Thursday, December 14, 2006

~so long, farwell, ciao, goodbye!

I am off on holiday for 2 weeks. I will miss the blogosphere but I shall return!


~RN Faye

Wednesday, December 13, 2006

Seasons Greetings for the Politically Correct~

Please accept with no obligation, implied or implicit, my best wishes for an environmentally conscious, socially responsible, low-stress, non-addictive, gender-neutral celebration of the winter solstice holiday, practiced within the most enjoyable traditions of the religious persuasion of your choice, or secular practices of your choice, with respect for the religious/secular persuasion and/or traditions of others, or their choice not to practice religious or secular traditions at all.

I also wish you a fiscally successful, personally fulfilling and medically uncomplicated recognition of the generally accepted calendar year 2007, but not without due respect for the calendars of choice of other cultures whose contributions to society have helped make America great. Not to imply that America is necessarily greater than any other country nor the only America in the Western Hemisphere, and without regard to the race, creed, color, age, physical ability, religious faith or sexual preference of the wishes.

~author unknown

Hospitals Fight Nurse-to-Patient Ratios, Seek Alternatives To Use Nursing Staff More Efficiently

The Kaiser Family Foundation reported today that "The Wall Street Journal on Wednesday examined how "hospitals are fighting back against efforts to set minimum nurse-to-patient ratios and adopting new strategies to use nursing staff more efficiently" as the U.S. faces "a worsening" nurse shortage. According to the Journal, "an increasing number of states ... are considering legislation to ensure minimum" nurse-to-patient ratios at hospitals, and California already has passed a law mandating ratios in medical-surgical units. Proponents of the ratios say that "forcing hospitals to meet minimum staffing requirements is the only way to ensure patient safety, reduce patients deaths, recruit new nurses, and stop the ones already on the job from burning out and leaving the profession," the Journal reports. However, critics say that the ratios are not flexible enough to allow hospitals to operate safely and efficiently and that certain hospital units could be forced to close if the ratios cannot be met. In addition, opponents of ratios say there is no direct evidence that staffing ratios improve patient care. Pat Rutherford, a nurse and vice president of the not-for-profit Institute for Healthcare Improvement, at a patient-safety conference on Wednesday plans to propose that rather than impose staffing ratios, medical-surgical units should be restructured so nurses spend less time on paperwork, charting, finding supplies and operational problems. The Journal reports that hospitals also are "turning to more sophisticated computer programs and models to help them analyze their staffing needs and allocate nurses on staff more efficiently." In addition, staffing specialists are working with organizations like the American Nurses Association to develop "nurse-staff reporting cards that help hospitals compare staffing levels and patient outcomes with those of other hospitals," according to the Journal. The goal of such comparisons is to ensure that nurses with proper training and backgrounds are in certain units when needed, according to Gina Mumolie, a nurse and vice president of Aon Consulting (Landro, Wall Street Journal, 12/13)."

Dr. Linda Aiken did have supportive research concluding that hospitals with high patient-to-nurse ratios patient experience higher risk-adjusted 30-day mortality and failure to rescue rates. Supportive research needs to be conceived in this area as it is only looking at part of elephant. Individual institutions might benefit from conducting their own analysis of nurse-to-patient ratios and it's impact on quality and outcomes. However, the concept of ratios should not be ignored, besides a decrease in quality care, nurses are more likely to leave the patients bedside if they are burned out and feel powerless to change their work environment. This is a problem that is not easily solved and with each "knot released" there is the potential to create further complications.

Linda Aiken Sheds Some Light on the Nursing Shortage

Last month the Health Affairs Blog featured Linda Aiken . Dr. Aiken has been a major contributor to health workforce and outcomes research for the past two decades. She discusses the 7 Myths currently surrounding the nursing shortage as it exists today and as projected in the future.

"Currently, the United States is short an estimated 150,000 nurses. Yet over the next decade, more than 650,000 new jobs in nursing will be created. At the same time, an estimated 450,000 nurses will have retired. By 2020, the nurse shortage is expected to increase to 800,000. I set out to debunk a number of popular myths surrounding the current nurse shortage at a recent meeting convened in Washington, D.C. on the future of nursing. The September 20-21 meeting was sponsored by Health Affairs, the Robert Wood Johnson Foundation, and the John A. Hartford Foundation ."

I agree with Dr. Aiken's assessment that we do not know how to solve the nursing shortage is a myth. We need more support of the education of nurses and the creation of more efficient ways to obtain a BSN. Higher pay incentives for faculty need to be available and nurses should be reimbursed for their services not as viewed as an hospital expense.

I would like add that stronger media representation of nurses should be advocated for similar to the initiatives of The Center for Nursing Advocacy. Many young people today who do not have personal contact with a nurse (social or through the health care system) will get their perception of nursing primarily through the media. Negative and inaccurate images of nurses in the media will deter intelligent men and women from entering the profession and will undervalue our life-saving skills and education.

Monday, December 11, 2006

Emerging Trends in Health Care

Increased focus on the current demographic changes of the aging population will most likely be the most important health care trend within the next 20 years.

Americans are living longer than ever before as a result of technological advancements in medicine. Now more than ever, people are living into old age with physical and cognitive disabilities. By the year 2019 the aging population (65 and older) will increase to about 50 million people in the United States. The U.S Census Bureau reported in 2004 that the over -80 population will increase to about 7 million of those in need of health care services. Most of health care spending is exhausted through end of life care and chronic illness. Not surprisingly , the Kaiser Family Foundation reports that "Medicaid's long-term care users (LTC) reveals that the 7% of Medicaid beneficiaries using LTC account for over half (52%) of all Medicaid spending. Medicaid's LTC users not only use LTC services, but they also use the program's acute care services more intensively than non-LTC users. Three-quarters of the spending by these high-cost LTC users went towards LTC (community-based and institutional care) and the remaining 25% went towards acute care and other supportive services. These high-cost beneficiaries are among the most disabled and chronically ill of the Medicaid population, with over half being elderly, one-third being disabled and under age 65, and 11% being adults or children not classified as disabled."

As health care service costs increase, so will the ability of people to pay for them. These costs include but are not limited to the use of pharmaceuticals, ED visits and hospital stays, surgeries and increased use and dependence on technology. With such a rapid rate of growth in this population the types of volume of services required will have a significant impact on the economy, consumers, and health care professionals.

This trend will impact nursing in two ways. First, the median age of a nurse is about 47 years old. These nurse ‘baby boomers” will begin to retire in 15 years leaving a dearth of nurses to take care of the octogenarians that will need nursing care. As nurses retire and as less people choose nursing as a career, or are not admitted to programs due to lack of faculty, the outcome will result in a labor shortage. Sadly, the nurses who spent their lives taking care of others will not have anyone to take care of themselves. Another aspect of labor issues concern the increased need for nurse specialization in the field of gerontology. The aged need specialized care, similar to that of pediatric nursing and Medicine. Secondly, the volume and acuity of these patients will increase in the hospital and nursing home settings. Most of these patients will be admitted to a medical-surgical or rehab floor in the hospitals and nurses work on these units tend to be arduous and stressful and will likely contribute to nurse burnout. There will be an imbalance in nurse to patient ratios, and as a result of all of these factors quality and patient safety will suffer.

Parallel to the increasing aging population is the growing demand for policy development, research, and assistance with Long-term care (LTC) needs. Home and community based services (HCBS) for the elderly offered through Medicaid waiver programs have released some of the strain on the system. Participants and families are happier and healthier in their homes. The cost for providing services in the home is significantly less than they would be in the nursing home. Perhaps this trend will increase as the consumer demands it. However, the same challenges of nursing and paraprofessional workforce face HCBS as in the nursing homes. As a result recruitment and retention of quality workforce in LTC is essential in maintaining and effective system.