Comparative views of the impact of the nursing shortage on quality of hospital care
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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 ….

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Comparative views of the impact of the nursing shortage on quality of hospital care

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

Disclosure

Funded by:

  • Johnson & Johnson Campaign for Nursing’s Future


Data come from

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

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

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

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

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

Themes Across Surveys


Observations of rns physicians hospital ceos and hospital cnos

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

Percent Observing Nursing Shortage in Hospitals


Impact of nursing shortage on care processes

Impact of Nursing Shortage on Care Processes


In the past year have you observed any of the following as a result of nursing shortage

In the past year, have you observed any of the following as a result of nursing shortage?


Impact of shortage on hospital capacity

Impact of Shortage on Hospital Capacity


In the past year have you observed any of the following as a result of nursing shortage1

In the past year, have you observed any of the following as a result of nursing shortage?


Impact of shortage on nurses

Impact of Shortage on Nurses


How much of a problem do you think the shortage of nurses has been for major problem

How much of a problem do you think the shortage of nurses has been for…“Major problem”


How much of a problem do you think the shortage of nurses has been for major problem1

How much of a problem do you think the shortage of nurses has been for…“Major problem”


Comparative views of the impact of the nursing shortage on quality of hospital care

Impact of Shortage on Institute of Medicine’s Six Aims for Improving the Quality of the HealthCare SystemsIOM 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

Institute of MedicineSix Aims for Improving Quality of HealthCare System


Shortage frequently or often impacting

Shortage frequently or often impacting….


Patient centered care

Patient-Centered Care

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

Effective Care

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

Safety of Care

Safe:Avoiding injuries to patients from the care that is intended to help them


Timeliness of care

Timeliness of Care

Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care


Efficiency of care

Efficiency of Care

Efficient:Avoiding waste, including waste of equipment, supplies, ideas, and energy


Equity of care

Equity of Care

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

Expectations of Where Nursing Shortage Will Lead


Expect shortage will lead to

Expect Shortage Will Lead to …


3 wee bit about the changing composition of the rn workforce older and more foreign born

3. Wee bit about the Changing Composition of the RN workforceOlder and More Foreign-Born


Recent total rn employment growth in us by age

Recent Total RN Employment Growth in US by Age

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.


Comparative views of the impact of the nursing shortage on quality of hospital care

Source: Auerbach, Buerhaus, Staiger “Better Late than Never: Implications of Later Entry into the Profession for the Future

Supply of Nurses” Health Affairs, January/February 2007


Growth in foreign born rns

Growth in Foreign-born RNs


Comparative views of the impact of the nursing shortage on quality of hospital care

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

Recent Total RN Employment Growth By US and Foreign-Born Status

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

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

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

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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