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Comparative Views of the Impact of the Nursing Shortage on Quality of Hospital Care. AcademyHealth Health Workforce Interest Group June 2, 2007 Peter I. Buerhaus. Disclosure. Funded by : Johnson & Johnson Campaign for Nursing’s Future. Data come from …. - PowerPoint PPT Presentation
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Comparative Views of the Impact of the Nursing Shortage on Quality
of Hospital Care
AcademyHealth
Health Workforce Interest Group
June 2, 2007
Peter I. Buerhaus
Disclosure
Funded by:
• Johnson & Johnson Campaign for Nursing’s Future
Data come from …
• Project to Evaluate the Johnson & Johnson Campaign for Nursing’s Future
• Project Personnel:– Peter Buerhaus (PI) and Robert Dittus
Vanderbilt University Medical Center– Karen Donelan (Co-PI) and Cate DesRoches
Massachusetts General Hospital
National Random Sample Surveys Public opinion of nursing profession (2001) Web-based survey of teens (2003) Parents and teenagers (2003) Nursing students (2003) Physicians (2004) Nurses (2002, 2004 & 2006) co-funded by
Nursing Spectrum (Beth Ulrich, Co-PI) Hospital chief executive officers (2005) Hospital chief nursing officers (2005) Public opinion of nursing profession
(Completed mid-April, 2007)
National Survey of Physicians• Mailed survey to 840 primary care and specialty
physicians reporting more than 20 hours per week in patient care activities
• Conducted January 6 through March 5, 2004
• 500 completed surveys, response rate 55%
• First survey of physicians on nursing shortage
National Surveys of Registered Nurses
• Surveys:– Random national samples– Mail and web based – Conducted by Harris Interactive, Inc.
• 2002 survey: Data from 4004 RNs, response rate 55%
→2004 survey: Data from 1783 RNs, response rate 53% (co-PI B. Ulrich)
• 2006 survey: Data from 1392 RNs, response rate 52% (co-PI B. Ulrich)
• Provides national follow-up survey of nurses
National Survey of CEOs and CNOs
• Conducted from December 2004 - February 2005
• Telephone interviews and mailed questionnaire
• 222 of 443 contacted completed surveys from CNOs, 50% response rate
• 142 of 404 contacted completed surveys from CEOs, 31% response rate
Themes Across Surveys
• Causes, effects, and hospitals’ responses to the nursing shortage
• Work environment– Physical and mental safety– Professional practice– Working relationships
• Quality of care• RN job and career satisfaction
Observations of RNs, Physicians, Hospital CEOs,
and Hospital CNOs
See: Buerhaus, Donelan, Ulrich, DesRoches, Dittus. Impact of the Nurse Shortage on Hospital Patient Care:Comparative Perspectives. Health Affairs, 26(3); 2007: 853-862.
Percent Observing Nursing Shortage in Hospitals
RNs
2004
MDs
2004
CNOs
2005
CEOs
2005
Serious or somewhat serious shortage of nurses
82% 81% 74% 68%
Impact of Nursing Shortage on Care Processes
In the past year, have you observed any of the following as a result of nursing shortage?
Observed…RNs
2004
MDs
2004
CNOs
2005
CEOs
2005
Increase in time it takes for nurses to respond to pages or calls
89% 67%* 84% 76%*
Increase in patients’ complaints about nursing care
87 74* 58* 55*
Increase in staff communication problems
88 71* 72* 69*
Increase in workload for physicians
53 55 29* 30*
Impact of Shortage on Hospital Capacity
In the past year, have you observed any of the following as a result of nursing shortage?
ObservedRNs
2004
MDs
2004
CNOs
2005
CEOs
2005
Increased reduction in the number of available beds
81% 64%* 60%* 56%*
Increase wait time for discharge
72 50* 60* 61*
Increased patient wait time for surgery or tests
75 45* 47* 48*
Increase in discontinued or closed patient care programs
42 49 20* 20*
Impact of Shortage on Nurses
How much of a problem do you think the shortage of nurses has been
for…“Major problem”
RNs
2004
MDs
2004
CNOs
2005
CEOs
2005
Quality of patient care provided by nurses
78% 61%* 64%* 54%*
Time to collaborate with other team members
55 33* 56 50
Ability of nurses to maintain patient safety
69 21* 62 38*
How much of a problem do you think the shortage of nurses has been
for…“Major problem”
RNs
2004
MDs
2004
CNOs
2005
CEOs
2005
Early detection of patient complications by nurses
65% 44%* 60 47*
Nurses’ time for patients 91 78* 66* 59*
Quality of nurses’ work life 82 59* 76 62*
Impact of Shortage on Institute of Medicine’s Six
Aims for Improving the Quality of the HealthCare
Systems
IOM Report: Crossing the Quality Chasm, 2003
See: Buerhaus, Donelan, DesRoches, Ulrich, Norman, Dittus. Impact of the Nurse Shortage on Hospital Patient Care: Comparative Perspectives. Health Affairs, 26(3); 2007: 853-862.
Institute of Medicine
Six Aims for Improving Quality of HealthCare System
• Patient-centered
• Effective
• Safe
• Timely
• Efficient
• Equitable
Shortage frequently or often impacting….
Patient-Centered Care
73
61
43 41
0
10
20
30
40
50
60
70
80
Hospital RNs Physicians CNOs CEOs
Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions
Effective Care
73
58
34
27
0
10
20
30
40
50
60
70
80
Hospital RNs Physicians CNOs CEOs
Effective: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit
Safety of Care
63
36
25
17
0
10
20
30
40
50
60
70
Hospital RNs Physicians CNOs CEOs
Safe: Avoiding injuries to patients from the care that is intended to help them
Timeliness of Care
81
72
4944
0
10
20
30
40
50
60
70
80
90
Hospital RNs Physicians CNOs CEOs
Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care
Efficiency of Care
71
55 55
47
0
10
20
30
40
50
60
70
80
Hospital RNs Physicians CNOs CEOs
Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy
Equity of Care
61
38
26
18
0
10
20
30
40
50
60
70
Hospital RNs Physicians CNOs CEOs
Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
Expectations of Where Nursing Shortage Will Lead
Expect Shortage Will Lead to …
RNs
2004
MDs
2004CNOs 2005
CEOs
2005
Higher pay for nurses 48% 78% 86% 94%
The need to have other staff perform some nursing patient care activities
83 92 81 87
Nurses leaving for non-nursing jobs 91 84 83 79
More respect for nurses 21 44 36 59
Improvements in workplace environment 25 34 74 75
Lower quality care for patients 90 83 71 69
Increased stress on nurses 96 86 97 98
3. Wee bit about the Changing Composition of the RN workforce
Older and More Foreign-Born
Recent Total RN Employment Growth in US by Age
RN Age
Year 21-34 35-49 50-64
2002 - 21,170 43,152 63,911
2003 87,131 - 32,271 65,839
2004 - 45,034 21,294 23,212
2005 - 31,277 - 87,284 91,312
2006 46,172 16,970 12,888
2002-2006 35,822 - 40,139 257,161
Source: Buerhaus, Auerbach, Staiger. Recent trends in the registered nurse labor market in the US: Short-run swings ontop of long-term trends. Nursing Economic$, 25(2); 2007: 59-67.
RN FTEs by age group for selected years
-
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
2005 (obs) 2012 2020
<30
30s
40s
50s
60+
43.5 yrs, avg. 44.7 yrs 44.7 yrs
Source: Auerbach, Buerhaus, Staiger “Better Late than Never: Implications of Later Entry into the Profession for the FutureSupply of Nurses” Health Affairs, January/February 2007
Growth in Foreign-born RNs
Percent FTE Foreign-Born RNs, 1994-2006
5%
7%
9%
11%
13%
15%
17%
19%
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
Source: Buerhaus, Auerbach, Staiger. Recent trends in the registered nurse labor market in the US: Short-run swings on top of long-term trends. Nursing Economic$, 25(2); 2007: 59-67.
Recent Total RN Employment Growth By US and Foreign-Born Status
Year U.S. Foreign-Born
2002 44,045 41,849
2003 94,503 24,190
2004 - 9,824 9,275
2005 - 5,897 -21,353
2006 36,616 39,075
2002-2006 159,443 93,036
Source: Buerhaus, Auerbach, Staiger. Recent trends in the registered nurse labor market in the US: Short-run swings on top of long-term trends. Nursing Economic$, 25(2); 2007: 59-67.
4. Conclusions
• Across the four groups, considerable majorities report shortage harming nearly all of 20 indicators of hospital capacity, care processes, nurses’ ability to provide care, and six IOM aims
• Most hold pessimistic views of where the shortage will lead
Conclusions
• Several areas where clinicians and executives are not on the same page:– Majorities of RNs and CNO: early detection, safety,
quality of work environment; MDs and CEOS don’t agree
– Clear majorities of RNs reported six IOM aims affected, physicians were somewhat less likely to agree, executives substantially less likely to agree
Recommendations aimed at promoting problem recognition
• Build teamwork• Focus on safety
– Early detection of complications
• Stronger interdisciplinary curriculum on quality and safety
• Recognize that, in the future, teams will be composed of much older and more foreign-born RNs
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