DiversityNursing Blog

Legislation in California that set nurse-to-patient ratios added more registered nurses to the hospital staffing mix, not fewer as feared, researchers say.

Lead researcher Matthew McHugh, a nursing professor at the University of Pennsylvania in Philadelphia, says California was the first state to pass legislation setting staffing levels. However, mindful of the ongoing nurse shortage California legislators determined that hospitals could employ licensed practical nurses as well as registered nurses to meet the requirements of the law, McHugh says.

“California’s state-mandated nurse staffing ratios have been shown to be successful in terms of increasing registered nurse staffing,” McHugh says in a statement. “From a policy perspective, this should be useful information to the states currently debating legislation on nurse-to-patient ratios.”

California experienced a more serious nurse shortage than other areas of the country but made up the gap by hiring “travel nurses” — temporary workers who move from hospital to hospital as needed and ae not less educated LPNs, the researchers say.

The study, published in the journal Health Affairs, examined hiring practices from 1997 to 2008, pre- and post-implementation of the legislation, concluding that the increase in nurse staffing did not come at the expense of decreasing RNs.

“Our findings demonstrate that the nurse-to-patient ratio mandate in California was effective in increasing registered nurse staffing in hospitals,” McHugh says.

From monster.com

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Does your state have legislation like this? What do you think? Does it help or hinder you in doing your job? How about your patients? Let us know in the comments!

“Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act, legislation that represents the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs. A number of barriers prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system. These barriers need to be overcome to ensure that nurses are well-positioned to lead change and advance health.”

80% BSN Nurses by 2020?

One of the most ambitious recommendations in the report is the section on advancement of nursing education. It proposes the goal of transitioning the average 50% of the nursing workforce at the BSN level today to that of 80% of the workforce in the next 10 years. While this is a worthwhile goal, without the funding to pay for the ADN nurses to advance to the BSN level and the increase in pay that such an advance might ordinarily offer in another field, there is little hope of achieving this goal.

It makes no sense to shut down the existing pipeline of ADN nursing programs and requiring BSN as the minimum standard of education for registered nurse (RN). With the predicted nursing shortage, these ADN programs will be the only way we can meet the needs of the aging population and declining nursing workforce. Unless there is a major influx of scholarship funding from public and private sources to encourage nurses to go back to school in droves and provide them the financial incentive to do so, it is unlikely that the 80% goal will be reached by 2020.
Practice Within Full Scope of Nurse Training

One part of the process that met with approval from all of the panelists was the focus on expanding the scope and inclusion of advanced practice nurses nationwide. With health care costs continuing to skyrocket and a lack of needed primary care resources, offering a full provider status to nurse practitioners nationwide is one of the most effective ways to approach the broad primary care gap that exists. When physicians purport that they should be the only primary prescribers and decision makers for all patients, the IOM reports suggests that these objections be treated as anti-competitive practices and price fixing in the health care marketplace.

If you are a nurse, what do you think about shifting the educational percentages to 80% BSN? In some organizations, there is even a push for higher percentages of MSN degrees. What are you seeing where you work?

Pay should not be your only considering when deciding on a specialty, but the list below of the highest paying nursing specialties provides a good primer on which types of nurses have the greatest earning potential.

1) Certified Registered Nurse Anesthetist – $135,000

A Certified Registered Nurse Anesthetist is someone who administers anesthesia to patients. They collaborate with surgeons, anesthesiologists, dentists and podiatrists to safely administer anesthesia medications. For additional information, please refer to the entire CRNA profile.

2) Nurse Researcher – $95,000

Nurse researchers work as analysts for private companies or health policy nonprofits. They publish research studies based on data collected on specific pharmaceutical/medical/nursing product and practices.

3) Psychiatric Nurse Practitioner – $95,000

Psychiatric Nurse Practitioners are advanced practice nurses who provide care and consultation to patients suffering from psychiatric and mental health disorders.

4) Certified Nurse Midwife – $84,000

Nurse midwives provide primary care to women, including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care. CNMs work in hospitals, clinics, health departments, homes and private practices. Midwives will often have to work unpredictable hours (due to the unpredictable nature of childbirth). They should have good communications skills and be willing to commit to a holistic approach to patient care.

5) Pediatric Endocrinology Nurse – $81,000

Pediatric endocrinology nurses provide care to young children who are suffering from diseases and disorders of the endocrine system. This often involves educating both parents and children on the the physical and sexual development issues that arise from these disorders.

6) Orthopedic Nurse – $81,000

Orthopedic nurses provide care for patients suffering for musculoskeletal ailments, such as arthritis, joint replacement and diabetes. They are responsible for educating patients on these disorders and on available self-care and support systems.

7) Nurse Practitioner – $78,000

Nurse practitioners provide basic preventive health care to patients, and increasingly serve as primary and specialty care providers in mainly medically underserved areas. The most common areas of specialty for nurse practitioners are family practice, adult practice, women’s health, pediatrics, acute care, and gerontology; however, there are many other specialties. In most states, advanced practice nurses can prescribe medications.

8) Clinical Nurse Specialist – $76,000

Clinical Nurse Specialists develop uniform standards for quality care and work with staff nurses to ensure that those standards are being met. They are required to possess strong managerial skills and an ability to anticipate potential staff/patient conflicts.

9) Gerontological Nurse Practitioner – $75,000

Gerontological Nurse Practitioners (GNPs) hold advanced degrees specializing in geriatrics. They are able to diagnose and manage their patients’ often long-term and debilitating conditions and provide regular assessments to patients’ family members. Similar to all geriatric nurses, GNPs must approach nursing holistically and pay special attention to maintaining a comforting bedside manner for their elderly patients.

10) Neonatal Nurse – $74,000

Neonatal nurses care for sick and/or premature newborn babies. They also provide consultation to the newborn’s family during what can be an emotionally draining period.

Hospital employment climbed by 15,400 in February

Employment at the nation's hospitals increased 0.32% in February to a seasonally adjusted 4,806,600 people, the Bureau of Labor Statistics reported today. That's 15,400 more people than in January and 109,600 more than a year ago. Without the seasonal adjustment, which removes the effect of fluctuations due to seasonal events, private hospitals employed 4,797,600 people in February - 13,300 more than in January and 111,500 more than a year ago. The nation's overall unemployment rate was unchanged in February at 8.3%.

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What are your thoughts? Is your hospital hiring? Growing? Why do you think so?

Marilen Logan, RN, MSN, PHN, stands hunched over a table. In her hands are vials. That's not unusual for a nurse in a busy city hospital - until you look inside the vials. Rather than a blood sample, these vials contain lavender, peppermint and lemongrass.   

 

"Patients in the hospital are often under a lot of stress," says Marilen. "Certain scents can enhance a feeling of calm, reduce anxiety and in turn improve outcomes."   

 

She adds, "It's also a familiar healing approach for many of my patients, who have been exposed to the benefits of aromatherapy because of their unique cultural backgrounds."

Marilen says her own diverse background inspired her to create the aromatherapy program. "I grew up using aromatherapy. My aunts in the Philippines would boil certain leaves when my mom suffered migraines. And my mother would give me citrus fruits to smell when I got carsick."   

 

Marilen created the unique program last year while at Sutter Health's California Pacific Medical Center (CPMC) in San Francisco. Her program was the centerpiece of a study the hospital conducted to determine how aromatherapy could improve patient satisfaction and overall experience. It was so successful there; she hopes to import the program to CPMC's St. Luke's campus, where she's now the interim supervisor of nurses in the telemetry, medical-surgical, and intensive care units.     

 

Journey to Nursing  

Growing up in her native Philippines and then Dubai before moving to the San Francisco Bay Area, Marilen always admired the work of her aunts -- all nurses. Although she wanted to follow in their footsteps, Marilen's journey to nursing took a slight detour.   

 

"Believe it or not, I was squeamish about blood," she laughs. So after earning a degree in psychology she worked in the world of finance.   

 

But as Marilen watched her parents get older, she realized that the need for high-quality medical caregivers would grow. So she banished her fears and entered a masters nursing program with an emphasis in health care systems leadership.   

 

"My parents believe strongly in education and compassion for others," Marilen says. "I want to pass along those same values to my teams. When nurses are supported and encouraged, they see the bigger picture and begin to really 'own' their unit. This results in a better working environment for nurses and better patient care."   

 

Marilen says her deep-rooted values also created a foundation for her professional success. "I have been able to move into leadership because I'm always looking for ways to continue my education. My supervisors at CPMC also have confidence in me and help me find these opportunities," Marilen says.   

 

In fact, her aromatherapy program was her final project for the Leadership Residency Program, a one-year paid leadership development program sponsored by Sutter Health. "I was amazed and grateful to be selected by my Chief Nursing Officer to take part in the LRP," Marlien says. "I'm also thankful to work for a hospital and health system that supports its employees with such wonderful opportunities."   

 

Future Smells Sweet  

Marilen's dreams for her future are as strong as the lavender oil in her aromatherapy program. "I hope to become a chief nursing officer someday," she says. "I also hope to teach student nurses and honor my aunts by mentoring my younger cousins who have gone into nursing."

"I've found a great place to work and see myself staying here a long time so that I can give back," she adds," "I want nurses to be happy where they work."

 

To learn more about nursing at Sutter Health, please click here.

Thought you'd be interested to know The Institute for Diversity in Health Management is launching a new program designed to develop a pipeline of current mid-level health care managers for senior executive roles. This program will accelerate the preparation of minority leaders to represent the growing diversity of the U.S. patient population.

The course will feature nationally prominent CEOs and other senior health care leaders whose first-hand insights and leading roles in advancing American health care provide a model for future leaders.

Join us on Wednesday and Thursday, April 25 and 26 for a two-day seminar with the health care leaders. The cost is $975, which includes breakfast and lunch both days. Among other things you will learn: 

• The challenge of diversity for health care leaders
• How to define, develop and evaluate the role of the CEO
• How to formulate your personal CEO career strategy
• To "Run Toward the Roar" – how great CEOs identify and transform risk into opportunity
• How to manage the CEO relationship network

REGISTER TODAY

Program Cost: $975

When: Wednesday & Thursday, April 25 & 26, 2012 from 8 am - 4:30 pm Central Time

Where: 155 North Wacker Drive, Chicago, IL 60606

Contact: Craig Blassingame, (312) 422-2693, cblassingame@aha.org

 

1. Communication Skills

Solid communication skills are a basic foundation for any career. But for nurses, it’s one of the most important aspects of the job. A great nurse has excellent communication skills, especially when it comes to speaking and listening. Based on team and patient feedback, they are able to problem-solve and effectively  communicate with patients and families.

Nurses always need to be on top of their game and make sure that their patients are clearly understood by everyone else. A truly stellar nurse is able to advocate for her patients and anticipate their needs.

 

2. Emotional Stability

Nursing is a stressful job where traumatic situations are common. The ability to accept suffering and death without letting it get personal is crucial. Some days can seem like non-stop gloom and doom.

That’s not to say that there aren’t heartwarming moments in nursing. Helping a patient recover, reuniting families, or bonding with fellow nurses are special benefits of the job. A great nurse is able to manage the stress of sad situations, but also draws strength from the wonderful outcomes that can and do happen.

3. Empathy

Great nurses have empathy for the pain and suffering of patients. They are able to feel compassion and provide comfort. But be prepared for the occasional bout of compassion fatigue; it happens to the greatest of nurses. Learn how to recognize the symptoms and deal with it efficiently.

Patients look to nurses as their advocates — the softer side of hospital bureaucracy. Being sympathetic to the patient’s hospital experience can go a long way in terms of improving patient care. Sometimes, an empathetic nurse is all patients have to look forward to.

4. Flexibility

Being flexible and rolling with the punches is a staple of any career, but it’s especially important for nurses. A great nurse is flexible with regards to working hours and responsibilities. Nurses, like doctors, are often required to work long periods of overtime, late or overnight shifts, and weekends.

Know that it comes with the territory. The upside is that a fluctuating schedule often means you’re skipping the 9 to 5, cubicle treadmill. Sounds perfect, right? Run errands, go to the movies, or spend time with the family — all while the sun still shines!

5. Attention to Detail

Every step in the medical field is one that can have far-reaching consequences. A great nurse pays excellent attention to detail and is careful not to skip steps or make errors.

From reading a patient’s chart correctly to remembering the nuances of a delicate case, there’ s nothing that should be left to chance in nursing. When a simple mistake can spell tragedy for another’s life, attention to detail can literally be the difference between life and death.

6. Interpersonal Skills

Nurses are the link between doctors and patients. A great nurse has excellent interpersonal skills and works well in a variety of situations with different people. They work well with other nurses, doctors, and other members of the staff.

Nurses are the glue that holds the hospital together. Patients see nurses as a friendly face and doctors depend on nurses to keep them on their toes. A great nurse balances the needs of patient and doctor as seamlessly as possible.

7. Physical Endurance

Frequent physical tasks, standing for long periods of time, lifting heavy objects (or people), and performing a number of taxing maneuvers on a daily basis are staples of nursing life. It’s definitely not a desk job.

Always on the go, a great nurse maintains her energy throughout her shift, whether she’s in a surgery or checking in on a patient. Staying strong, eating right, and having a healthy lifestyle outside of nursing is important too!

8. Problem Solving Skills

A great nurse can think quickly and address problems as — or before — they arise.

With sick patients, trauma cases, and emergencies, nurses always need to be on hand to solve a tricky situation. Whether it’s handling the family, soothing a patient, dealing with a doctor, or managing the staff, having good problem solving skills is a top quality of a great nurse.

9. Quick Response

Nurses need to be ready to respond quickly to emergencies and other situations that arise. Quite often, health care work is simply the response to sudden incidences, and nurses must always be prepared for the unexpected.

Staying on their feet, keeping their head cool in a crisis, and a calm attitude are great qualities in a nurse.

10. Respect

Respect goes a long way. Great nurses respect people and rules. They remain impartial at all times and are mindful of confidentiality requirements and different cultures and traditions. Above all, they respect the wishes of the patient him- or herself.

Great nurses respect the hospital staff and each other, understanding that the patient comes first. And nurses who respect others are highly respected in return.

Kellye Whitney -  2/23/12
reprint from Diversity Executive

Just because you don’t see unconscious bias doesn’t mean it doesn’t exist and that the unseen isn’t having a tangible impact on actual people.

Iowa is dealing with one of the largest class-action lawsuits of its kind against the entire state government’s civil service system. Some 6,000 African-American plaintiffs are saying since 2003 they were systemically passed over for jobs and promotions.

“The plaintiffs … do not say they faced overt racism or discriminatory hiring tests in Iowa, a state that is 91 percent white. Instead, their lawyers argue that managers subconsciously favored whites across state government, leaving blacks at a disadvantage in decisions over who got interviewed, hired and promoted,” an article about the case said.

This is particularly interesting because apparently similar cases against local governments have failed — it’s tough to explicate and prove disparities in mistreatment of this type. But science may be the answer — or at least offer some measure of proof.

The article said that University of Washington psychology professor Anthony Greenwald, an expert on implicit bias who testified on the plaintiffs’ behalf, developed an Implicit Association Test to test racial stereotypes. The resulting research found a preference for whites over blacks in up to 80 percent of test takers among people who did not consider themselves to be racist.

This kind of research makes me want to hop up and down pointing and yelling, ‘See! Told ya.’ This is why I talk the subject of unconscious bias darn near to death. Just because you don’t see it — or don’t want to acknowledge it exists — doesn’t mean it doesn’t exist and that the unseen isn’t having a tangible impact on actual people.
“Attorney Thomas Newkirk said the science and other evidence that shows disadvantaged groups such as blacks face employment discrimination in subtle ways ‘is becoming overwhelming,’” the article said.

Lawyers are asking for lost wages to the tune of $67 million minus what plaintiffs earned in the meantime, and that changes be made in the way state officials train managers, screen candidates and track disparities in hiring. We’ll see how it plays out.

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We are interested in what you think? Do you believe Bias can be a subconscious thing? Let us know what you think of this article and the lawsuit that is its subject. Do you agree? Disagree?

Baby boomers are turning 65, and they will need lots of help
By Ilan Kolet and Shobhana Chandra
Businessweek.com

While the economy lost 7.5 million positions during the 18-month recession, the health-care industry added doctors, nurses, and other hospital personnel. Together with the social assistance category, which includes day-care workers, career counselors, and similar positions, the sector will add more than 5.6 million employees and be the biggest job gainer by 2020, according to new projections by the Bureau of Labor Statistics. Manufacturing is forecast to lose 73,000 jobs by then.

“The first baby boomer just turned 65 last year, so when it comes to health-care jobs, we haven’t seen nothing yet,” says Chris Rupkey, chief financial economist at Bank of Tokyo-Mitsubishi UFJ in New York. Almost 87 million Americans, or one in four, will be 65 or older by 2050, according to the Organization for Economic Cooperation and Development. Health services require face time with patients, which means “these jobs are protected from the forces of globalization,” says Rupkey. “We can’t imagine a time when we’ll be able to outsource the job of a home health aide giving a senior a bath or helping with physical therapy.”

Openings in health care are broadly distributed geographically, even in economically distressed small towns where they often are “all that’s left,” says David Card, a director of the Labor Studies Program at the National Bureau of Economic Research. They also provide “pretty good” opportunities, particularly for women, he says. During the recession, health care added almost half a million positions, while construction, which typically employs more men, shed 1.1 million workers.

Sharon Rudolph, 64, is studying to be a registered nurse alongside classmates who had previously worked in real estate and banking, as well as one who owns a nail salon. The Fort Lauderdale resident was a radiologic technologist before she took a break in the 1990s to raise her family. Now she’s in a 27-month training program at the city’s Nova Southeastern University. “I felt I’d become more marketable once I get out,” says Rudolph, who has managed to keep her other licenses in diagnostic medical and cardiac sonography current. “I have to work twice as hard as some of the kids” to keep up with the coursework.

Registered nursing, which requires at least an associate degree, will have the largest growth of all U.S. occupations, according to the Bureau of Labor Statistics, adding 711,900 jobs between 2010 and 2020, reaching a total of 3.4 million. The number of home health aides, who don’t need a high school diploma but require on-the-job training, will increase by 69 percent, to 1.7 million. Hiring of physicians and surgeons will rise by 24 percent, to 859,300, the bureau predicts.

While the additional jobs probably will lift employment, many pay low wages. That means these workers will be less able than employees in higher-paid industries to boost consumer spending. Yet health-care jobs may provide more stability than factory and construction work, which tends to fluctuate with the economy. According to BLS data that are seasonally unadjusted, the unemployment rate for health-services employees was 6 percent in December, compared with 16 percent for construction.

According to Charles Roehrig, director of the Altarum Center for Sustainable Health in Ann Arbor, Mich., every 10 jobs in health care ultimately generate an additional 12 elsewhere in the economy. If he’s right, then without the industry’s recent hiring growth, the unemployment rate would have been 9.5 percent in December, instead of 8.5 percent.

This is a subject matter we are always talking about. You hear the labor projections, but in a way it is a grim and sobering reminder that the healthcare labor force is in for some major gwoing pains. Are you experiencing this in your workplace? What do you think?

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(from Reuters.com) - The graying of America and a booming Hispanic population is driving major changes in the structure of the U.S. workforce and the types of jobs that will be available over the next decade, a new government report shows.

Health care and social assistance jobs will be the fastest-growing sectors, accounting for one quarter of the 20.2 million new jobs the economy is expected to generate by 2020.

Retiring baby boomers will help open up an additional 33.8 million positions for total vacancies of 54 million, the Labor Department said on Wednesday in its biannual Employment Outlook report for job growth between 2010 and 2020.

During the recent recession, employment declined by 7.8 million jobs to a total of 129.8 million in 2010. The report does not estimate by what year those jobs will be replaced.

In addition, the workforce is getting older. Despite the retirement surge, a slowdown in population growth means that the post-World War II baby boomers will make up a quarter of all U.S. workers by 2020, up from 19.5 percent today.

Hispanics, meanwhile, are joining the workforce at a fast pace. They will represent 18.6 percent of overall employment by decade's end, up from 14.8 percent today. In contrast, Asians and African-Americans will see their share in the labor force rise by 1 percentage point or less to 5.7 percent and 12 percent, respectively.

"The labor force is projected to get older, become racially and ethnically more diverse and show a small increase in women as a share of the total," the department said.

Professional and business services will be the second-fastest growing industry, adding 3.8 million positions.

It will be followed by construction, although the 1.8 million new construction jobs will not bring employment in the industry back to levels seen during the housing boom.

SKILLS DIVIDE

The report also spelled out the skills workers of the future will need.

Two thirds of the total job openings will require only a high-school education or less, it said. For example, there will be roughly 70 percent growth in personal care aides and health-care support employment, the fastest-growing occupations. No high school diploma would be required, and workers would get short, on-the-job training.

At the same time, demand for people with master's degrees will increase by 21.7 percent, the Labor Department said.

The manufacturing sector and the federal government will both lose jobs over the next decade.