Nurses are the largest group of health care professionals providing direct patient care in hospitals, and the quality of care for hospital patients is strongly linked to the performance of nursing staff, according to an Institute of Medicine report. In the first post of this Luminous Nursing Blog, I began to address the number one reason that most Nurses do not survive beyond the first three to four years of working in a hospital setting, and that number one reason is, of course, burn-out. Burn-out is a condition whose symptoms include extreme stress created by unreasonable demands made upon nurses by doctors & administration, overload of patient care and dysfunctional family dynamics on the ward with patients who are very ill, excessive paperwork, charting and administrative demands, anxiety regarding whether or not one is perceived as functioning at full capacity & adequately as a Nurse, long shifts with no relief and often no breaks for meals or fresh air, and poor dynamics between nurses on the wards, as well as ill-equipped Nursing Leaders who actually have very little leadership training, thus leaving nurses without support and direction. Sounds pretty bleak, doesn't it?
According to a study by the Robert Wood Johnson Foundation in 10/2012, throughout the past few decades, U.S. hospitals have faced cyclical shortages of nurses; in 2000 an estimated 126,000 hospital nursing positions were unfilled. The percentage of nurses working in hospitals dropped from 59 percent in 2000 to a little more than 56 percent in 2004. The current nurse shortage is driven by a broad set of factors related to recruitment and retention, among them, fewer workers, an aging workforce, and unsatisfying work environments, that have contributed to a different kind of shortage that is more complex, more serious, and expected to last longer than previous shortages.
Too few new nurses are being trained (largely because of a shortage of nursing school faculty), but to a greater extent, the current shortage results from the reluctance of newly educated nurses to make their careers in hospitals. Nurses cite stress-related burnout and the large amount of time they must spend on non-nursing tasks as top reasons for feeling dissatisfied with their jobs; 43 percent of nurses report that they plan to leave their jobs within three years. Thus, the average age of hospital nurses is in the mid-forties.
On average, nurses work eight and a half weeks of overtime every year. Recent studies continue to show that taking care of too many patients and working overtime and long shifts (twelve & sixteen-hour shifts are not uncommon) are associated with medical errors and poorer quality of care.
It would be correct to say that a kind of vicious cycle surrounds the nursing profession. Fewer people are working in nursing, which has led to a shortage. Because of the shortage, nurses who remain in hospital work must care for more patients under increasingly difficult working conditions. Because of these strained working conditions, more nurses leave the hospital workforce, thereby worsening the shortage and making recruitment of new nurses more difficult. This is most certainly a vicious cycle that never ends, unless these vital issues are addressed adequately.
The nurse shortage also has important cost implications for hospitals. Although estimates vary widely, the cost of recruiting and training one new nurse for a medical-surgical floor is usually equal to 100 percent of a nurse’s annual salary, ($42,000–$60,000); that investment is much higher for an intensive care or emergency department (ED) nurse.
It is of vital importance that we must be concentrating on the underlying issues that can make the hospital a more appealing and functional workplace for Nurses and other hospital personnel. This includes improving the work place culture among Nurses and administration, along with other staff. The RDW foundation’s objective is to help convert hospitals into places that are designed to promote healing, not just provide treatment; places where workers are engaged and supported in their jobs, and places where better work processes and culture increase institutional vitality and enhance patient care. Now this is what we are talking about when we say that Change is necessary in order for transformation to take place in the field of Medicine and in Patient Care, and an important part of the change must come in the name of Caring for our Nurses. Without Nurses, and Nurses Aides , there would be no care and no hospitals, as Nurses are the linch pins that hold a hospital together.
Hospital nurses have difficult, demanding jobs; they need to feel inspired by their work and supported as professionals if optimal patient care is to be achieved. In addition, a hospital is supposed to be a place in which healing is created and promoted on every level, from the quality of compassionate and competent care that is offered, to supporting the patient's needs for privacy, protection, serenity, nutritious meals, beauty, spiritual support, creativity, and a healing atmosphere. All of these services provide an opportunity for Healing and Restoration on every level. This can also include the elements of Alternative Medicine that promote healing and emotional & spiritual support, including Medical Massage, Acupuncture, Yoga, Meditation, Music Therapy, Therapeutic Touch, and Art therapy. These modalities must also be offered to the Nurses and Staff, whose vulnerability to depression, addiction and burn-out issues create a slew of problems that can be completely avoided if we simply took good care of the Care -givers. The level of Care that is also offered to staff as well as patients creates harmony among staff and a feeling of well being and appreciation that they are so deserving of. In addition, there should be a Nurse Mentor who is available to support Nurses and assist them with issues such as burn-out and stress related symptoms. These simple, low cost modalities create a general feeling of well being and tolerance, and an atmosphere of support and respect.
With Love & Peace,
Sanatani Maa
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