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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 Quality

Funded by:

  • Johnson & Johnson Campaign for Nursing’s Future


Data come from
Data come from … Quality

  • 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 Quality

  • 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 Quality

  • 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 Quality

  • 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 Quality

  • 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, shortage 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 Shortage in Hospitals




Impact of shortage on hospital capacity
Impact of Shortage on a result of nursing shortage? Hospital Capacity



Impact of shortage on nurses
Impact of Shortage on Nurses a result of nursing shortage?




Impact of Shortage on has been for…“Major problem”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 has been for…“Major problem”

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…. has been for…“Major problem”


Patient centered care

Patient-Centered Care has been for…“Major problem”

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 has been for…“Major problem”

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 has been for…“Major problem”

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


Timeliness of care

Timeliness of Care has been for…“Major problem”

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


Efficiency of care

Efficiency of Care has been for…“Major problem”

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


Equity of care

Equity of Care has been for…“Major problem”

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 has been for…“Major problem”


Expect shortage will lead to
Expect Shortage Will Lead to … has been for…“Major problem”


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 workforce

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.


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 Never: Implications of Later Entry into the Profession for the Future


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 Status

  • 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 Status

  • 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 Status

  • 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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