Sick & Getting Sicker: the Perils of Nursing

By B. Lana Guggenheim, Staff Writer

The recession might be over officially, but many professions are still feeling the squeeze. Healthcare demands are rising as the Boomer generation ages, but even though they are mostly protected from the worst of the volatile job market by virtue of being unionized, nurses are starting to feel the pain of job insecurity.

First in the 90s and again recently, there have been severe budget cuts impacting the health sector as government attempts to minimize budget deficits. Then and now, the results have been mostly negative across the board.  One of the biggest threats to nurses’ jobs are hospital restructurings - which are results of these budget cuts, and are significant changes that nurses often have no voice in. They also have no way to predict or prepare for the nature of those changes either.

Downsizing can make work intolerable: between budget cuts, hiring freezes, overtime restrictions, and wage freezes, nurses reported they had an increasing desire to quit, citing burnout and decreased life satisfaction in addition to job insecurity. In short, hospital restructures often lead to fewer nurses on staff, thus increasing the workload of those who remain, sometimes dangerously so.

Insufficient staffing raises the stress level of the nurses remaining on staff, but it also leads to dangerous levels of insufficient care for patients. Stressed nurses are driven to the breaking point, and many choose to leave their profession as a result. And high nurse turnover and vacancy rates cause avoidable patient deaths. Similar nursing cuts in Canada have led to nurses speaking out about the dangerously sub-optimal care patients now receive as a result.

The increasing instability of nursing jobs might lead one to think that the job market for nurses is over-saturated, but the opposite is true. An aging Baby Boomer population means there is more demand for nurses than ever before. And the aging nurse population means that there are ever increasing numbers of vacancies to be filled as well. The American nursing shortage is projected to grow to 260,000 RNs by 2025 - a shortage not experienced since the mid-1960s, the worst of which is projected to manifest in the South and West. Yet, nursing schools across the country are struggling to expand the capacity to meet this rising demand. Part of the problem is that these schools simply do not have the faculty necessary to expand their programs. According to the AACN’s enrollment data from 2012-2013, American nursing schools turned away nearly 80,000 qualified applicants from bachelor’s and graduate nursing programs due to the insufficient number of faculty, clinical sites, classrooms, and budget.

There is no magic solution to this problem, no easy quick-fix. But there are strategies that can be employed to ameliorate some of the worst effects of this nurse shortage. Hiring retired nurses, or giving incentives to retirement-age nurses to stay on is one way to slow the shortage. This can be done via financial incentives and job enrichment opportunities, such as leadership positions or taking on special assignments. This can also include mentorship programs, which help train newly hired nurses at the start of their careers under a senior nurse with a lot of experience. And it is cheaper than hiring and training a new nurse to take their place. New technology, along with process improvements, can relieve nurses of onerous and redundant administrative tasks, freeing up more time for them to get back to actual nursing. Finally, allowing for flexible scheduling gives nurses a measure of control over their lives. When allowed to dictate their own hours, nurses reported greater job satisfaction, and turnover rates were significantly lowered.

None of the above strategies will resolve the ultimate cause of this nursing shortage in the first place: budget cuts, both at universities and at hospitals and health care centers. However, addressing budget shortfalls is probably out of the reach of most individual nurses, or even most hospitals. These strategies, once implemented, should help stave off some of the worst effects until we ride this crisis out.

Sources:

https://www.psychologytoday.com/blog/diverse-and-competitive/201603/economic-austerity-and-threat-job-security

http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage

https://www.psychologytoday.com/blog/diverse-and-competitive/201602/managing-and-sustaining-aging-nursing-workforce

http://www.tandfonline.com/doi/abs/10.1080/09585192.2014.921634

http://www.thestar.com/news/queenspark/2015/10/22/nursing-cuts-hurting-hospital-care-in-ontario-union-says.html

Mental Health First Aid

Guest Post by Kristin DiMiceli, LMSW

What would you do if you are walking down the street and see someone fall & potentially break a bone? If you are a considerate human being, you might run over to help them and/or call someone for help. Now think about a situation where you are walking & see someone in emotional distress: leaning over, breathing heavily, crying, & looking a bit disoriented. There are a variety of ways one might respond, but think about your initial feelings when imagining this scenario. One might turn the other way, try to solve the problem, or start to look panic stricken themselves. It doesn’t feel as clear cut as when you are addressing a medical problem, right?

To help solve this problem, the National Council for Behavioral Health (NCBH) started a movement to train people in Mental Health First Aid. This training was first created in Australia in 2001 by a nurse, Betty Kitchener, & a mental health literacy professor, Tony Jorm. It has been adapted in 23 other countries & was started in the United States in 2008. The NCBH has trained over 500,000 people, & is working towards the goal of reaching 1 million people with the help of Congress putting $15 million towards their cause. Their training sessions are conducted all over the United States to address helping adults & youth who may be experiencing emotional distress.

As a Licensed Social Worker working in the mental health field, I feel that this is a very important movement that will not only help people find ways to help those in need mentally, but to also reduce the stigma that is so heavily ingrained in our society regarding mental health. Whether we mean to or not, we tend to shy away from helping those who are in need due to mental health problems. First Aiders are trained to address individuals who may be suicidal, experiencing a panic attack, or using drugs.

With this training, one can at least try to help those in need by pointing them in the right direction using the Mental Health First Aid acronym, ALGEE. It stands for:

1. Assess
2. Listen non-judgmentally
3. Give reassurance and information
4. Encourage appropriate professional help
5. Encourage self-help and other support strategies.     

There is no quick fix in the moment, but at least the individual is being addressed & recognized, as opposed to being ignored. You never know if you might be the catalyst for a more positive path in their life. This Mental Health First Aid training is excellent for a variety of professionals, from police officers to teachers, as well as lay people. You don’t have to be a medical professional to give the Heimlich Maneuver & you don’t have to be a mental health clinician to give Mental Health First Aid.   

For more information and to sign up for training sessions, check out MentalHealthFirstAid.org.

Also, don’t be afraid to call 911 if you feel someone may need to be further evaluated.  Emergency rooms can evaluate individuals if they appear to need to be admitted.

Images courtesy of Shutterstock.