5 of the biggest issues nurses face today

Nurses are crucial to all healthcare environments, and take pride in the care they provide each day.

But nurses also face many challenges in today's complex healthcare environment. 

Here are five big issues facing nurses:

1. Staffing. Short-staffing in hospital settings is a top concern for nurses. A 2017 survey conducted by AMN Healthcare showed 72 percent of CNOs acknowledged moderate, significant or severe nursing shortage at their healthcare organizations, and most believe the shortages would worsen over the next five years. Overall, the U.S. Bureau of Labor Statistics estimates more than 1 million registered nurses will be needed by 2022 due to occupational growth and replacement hiring. It is worth noting, though, that other research showed variation among the nation's major metropolitan areas, with some facing nurse shortages and others facing surpluses.

In locations with shortages, nurses are concerned because it means they don't have the time to provide the care they believe is necessary for patients and families, according to Pamela F. Cipriano, PhD, RN, President of the American Nurses Association.

"Nurses may not feel like they are doing enough, which causes dissatisfaction and burnout. We call this moral distress. It can be emotionally and physically draining when repeatedly you can't provide care you think is necessary," she said.

Dr. Cipriano contended nurses also consider staffing issues as a hindrance to patient safety. This is because of research showing the benefits of the penetration of nursing care, she said. For instance, the AMN Healthcare survey found 34 percent of CNOs said nurse shortages have a considerable or great negative impact on patient care. Additionally, research published by the National Center for Biotechnology Information showed nursing shortages resulted in errors, higher morbidity and mortality rates.

Dr. Cipriano said nurse staffing is a key consideration for nurses when deciding whether to stay with a particular job or employer.

"We see significant turnover in many healthcare organizations and settings," she said. "Inadequate staffing is one of the top reasons nurses are dissatisfied in the workplace."

Still, Dr. Cipriano acknowledged hospitals face various challenges with providing adequate staffing. One challenge involves an increasing number of experienced nurses who are retiring. She said some nurses stayed in their jobs or increased their labor force participation during the most recent recession to ensure their families were taken care of.

"Many nurses delayed retirement, re-entered the workforce or increased their shift hours. New graduates then found it difficult to obtain jobs and there was about a two-year waiting period in many parts of country to enter the profession," said Dr. Cipriano.

But now, more experienced nurses are beginning to retire as the economy has improved. A separate 2017 AMN Healthcare survey of registered nurses showed 73 percent of baby boomer nurses plan to retire within three years.

Demand for healthcare services also increased as the economy improved and more people gained insurance coverage, according to Dr. Cipriano. She said that's exacerbated by the number of baby boomers who are living longer and seeking more care for things like joint replacement and treatment of diseases.

"The constant demand for nurses combined with  baby boomer nurses leaving the workforce is contributing to the 'shortfall' of nurses," she said.

2. Long working hours. To help make up for staffing shortages, nurses are often required to work long shifts. Sometimes, nurses must work extended hours and overtime, risking fatigue that could lead to medical errors. The Medscape RN/LPN Salary Report 2016 showed 47 percent of registered nurses and 52 percent of licensed practical nurses reported working regular overtime.

Dr. Cipriano believes the issue likely hasn't changed significantly in the last few years, but people are discussing it more. ANA released a revised policy a couple years ago about nurse fatigue, for example.

"We know nurses should not work more than 40 hours a week, and we believe they should be working no more than 12 hours in a day or less if possible, because you reach a point where you start to have cognitive decline," she said. " Nurses will stay late, work extra hours or come back to work after little sleep if their workplace needs them. But in reality, that's at odds with evidence we have about being the most productive and safest healthcare professionals."

3. Workplace hazards. Nurses face a number of workplace hazards such as exposure to bloodborne pathogens, injuries, hand washing-related dermatitis and cold and flu germs.

Dr. Cipriano said she continues to see needlestick injuries as problems for nurses, but overall believes hospitals have done a better job of decreasing known workplace hazards.

At Salt Lake City-based Intermountain Healthcare, caregiver safety is a top priority, said Kim Henrichsen, RN, MSN, Intermountain's senior vice president of clinical operations and chief nursing executive. The system even set a board level goal to reduce workplace injuries, particularly injuries where skin is penetrated by a sharp object such as a needle or scalpel.

"We have instituted 'safe pass zones' in the operating rooms and have seen a significant reduction of sharps injuries with this practice," said Ms. Henrichsen."Our first facility to implement this process has not had a single sharps injury in the operating room for over one year."

She said nurse injuries are also reported in various tiers of morning huddles each day and ultimately reach executive leadership.

"Bringing additional awareness to injuries has created an urgency around understanding the causes and evaluating best practices to reduce these events for our caregivers," she said.

4. Workplace violence. Workplace violence is also a pressing issue for nurses. A Government Accountability Office report published in March 2016 found healthcare workers in inpatient facilities, such as hospitals, experienced substantially higher estimated rates of nonfatal injuries compared to private-sector workers overall. Hitting, kicking and beating were the most common incidents reported.

But the GAO noted it is unknown what the full extent of the problem and associated costs are because federal data on workplace violence showed workers at healthcare facilities "may not always report such incidents, and there is limited research on the issue, among other reasons."

5. Bullying and harassment. Nurses also experience bullying and harassment. A Medscape Medical News poll conducted in December 2017 showed 71 percent of nurses said they had been harassed by a patient. That compares to 47 percent of physicians. Harassment was defined as "patients stalking, persistent attempts at communication, and inappropriate social media contact."

Dr. Cipriano said the ANA also conducted a survey of nurses that revealed more than 62 percent of nurses said they have had a personal experience with physical or verbal abuse on the job, and one in four said they have been physically assaulted at work.

Bullying and harassment also take place among colleagues. A 2017 survey by employment agency RNnetwork found 45 percent of nurses have been verbally harassed or bullied by other nurses.

Such incidents are what sparked the ANA to launch its #EndNurseAbuse awareness initiative. As part of the initiative, the association aims to combat nurse abuse and encourages healthcare organizations to teach communication skills with respect to interacting with those who could become upset or agitated at work, according to Dr. Cipriano.

"Some accrediting organizations do insist that there are policies and practices in place to keep staff safe, such as screening for firearms, lockdown procedures, security, and some are trying to help workers be more aware of how to stay safe," she said.  

Overall, "the message we believe is important … is experiencing violence is not part of the job and should never be accepted as part of the job."


More articles on workforce:
Samaritan Medical Center seeks to fill healthcare jobs
Looking for a healthcare job? Hiring from New York to Texas
What can hospitals do to mitigate workplace violence? Q&A with 2 RWJBarnabas Health execs

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