The Nursing Crisis: Improving Job Satisfaction and Quality of Care Linda Searle Leach, Ph.D., R.N., C.N.A.A. Assistant Professor California State University, Fullerton

Current Conditions Turnover Unstable Workforce Few Incentives for Experienced RNs Increased Cost of RN staff Declining Morale Quality Concerns Unionizing/Labor Activity Higher Census Aging Patient Population Shorter Lengths of Stay Increased Patient Load Lack of Collaboration Increase Overtime Stressful Work Environment Aggressive Recruitment Image Campaigns Registry/Traveler Staffing Hiring Bonuses Higher Wage Rates Salary Compression

Increase the Supply of RNs  Expand educational capacity and opportunity Increase state and federal support for nursing education Increase state and federal support for nursing education Do not cut budgets that currently fund nursing education Do not cut budgets that currently fund nursing education Provide incentives for and access to degree-granting education programs Provide incentives for and access to degree-granting education programs  Fund workforce data collection and planning Systematically compile workforce data Systematically compile workforce data Forecasting models of supply and demand Forecasting models of supply and demand  Promote partnerships between service and education  More effective recruitment Recruit future generations Recruit future generations Enhance diversity Enhance diversity American Organization of Nurse Executives(AONE) Legislative Priorities 2003 Health Care's Human Crisis: The American Nursing Shortage. The Robert Wood Johnson Foundation

Increase Retention  View RNs as strategic assets Satisfying work relationships Satisfying work relationships Improve compensation Improve compensation  Make positive changes in work environments Support integration and development of new nurses Support integration and development of new nurses Labor saving technology Labor saving technology Ergonomic technology Ergonomic technology Adopt characteristics of Magnet hospitals Adopt characteristics of Magnet hospitals Health Care's Human Crisis: The American Nursing Shortage. The Robert Wood Johnson Foundation

Increase Retention  Expand career options Paid opportunities Paid opportunities  Strengthen nursing leadership Support education for managers and administrators Support education for managers and administrators Nurse executives must be key decision-makers Nurse executives must be key decision-makers Nurse involvement in decisions Nurse involvement in decisions  Increase visibility of RNs contributions to quality of health care Decrease individual workloads Decrease individual workloads Health Care's Human Crisis: The American Nursing Shortage. The Robert Wood Johnson Foundation

State Strategies to Address Workforce Issues  Increase Supply Registered Nurses Registered Nurses Master’s Prepared Nurses Master’s Prepared Nurses Faculty Faculty  Protect Workforce, Ensure Safety  Obtain Data for Workforce Planning

California’s Nurse Staffing Legislation  Assembly Bill 394 (2002) Directs the California Department of Health Services (CDHS) to establish “minimum, specific, and numerical licensed nurse-to- patient ratios by licensed nurse classification and by hospital unit.” Little data to drive decision-making process, even less agreement Increased costs Expected implementation date: July ‘03 Enforcement challenges

Hospital UnitNurse to Patient Ratios General Medical-Surgical1:6 (1:5 after months) Labor & Delivery1:2 Postpartum1:6 (Mothers Only) Couplets (moms & babies)1:4 Behavioral Health & Psychiatric Units 1:6 Telemetry Unit1:5 Step-Down Unit1:4 Emergency Departments1:4 Trauma1:1 Critical Care1:2 Pediatrics1:4 Specialty Care (Oncology)1:5 Post-Anesthesia Care Unit1:2 Mixed Units1:6 (1:5 after months) Operating Room1:1* - Current law/regulation Neonatal ICU1:2* - Current law/regulation ICU/CCU1:2* - Current law/regulation Burn Unit1:2 Well-Baby Nursery1:8* - Current law/regulation Intermediate Care Nursery1:4* - Current law/regulation Nurse means Licensed Nurse = RN LVN LPT CDHS Nurse Staffing Ratios