NAQC. “The patient is at the center of the team and must assume accountability for self-care and part of the outcome. But that evolution has yet to take place.”
Nurses must instill confidence and competence in patients’ self-care, Dailey explained. And patients need nurses to provide knowledge, support and symptom management.
“Nurses hold a central role in patient engagement,” Dailey concluded.
Combing nursing skills with technology
Along with the personal touch, many nurses are finding technology can assist with their patient-engagement efforts.
“As the responsibility of nursing advances to one of building and sustaining patient activation and the role of nursing moves to be more consultative across care settings, technology will play a vital role for both the nurse and the patient,” said Karen Drenkard, PhD, RN, NEA-BC, FAAN.
Drenkard, who has served as executive director of the American Nurses Credentialing Center (ANCC) and past director of the ANCC Magnet Recognition Program, will join GetWellNetwork in January as chief clinical/nursing officer, where she will lead the development of a nursing model of patient engagement. Her responsibilities will include studying and designing new ways to assess and improve patient activation through clinical practice and technology solutions across all care settings.
“Nursing can use interactive patient care technology to proactively engage the patient and shift the responsibility for completing certain care interventions,” said Drenkard, explaining patients can document daily signs and symptoms. Care providers use the network to send reminders about taking medications or the need for follow-up visits to their physician when data and input from the patient indicates the need to do so.
Analytics spot trends, and nurses can intervene at the first sign of trouble with a personal follow-up. The data also helps them identify where the patient is on the readiness scale of change.
“To be most effective in engaging patients and more so activating patients, the nursing role
must evolve and develop,” Drenkard concluded. “The need for change and adaptation is certainly not new to our profession. However, there is a pivotal opportunity today to shift the role of the nurse away from a more task-oriented, episodic care management function to one that more centered on building, sustaining a care management relationship with a population of patients with the effective use of interactive patient care technology.”
© 2013. AMN Healthcare, Inc. All Rights Reserved.
Source: AMN Healthcare
By Heather Stringer
For several years, Russell Atkins, RN, CEN, earned about $100,000 annually as a traveling nurse working in EDs and ICUs, but beginning in 2009 he started seeing a disturbing trend. The job assignments in higher-paying states such as California and Massachusetts were increasingly rare, and his hourly wage dropped roughly 20% within a year.
Desperate to provide for his wife and two children, Atkins could no longer afford the unpredictable assignments. He accepted a lower-paying, but permanent, job in his home town of Bastrop, La.
Atkins is not alone. Most nurses throughout the country are feeling the impact of significant national factors, such as the recession and healthcare reform, that are changing the landscape of nursing jobs.
“Nurse salaries — and really salaries for any profession — are generally determined by supply and demand,” said Joanne Spetz, PhD, a noted healthcare and nursing economics researcher and professor at the Institute for Health Policy Studies, University of California, San Francisco. “What we’ve been seeing in California is that the wages of nurses really flattened out and may have even dropped in the past four years after a period of rapid wage growth.”
According to data from a 2012 survey from the California Board of Registered Nursing, the annual salary of nurses in California increased from $45,073 to $81,428 between 1997 and 2008. In the past five years, however, salaries flattened and even dropped between 2010 and 2012.
RNs across the nation are experiencing a similar trend, according to data from the U.S. Bureau of Labor Statistics. Starting in 2009, the median annual wage increases were 2% or less, compared with double or triple that percentage the previous five years. Between 2011 and 2012, the latest data available, the median annual wage for RNs nationally increased only 1%, from $69,110 to $69,935. Data from the American Association of Colleges of Nursing shows that nurse faculty salaries are stagnating as well.
Although many hospitals have become more conservative in hiring nurses, Spetz suggested there are strategies nurses can use to increase their chances of securing a desirable position in the long run. “I know a lot of new graduates like to look for the perfect job, but if the labor market is tight in your area, just get a job because some experience will make you more competitive and help you get that perfect job in the future,” she said. “If you are an associate-degree graduate and can go back to school, do it.”
For Atkins, the willingness to be flexible paid off in the short term. After a year as director of an ED in Louisiana, he was recruited to fill an interim ED director position at a larger hospital system in Missouri. Although the position was short-term, he hoped the experience would help him eventually land a position in California. Then the call came: A traveling company recruited him for an interim position in California. This interim position eventually turned into a full-time permanent role as house and bed control supervisor at Kaiser Permanente in Hayward, Calif., with an annual salary well above any of his previous salaries.
“During my previous director roles, I tried to learn everything possible about budgets, audits and the hospital, such as how to set up an incident command center and emergency response teams,” Atkins said. “Now I absolutely love my job, and my hours allow me to be home with my children in the evening.”
Forces at work
While recessions and salary changes tend to be cyclical, the future is less predictable with the convergence of several national trends.
“The first factor is the real impact healthcare reform will have, and a lot of that is relatively unknown,” said Terry Bennett, RN, MS, CHCR, president of the National Association for Health Care Recruitment, based in Lenexa, Kan. “Organizations are struggling to predict the impact of decreasing physician and Medicare reimbursements, and they are really trying to maintain financial security. They are not giving the same type of market adjustments that they used to [give nurses], and some are decreasing the amount of merit increases given to nurses.”
In addition, the supply of nurses has increased in the past decade as a growing number of nursing school graduates join baby boomers still on the job, Spetz said. “The baby boomers have been more career-focused than any generation preceding them,” she said. “They might not want to fully retire even if the recession lifts.”
However, other factors could increase demand for RNs and drive up salaries. “What we would expect is that as the economy improves and as the Affordable Care Act allows more people with insurance to seek healthcare, we would see demand for nurses go up,” said Spetz. “Also, as baby boomers age and require more healthcare, this could also drive up demand for services.”
Nurse staffing ratio laws also may increase the number of positions available in hospitals, said Brannen Betz, general manager of Aureus Medical Group, a national nurse staffing company. According to the American Nurses Association, 15 states have enacted legislation or adopted regulations to address nurse staffing. “Many states are moving toward mandating nurse-to-patient ratios, and this could be the best thing that happens to nurses,” Betz said.
As healthcare employers prepare for these changes, nurses can position themselves to stand out from their competition.
“We are no longer just putting someone in the job because they have a credential,” said Julie Hill, RN, BSN, CHCR, RACR, recruitment coordinator for Georgetown Hospital System in South Carolina and vice president of NAHCR. “Now we have a larger applicant pool, so we can select the best nurse for the job. Many hospitals use behavioral assessment tools so they can make sure that an individual has the positive service attributes that lead to good hospital consumer assessment scores and less likelihood of turnover.”
Georgetown uses a behavioral assessment tool combined with a separate reference assessment tool, Hill said. Hospitals are looking for nurses who are flexible, customer-focused, compassionate, have a strong work ethic and work well with team members, she said.
Nurses with specialty training also are in higher demand, said Kay Cowling, CEO of Fastaff Travel Nursing, based in Denver. Nurses with experience in ORs, labor and delivery, cardiovascular ICUs or pediatric areas have more options, Cowling said. RNs who know how to use electronic health record systems also have an advantage in the job market, she said.
Advanced education also can open doors, said Jean Moore, RN, MSN, director of the Center for Health Workforce Studies at the SUNY Albany School of Public Health. “The demand for nurse practitioners will grow as we face an emerging primary physician shortage.”
Nurse practitioners also earn significantly more than most RNs. According to the BLS, their mean annual wage in 2012 was $91,450. Nurse midwives earned $91,070 and nurse anesthetists earned $154,390.
For those who cannot pursue higher education, Atkins’ story suggests that an ideal job can be secured through other routes. A willingness to relocate, which put him in situations where he was forced to learn new skills, provided clear advantages. “As nurses, we need to be willing to try new things and work in new types of settings and with different types of technology,” Bennett, NAHCR president, said. “Take advantage of opportunities to learn within your current setting or try to prepare for new settings that may become available.”
(Please click pdf links below to view or download nursing salary charts related to this story)
By Jacqueline Lee
Doctors may have led the medical BYOD revolution, but nurses have followed their examples. According to a report from Spyglass Consulting group, 69 percent of nurses bring their own devices to work.
According to another survey from Absolute Software, half of hospital staff members bring mobile devices to work access e-mail and calendar applications. However, 36 percent use their mobile phones and tablets to access patient information.
The winner, in many cases, is the patient. Nurses often use their devices to access clinical reference materials right at the point of care. They also use devices to coordinate care with other clinicians.
Overall, nurses that exercise their BYOD power report a greater sense of autonomy in the workplace. They are more comfortable using their own devices, they feel a sense of control over computing and they report an improvement in work-life balance.
Many analysts predict that mobile devices will spell the end for overhead paging systems in hospitals. They may also replace nurse call systems that don't quite get the job done. To make the change as smooth as possible, however, hospitals and medical clinics will have to take an attitude of, "If you can't beat 'em, join ’em." Intel has made an interesting video on the subject:
For example, if staff members are demanding BYOD in a hospital, then the hospital's CIO and IT department need to develop a BYOD strategy that protects patient information. The BYOD strategy should be integrated hospital-wide so that staff members have a unified method of communicating with one another.
A BYOD-friendly hospital, for example, would not only be able to use smartphones to page nurses and to coordinate care. They could transmit alerts from different areas of the hospital as well as communicate lab results and radiology reports. Nurses and doctors could also use their own devices to place orders for important medical tests and to access patient records.
In a world where HIPAA violations garner heavy government fines, medical facilities have to be savvy about how staff members are using patient information. No personal mobile device, for example, should store patient records.
Hospitals that embrace BYOD can make the work of doctors and nurses much easier. In the end, happy medical staff translates to better patient care.
There is a lot of advice out there about how you should enter, develop and progress in nursing.
Do you get your feet wet by simply gaining some “field” experience before transferring to a specialty like Emergency, Critical Care, or the Operating Room?
What about pursuing an advanced degree? What are the qualities you should acquire and maintain to stay sharp? How do you avoid burnout? Where is the best place to work? What about workplace bullying? Nurses eat their young, right?
The list is long and the questions are never-ending And, quite honestly, there is never a simple answer, or a single correct answer.
Over the years, I think I’ve finally figured it out: I found that “one thing” that matters. I found that “one thing” that can ensure you don’t get bogged down with the rhetoric and negativity. What is it?
Being honest is the key to success in this profession. And I’m talking global honesty across every facet of your job.
Be honest with your patients
- If you don’t know something, admit it. It’s okay to share stories with them. It’s okay to be human. It’s nurses’ genuine nature that keeps patients voting us the most trusted profession every year.
Be honest with your coworkers
- Don’t pull a fast one on the very people you’ll be relying on to pull you through that hellish shift. But don’t be a pushover. Be honest. Be genuine. You may be a little more vulnerable, but the reward you get always outweighs the risk.
Be honest with management
- This goes hand-in-hand with coworker honesty. Take care of those who will take care of you. Even if it’s the worst boss in the world, hate and evil just beget more hate and evil. I truly believe that honesty always wins out.
Be honest with your physician partners
- Respect has to be earned, not just expected. I have learned over the years to be honest about your skills, your knowledge and your performance with your physician partners–they will respect your honesty more than any lie you can tell. Don’t try to fool the very professionals who are your biggest supporters.
Be honest with yourself
- Not happy with your job? Change it. Not happy with your position? Change it. Don’t let anyone convince you that your situation is not in your control. We work in the greatest profession I know. You have an unlimited number of opportunities–you just have to be enough of a forward-thinker to go find them.
Be honest. Now, remember, I never said being honest was easy. Just because it’s the right thing to do doesn’t mean it’s popular. Be honest, but be strong. You will find that being honest is tough, so hang in there and don’t succumb to the pressure of dishonesty.
Do you agree?