Articles of Interest
Job Order Index (November 2017-September 2018)
POSTED BY SARAH WENGERT, SENIOR CREATIVE CONTENT WORDSMITH, MEDICAL SOLUTIONS
As mentioned last summer, we hope you’re planning to attend Staffing Industry Analysts’ Healthcare Staffing Summit this November 5-7, 2018, in beautiful Denver Colorado.
It’s a fantastic way to continue to educate yourself and your team on the healthcare staffing industry. With a healthcare staffing event of such quality, you can bet NATHO will be there with bells on. In fact, NATHO invites members to join them for breakfast at the Healthcare Staffing Summit.
Click here to register to attend the members-only breakfast with NATHO at SIA’s Healthcare Staffing Summit. We hope to see you there!
POSTED BY AMN HEALTHCARE
Despite the confusion over national healthcare policy, jobs growth remains robust, with a 26,000 employment increase in September. Year to date, healthcare has grown by 302,000 jobs, according to the US Bureau of Labor Statistics. This potent growth rate reflects the fast pace of aging of our population, and the resulting rise in demand for healthcare services. It’s estimated that people over 65 use about three times as much healthcare services as the general population. This factor, plus the low unemployment rate in a fast-growing economy, continues to push up demand for healthcare services and for the nurses, physicians and allied healthcare professionals who provide them.
Healthcare workers are putting in more hours per week than ever before, according to newly released data, signaling potentially greater use of overtime in the face of continuing workforce shortages. This scenario creates many risks for healthcare organizations, because too much overtime has been linked to costly problems including medical errors and other threats to patient safety, declining patient satisfaction, clinician fatigue and burnout, depressed staff morale and rising turnover — and the bottom-line impacts from these problems.
The new data from the U.S. Bureau of Labor Statistics show that average weekly hours worked in all of healthcare and in hospitals in particular have reached record highs.
“The data infers that healthcare organizations may be using more overtime to cover for open shifts,” said Carolina Araya, Senior Vice President of Client Management at AMN Healthcare. “While this may seem like a viable option, a large and very convincing body of research shows that too much overtime can put a severe strain on nurses and other workers, which weakens their ability to provide quality patient care. Most clinicians will tell you plainly that this is true.”
According to the BLS data, hospital industry employees reached 37.1 average weekly hours worked in February through June 2018. Meanwhile, healthcare sector employees as a whole hit 34 average weekly hours in April, May and 2018. The average weekly work hours represent both full-time and part-time, and the split between the two has remained steady. The weekly hours worked represent a record high for both categories dating back to 1990, when collection of these statistics began.
Nurse Fatigue and Patient Safety
Research (IOM, 2003) has linked fatigue to several types of performance issues that can compromise the patient care environment. These include a decline in short-term and working memory; a reduced ability to learn; a negative impact on critical thinking, innovation, and insight; increased risk-taking behavior; and impaired mood and communication skills. Most notably, healthcare worker fatigue has been tied to an increased risk of patient-care errors. Tired, sleep-deprived nurses are more prone to errors that can endanger patient safety.
This point is clearly illustrated in a groundbreaking study (Rogers et al., 2003) involving 393 nurses over more than 5,300 shifts. Researchers found that work duration, overtime, and number of weekly hours worked had significant effects on errors. Specifically, the likelihood of making an error in patient care was three times higher when nurses worked shifts lasting 12.5 hours or more. The error risk began to increase when shifts exceeded 8.5 hours.
The study was among those cited in a Sentinel Event Alert issued by The Joint Commission in 2011 and updated in May 2018. The Alert, Health Care Worker Fatigue and Patient Safety, which noted that “shift length and work schedules have a significant effect on health care providers’ quantity and quality of sleep and, consequently, on their job performance.” It recommended designing work schedules to minimize fatigue.
Nurse Burnout and Staff Turnover
Nurse burnout is an ongoing problem in the healthcare industry, and it increases costly staff turnover, according to several studies. A 2013 survey released by CareerBuilder showed that 60% of healthcare workers have experienced job burnout, with more than 20% saying they often or always feel burned out.
The CareerBuilder survey, conducted by Harris Interactive, found that 34 percent of the more than 500 U.S. healthcare workers surveyed plan to look for a new job this year. Among the reasons were long hours and juggling multiple patient needs.
Nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction and to intend to leave the job, according to a 2012 study of nurses working in 577 hospitals (Stimpfel et al., 2012). The study concluded that “extended shifts undermine nurses’ well-being, may result in expensive job turnover, and can negatively affect patient care.”
Also, the Nurse Staffing Strategy Survey, commissioned by Kronos Inc. for the American Organization of Nurse Executives (AONE) meeting in 2013, found that 69% of nurses said that fatigue had caused them to feel concern over their ability to perform during work hours. And 96% reported having felt tired at the start of their shift. Most respondents to the survey said that overtime is assigned more often than anticipated during a payroll cycle.
The desire to switch jobs was also evident in AMN Healthcare 2017 Survey of Registered Nurses. While a majority of nurses (60%) said they are satisfied with their current jobs, more than a third said they often feel like quitting, and they hope they will not be working at their current job in a year. Such numbers do not bode well for healthcare organizations. Hospital nurse turnover is on the rise; the average cost of turnover for a bedside RN is $49,500 and ranges from $38,000 to $61,100 (NSI Nursing Solutions, 2018).
Exploring Options to Overtime
Due to the high potential for negative impacts, healthcare organizations need to consider options other than overtime for ensuring appropriate nurse staffing levels.
A number of solutions exist:
Expertise in healthcare staffing and workforce solutions resides outside the wall of the hospital today. Partnering with these external experts can help healthcare organizations reach and maintain staffing goals without risking patient care through too much overtime.
Institute of Medicine: Keeping patients safe: transforming the work environment of nurses. Washington, DC: National Academy Press, Nov. 3, 2003
Rogers A, Hwang W, Scott L, Aiken L, Dinges, D (2004). The Working Hours of Hospital Staff Nurses and Patient Safety. Health Affairs, 2004; 23(4):202-212
Stimpfel A, Sloane D, Aiken L (2012). The Longer the Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction, Health Affairs, 2012 Nov; 31(11): 2501–2509.
2018 National Health Care Retention & RN Staffing Report (2018). NSI Nursing Solutions, Inc.
Healthcare Staffing Summit (HSS) is a wonderful place for staffing agency leaders to come together for insightful conversations and presentations regarding the healthcare staffing industry.
This year’s event will be held November 5-7th, at the Hyatt Regency at Colorado Convention Center in beautiful Denver, Colorado. There are currently 25 speakers listed on the HSS event site from a variety of sources including authors, educators, marketing experts, representatives from Staffing Industry Analysts, former NATHO Board President, B. Gene Scott, and more!
NATHO will be at HSS this year with a lunch and reception for NATHO members — stay tuned to future NATHO updates for more detailed info, but we hope to see you there!
For more info or to register for HSS, visit: http://www.cvent.com/events/2018-healthcare-staffing-summit/event-summary-28d60fc7f5644933818c5cae291e164b.aspx
The NCSBN’s new enhanced Nurse Licensure Compact (eNLC) is in full swing. On January 19, 2018, the eNLC was implemented with the long-term goal of nationwide participation in the compact agreement. A few things have changed since then — so here a few updates and helpful reminders.
1. The only original NLC state that still has pending eNLC legislation is Rhode Island, but 24 of the 25 NLC states have now implemented the eNLC.
What that means for Rhode Island:
Since Rhode Island is the only NLC state that remains, travel nurses with a Rhode Island license must get a single state license to work in any other state except Colorado and New Mexico*.
2. *Because Colorado and New Mexico did not enact the eNLC until 1/18/18, just prior to the implementation date (1/19/18), they are members of both the original NLC and the eNLC for a 6-month period. This ends on 7/18/18, and both states will be an eNLC member only.
3. So far, five states that were not NLC states have implemented the eNLC:
4. Kansas has passed eNLC legislation, but it will not implement until July 1, 2019.
5. Louisiana has passed legislation to become part of the eNLC, but no implementation date has been set.
6. States with pending eNLC legislation include:
7. A main factor in more states getting on board with the eNLC is the 11 uniform licensure requirements a nurse must meet to obtain a multistate license. This adds extra protections through stricter requirements, which led to many non-NLC states to enact the eNLC legislation, and will hopefully lead to more state participation.
Check out this eNLC state map to find out which states are in the eNLC.
Job Order Index (November 2017-June 2018)
In this time of growing clinician shortages, AMN Healthcare is taking action to help healthcare organizations and their patients get the physical therapy services they need.
AMN has launched a major campaign to assist physical therapy professionals seeking multistate privileges through The Physical Therapy Licensure Compact. The Compact is a state-based initiative dedicated to reducing regulatory barriers to interstate practice for PT professionals. Thus far, 21 states have joined the Compact, with three that went live on July 9, 2018.
This innovative approach will greatly benefit patients, clinicians and healthcare providers. As part of our strong support for this effort, we are announcing today plans to underwrite the application fees for AMN physical therapists, or PTs, and PT assistants who desire to work in one of the Compact states.
Under the Compact system, qualified PTs, whose home state is a Compact participant, can apply for privileges to work in another Compact state without having to secure an additional license. While three states began issuing Compact privileges on July 9, 2018, many more states are expected to come online soon.
The Compact replaces the traditional system of requiring PTs to be separately licensed in each state where they practice -- a time-consuming process that has long hampered their ability to take up residence and begin working in another state or to travel across state lines to provide care.
We see multistate privileges as a win for all involved. Patients will have greater access to quality care, clinicians will have more mobility and new career opportunities, and healthcare organizations will be provided with larger numbers of qualified professionals. It will also allow the provision of electronic or telemedicine services by competent clinicians across state lines.
The multistate compact could also help rural areas, where shortages of all types of therapists are particularly acute and demand for their services is high. AMN data shows that demand is twice as strong relative to supply for rural areas when compared to urban areas.
AMN’s decision to fund the application fees is our contribution to advancing the growth of the PT Compact, which we see as another positive step toward national licensing for many healthcare professionals. Through this effort, we are helping our clients achieve greater flexibility in clinical staffing and supporting PTs themselves in achieving their professional and personal goals.
Multistate compacts are also underway for nurses and physicians. Compacts are part of an important evolution in healthcare, recognizing the need for greater clinician access to meet our nation’s growing patient needs and greater flexibility in an era of transformation for the healthcare industry.
Healthcare providers hiring advanced practitioners, such as nurse practitioners and physician assistants, as locum tenens has increased in recent years. The 2017 Survey of Temporary Physician Staffing Trends, by Staff Care, an AMN Healthcare company, shows that the percentage of healthcare facility managers who use locum tenens NPs or PAs in the past 12 months rose from 9.5% in 2012 to 26% in 2016.
But, despite that demand for NPs and PAs is high and growing, many healthcare facility managers and other leaders do not know that they are available as locum tenens.
Continued physician shortages, including in various surgery specialties, primary care, psychiatry, emergency medicine and elsewhere, suggest that advanced practitioner locums tenens usage should be a viable, patient-accepted alternative to physicians that have been shown to be cost effective.
Advanced practitioner locum tenens can be used to fill in for NP or PA vacancies, but more importantly could be strategically utilized in long-range workforce planning to create greater flexibility in physician staffing. This could become part of the solution to ongoing challenges such as physician burnout and care access, while supporting value-based healthcare, helping to reduce readmission rates, driving population healthcare models, and even utilizing advanced practitioners in temporary leadership situations.
The 2017 Staff Care survey of temporary physician staffing showed that 26% of healthcare managers used locum tenens advanced practitioners, but 94% used locum tenens physicians, with primary care as the highest demand specialty. This suggests that advanced practitioner locums are being underutilized.
The US Bureau of Labor Statistics projects that demand for nurse practitioners and physician assistants will grow at nearly three times the rate as increased demand for most physicians from 2016-2026. Advanced practitioners can particularly help healthcare providers facing critical shortages in primary care; a recent report from the American Association of Nurse Practitioners showed that 87% of NPs are certified in an area of primary care, and 78% deliver primary care.
The national trend toward increasing practice authority for nurse practitioners also makes locum tenens for advanced practitioners more beneficial for many healthcare providers. While advanced practitioners can prescribe in all 50 states, the range of what they can prescribe differs from state to state.
Currently, 23 states allow full authority to nurse practitioners, though the most populous states still reduce or restrict their practice. However, the Veteran’s Health Administration issued a new rule last year allowing full practice authority for nurse practitioners at all VA facilities, even in states where their practice is restricted. This has been seen as a major step forward in autonomy for advanced practitioners.
Locum tenens for advanced practitioners could have particular benefit for rural areas, where shortages of many types of healthcare practitioners are particularly acute. Recent research has concluded that nurse practitioners could be an important part of the solution to rural physician shortages, and that a higher proportion of nurse practitioners in rural areas are in primary care. Locum tenens advanced practitioners could therefore become an important piece of the puzzle in solving a growing crisis in rural healthcare caused by severe shortages of physicians and other clinicians.
It’s almost what many in healthcare consider the most wonderful time of the year. Nurses Week, celebrated annually from May 6-12, is a fabulous opportunity to celebrate hardworking nurses who give their all as the backbone of the healthcare field.
Many healthcare staffing companies, particularly those specializing in nurse staffing, make a point to celebrate their travelers in a big way in recognition of Nurses Week. That can mean different things for different agencies, of course, from creating a Nurses Week microsite to sending gifts to your travelers and leads.
There are as many ways to celebrate as there are agencies, but the important thing is that your organization take the time to recognize this special week in some fashion, whatever it may be! Your travelers will appreciate the thought and it can help foster loyalty to your agency in the long run.
If you have yet to hatch a plan to recognize your nurses this Nurses Week, the American Nurses Association puts together a wonderful toolkit each year, with all kinds of resources to help you honor and celebrate your nurses. There is also info on this year’s theme, which is “Nurses Inspire Innovate Influence.”
NATHO wishes you a happy Nurses Week and a fruitful celebration!
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