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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.

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Presentation on theme: "Comparative Views of the Impact of the Nursing Shortage on Quality of Hospital Care AcademyHealth Health Workforce Interest Group June 2, 2007 Peter I."— Presentation transcript:

1 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

2 Disclosure Funded by: Johnson & Johnson Campaign for Nursings Future

3 Data come from … Project to Evaluate the Johnson & Johnson Campaign for Nursings Future Project Personnel: –Peter Buerhaus (PI) and Robert Dittus Vanderbilt University Medical Center –Karen Donelan (Co-PI) and Cate DesRoches Massachusetts General Hospital

4 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)

5 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

6 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

7 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

8 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

9 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.

10 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%

11 Impact of Nursing Shortage on Care Processes

12 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 8774*58*55* Increase in staff communication problems 8871*72*69* Increase in workload for physicians 535529*30*

13 Impact of Shortage on Hospital Capacity

14 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 Increased reduction in the number of available beds 81%64%*60%*56%* Increase wait time for discharge 7250*60*61* Increased patient wait time for surgery or tests 7545*47*48* Increase in discontinued or closed patient care programs 424920*

15 Impact of Shortage on Nurses

16 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 5533*5650 Ability of nurses to maintain patient safety 6921*6238*

17 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%*6047* Nurses time for patients9178*66*59* Quality of nurses work life8259*7662*

18 Impact of Shortage on Institute of Medicines 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.

19 Institute of Medicine Six Aims for Improving Quality of HealthCare System Patient-centered Effective Safe Timely Efficient Equitable

20 Shortage frequently or often impacting….

21 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

22 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

23 Safety of Care Safe: Avoiding injuries to patients from the care that is intended to help them

24 Timeliness of Care Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care

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

26 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

27 Expectations of Where Nursing Shortage Will Lead

28 Expect Shortage Will Lead to … RNs 2004 MDs 2004 CNOs 2005 CEOs 2005 Higher pay for nurses48%78%86%94% The need to have other staff perform some nursing patient care activities 83928187 Nurses leaving for non-nursing jobs91848379 More respect for nurses21443659 Improvements in workplace environment25347475 Lower quality care for patients90837169 Increased stress on nurses96869798

29 3. Wee bit about the Changing Composition of the RN workforce Older and More Foreign-Born

30 Recent Total RN Employment Growth in US by Age RN Age Year21-3435-4950-64 2002- 21,17043,152 63,911 200387,131- 32,271 65,839 2004- 45,03421,294 23,212 2005- 31,277- 87,284 91,312 200646,17216,97012,888 2002-200635,822- 40,139257,161 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.

31 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

32 Growth in Foreign-born RNs

33 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.

34 Recent Total RN Employment Growth By US and Foreign-Born Status YearU.S.Foreign-Born 200244,04541,849 200394,50324,190 2004- 9,824 9,275 2005- 5,897-21,353 200636,61639,075 2002-2006159,44393,036 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.

35 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

36 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 dont agree –Clear majorities of RNs reported six IOM aims affected, physicians were somewhat less likely to agree, executives substantially less likely to agree

37 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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