Robyn Cheung

Education Policy Initiatives To Address The Nurse Shortage In The United States

Employment opportunities are expected to grow much faster for registered nurses (RNs) than for most other occupations. Yet a major shortage of nurses is projected by 2020. A nurse faculty shortage and financially strapped colleges and universities are limiting the ability of U.S. nursing schools to take advantage of historically high numbers of qualified applicants. Increased public subsidies are needed to provide greater access to nursing education, with a priority on baccalaureate and graduate nursing education, where job growth is expected to be the greatest.

Are Patient Falls and Pressure Ulcers Sensitive to Nurse Staffing

Research has demonstrated an association between more nurses and more qualified nursing staff in hospitals and better patient outcomes. Patient falls and pressure ulcers have been advanced as nursing-sensitive outcomes. This article evaluates the state of the science linking nurse staffing to falls and pressure ulcers. Studies that employed multivariate analysis to discern the effect of nurse staffing on patient falls and pressure ulcers in hospitals were evaluated. Eleven studies that met inclusion criteria were contrasted on their data sources and measures, data analysis, risk adjustment, and results. The evidence of an effect of nursing hours or skill mix on patient falls and pressure ulcers is equivocal. Substantial differences in research methods across studies may account for the mixed findings. Two study types were identified based on the level at which nurse staffing was measured, hospital or nursing unit, which exhibited systematic differences in measures and methods. Improvements in measurement and methods are suggested.

Nursing care and patient outcomes: international evidence

Countries across the globe are experiencing nursing shortages. In hospitals, supportive practice environments have positive effects on both nurse and patient outcomes. However, these relationships have been established primarily in the US. International studies of the effects of nurse staffing levels and the practice environment on nurse outcomes and the quality of care mirror the findings from the US, thus raising these issues to the international level. The solutions that have been successful in the US for improving the practice environment and patient outcomes are solutions that should be successful in any country, thus putting them on a global scale. The Magnet hospital program is one model that has been shown to improve nurse and patient outcomes and is one solution to the shortage of hospital nurses.

Hospital initiatives to support a better-educated workforce.

A 2003 article in the Journal of the American Medical Association documented that mortality rates from common surgical procedures were significantly lower in hospitals employing more staff nurses prepared at the baccalaureate level. In this report, that studys authors review case studies of 6 hospitals that demonstrate the kinds of initiatives employers are sponsoring to support a better-educated nurse workforce.

Nurse Workforce Challenges in the United States

The United States has the largest professional nurse workforce in the world numbering close to 3 million but does not produce enough nurses to meet its growing demand. A shortage of close to a million professional nurses is projected to evolve by 2020. An emerging physician shortage will further exacerbate the nurse shortage as the boundaries in scope of practice necessarily overlap. Nurse immigration has been growing since 1990 and the U.S. is now the world’s major importer of nurses. While nurse immigration is expected to continue to grow, the shortage is too large to be solved by recruitment of nurses educated abroad without dramatically depleting the world’s nurse resources. Moreover, the domestic applicant pool for nursing education is very strong with tens of thousands of qualified applicants turned away annually because of faculty shortages and capacity limitations. The national shortage could be largely addressed by investments in expanding nursing school capacity to increase graduations by 25 percent annually and the domestic applicant pool appears sufficient to support such an increase. A shortage of faculty and limited capacity for expansion of baccalaureate and graduate nurse education require public policy interventions. Specifically public subsidies to increase production of baccalaureate nurses are required to enlarge the size of the pool from which nurse faculty, advanced practice nurses in clinical care roles, and managers are all recruited. Retention of nurses in the workforce is critical and will require substantial improvements in human resource policies, the development of satisfying professional work environments, and technological innovations to ease the physical burdens of caregiving. Because of the reliance of the U.S. on nurses educated abroad as well as the benefits to the U.S. of improving global health, the nation should invest in nursing education as part of its global agenda. Les Etats-Unis comptent le plus grand nombre d’infirmiers(eres) diplomes au monde – pres de 3 millions – mais ils n’en forment pas suffisamment pour repondre a une demande en augmentation. Il devrait manquer pres d’un million d’infirmiers(ieres) diplomes, aux Etats-Unis, d’ici 2020. Et le deficit de medecins qui commence d’apparaitre ne fera qu’exacerber le probleme car les deux pratiques professionnelles sont necessairement interdependantes. L’immigration d’infirmiers(eres) n’a cesse d’augmenter depuis 1990 et les Etats-Unis sont desormais le premier pays d’accueil d’infirmiers(eres) etrangers au monde. Cette vague d’immigration devrait se poursuivre mais la penurie est trop importante pour pouvoir etre resorbee par des recrutements a l’etranger sans que cela ponctionne gravement les ressources en personnel infirmier au niveau mondial. Par ailleurs, les personnes desireuses de suivre une formation d’infirmier(ere) dans le pays sont nombreuses mais des dizaines de milliers de postulants qualifies sont refuses chaque annee en raison du manque de personnel enseignant et de l’insuffisance des capacites d’accueil dans les ecoles d’infirmiers(eres). On pourrait largement pallier ces insuffisances en intensifiant les investissements consacres aux ecoles d’infirmiers(ieres) de facon a accroitre de 25 % par an le nombre des diplomes, ce qui parait realiste au regard du nombre actuel de candidats. Le manque de personnel enseignant et l’insuffisance des capacites de formation appellent l’intervention des pouvoirs publics. Precisement, des subventions publiques doivent aider a accroitre le nombre d’infirmiers(ieres) diplomes, ce qui elargira l’effectif au sein duquel on pourra recruter du personnel enseignant, des infirmiers(eres) cliniciens de haut niveau et des gestionnaires. Inciter les infirmiers(eres) a rester dans la profession est fondamental et cela necessitera une amelioration significative des politiques de gestion des ressources humaines, la garantie d’un environnement de travail satisfaisant et des innovations technologiques pour alleger la charge physique que represente l’activite de soins. Compte tenu de l’importance des personnels infirmiers formes a l’etranger pour les Etats-Unis et des avantages qui resulteraient d’une amelioration generale de la sante publique, le pays devrait faire de l’investissement dans la formation d’infirmiers(eres) un des objectifs de l’action publique.

The nurse shortage: where we stand and where we're headed.

Whether its already touching your facility or its impact is still to come, this crisis will test your skills as a manager. Understanding whats driving the shortage and whats predicted will help you choose the best strategies for addressing its causes and dealing with its consequences.

Data Mining Strategies for Shaping Nursing and Health Policy Agendas

Data mining of electronic databases is becoming more popular as a method for researchers to study issues in the health policy arena. The advantages of using electronic databases, such as the decreased investments in time and costs associated with subject recruitment and data collection, contribute to its appeal. Despite these features, the use of electronic databases to address health policy issues in nursing has been limited. This article discusses potential uses of secondary analysis for nursing research and outlines the steps involved in the process of data mining. Examples of health services research using samples generated from electronic databases support the discussion. The growing popularity of secondary analyses has given rise to concerns regarding the protection of patient rights and confidentiality. The authors discuss steps taken by federal agencies and institutional review boards to ensure that data are protected while preserving the research potential of this method of analysis.

A focus group for caregivers of hospice patients with severe dyspnea

The use of focus groups has grown in all aspects of our society, including the areas of politics and business. More recently, clinical research investigators have begun using focus groups to acquire important information from potential study subjects, such as patients and caregivers. Researchers use focus groups to help them design and test data collection measures, assess responses to proposed interventions, and obtain guidance on recruitment and retention methods for clinical trials. This report explains the basic requirements and methods for conducting focus groups. The authors conducted a focus group study based on six former caregivers of hospice patients with severe dyspnea. The paper describes the results of this study and illustrates how caregivers assisted in evaluating potential interventions for dyspnea, which will be tested in a future clinical trial. Subsequently, the researchers used the focus group data to adapt the guided-imagery intervention to the lifestyle and culture of the study subjects and their caregivers.

Building an International Nursing Outcomes Research Agenda

A program of research begins with a good idea that materializes into a series of studies that carry the same theme. Each study builds upon the last, expanding on the findings to generate new questions, thus building the evidence base. The Center for Health Outcomes and Policy Research has built a 20-year program of research that has made great strides in establishing the evidence base that professional nurse practice models of care positively influence patient outcomes. This paper traces the evolution of the Centers program of research from a one-state focus to an international enterprise.