Nursing shortages across America—from the West Coast and Southwest to Texas, East Coast and the South—is severe and only getting worse, reports the American Association of Colleges of Nursing. The impact will be felt from health systems and local hospitals to long-term care and research initiatives. The aging of the workforce impacts nursing as well with one million of the 3.8 million registered nurses in American departing the work force between now and 2030.  There will be fewer nurses across healthcare sectors, including clinical research.

Cathy Rozmus, PhD, vice dean for academic affairs at Cizik School of Nursing with The University of Texas Health Science Houston (UTHealth), reports to LegalReader: “the Aging of the current nursing workforce is one reason for the nursing shortage” and then assesses how the crisis impacts Texas, given that 25% of all of the nurses are over 56 today. Hence, not only does a shortage loom but also a loss of a valuable segment of knowledge workers in the healthcare sector. Regardless of whether it be America or the world, global nursing will affect healthcare sectors.

Research Nurses

The ongoing nursing shortage may impact clinical research. Research nurses can have a profound impact on clinical research programs in major academic centers, health systems, and even regional practice networks. The research nurse may play a varied but at times critical role in a research program or a specific clinical trial—whether as directly working with the principal investigator, study coordinator, clinical trials nurse or as staff nurse caring for patients, who are research subjects have a responsibility to promote the ethical conductor clinical research. Serving an essential function, clinical research nursing can be considered a specialty practice with a primary emphasis on both A) ensuring the safety of protocol-related care while B) maintaining protocol fidelity and in the process continuously balancing the needs of patients and study requirements.

Safety and Nurses: The Association

Many rigorous studies connect the level and amount of registered nurse staffing and safe patient care. For example as published in Lancet, Linda Aiken and colleagues study the evidence from a study of European hospitals evidencing that an increase in nurses’ workload by 1% increases the probability of dying within that particular provider 30 days of admission by 7%—this same study the authors revealed that with a 10% increase of credentialed nurses comes a decrease in patient mortality by 7%.

Other studies identify correlations between higher nurse patient loads and higher hospital readmission rates (BMJ Quality & Safety, May 2013, Heather L. Tubbs-Cooley and colleagues) while higher nurse staffing levels are associated with few deaths, lower failure-to-rescue incidents, lower rates of infection and shorter hospital stays (UCSF, Dr. Mary Blegen and colleagues, April, 2011). Dozens of important studies are correlating nurses with patient safety.

Overcoming the Challenges

The existing shortages and associated challenges of Registered Nurses (RNs) can be overcome. But in the aggregate, such a feat will result from a combination of policy, education, technology and organizational efficiency imperatives not to mention disruption rooted in entrepreneurial activities.

The actual distribution of nurses represents a key challenge. For example, according to 2014 data from the American Nurses Association in America, the distribution of nurses per 100 residents equals 0.85 RNs in rural areas vs. 0.93 in urban areas. This association posited that RNs in urban areas tend to have more education than those in rural areas. 

U.S. nursing schools doubled the number of graduates since the early 2000s, which represented the shortage peak.  According to Joanne Spetz, PhD, professor at the University of California, San Francisco School of Nursing and Health Professions have seen an uneven distribution of nurses, with too few in rural, low income areas (and some inner-city regions) and perhaps too many in higher-income, more densely populated areas. This reflects a systematic inefficiency in the healthcare sector. Moreover, another pressing challenge associated with the aging of the baby boomers: the loss of expertise, knowledge and even wisdom as many nurses in this generation retire during the next years of 2020 to 2030.

What to Do?

Creative and disruptive new ways to develop, mobilize, organize and distribute nursing talent represent a fundamental imperative—from utilizing technology services, such as telehealth and AI, to innovative means of organizing and distributing talent for nursing activity—including research—leads to the need for revolutionary forces in healthcare sectors: not just in the U.S. but everywhere.

State, regional and local initiatives are required, often requiring public and private partnerships, to drive the outcomes required—whether that be more nurses, greater emphasis on particular specialties based on regional needs; improved distribution of nursing services; greater diversity in the ranks of the RN workforce; better and improved knowledge retention, and the like.

For example, health systems and hospitals are investing in new graduate on-boarding processes—similar to a residency for doctors. In some regions, providers (employers) work with local schools to map gap deficiencies, representing community need—e.g. in some regions where birth/delivery nurses are in short supply, the local health system works with the local schools to offer programs, add credits for delivery nursing as an example.

In other cases, financial incentives are offered: whether to attract or retain PhDs in Nursing or to certify and train nurses in particular areas that are deemed deficient in a specific community. Moreover, with the age of precision medicine now unfolding, a whole line of research reveals that nurses that look like a local population earn more trust and generate better results. Hence, diversity in nursing programs evolve and expand across the country. Programs to stop turnover become imperative as such activity compounds adverse effects in the context of a labor shortage.

New technologies, whether it be telemedicine/telehealth or cloud/big data and AI (natural language processing and machine learning), must be bundled and incorporated into disruptive new entrepreneurially-driven models. Put bluntly, these advances should turn the existing paradigm on its head so that nursing services can be delivered and maintained in far more efficient and effective ways that are heretofore not conceivable via the existing paradigm of nursing work.

Source: Legal Reader

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