1. Module 5 Nursing Workforce Trends

2. The Nursing Shortage is Back

3. Reimbursement Challenges
Healthcare’s Crisis
A Perfect Storm
An Aging Population +
Reimbursement Challenges
Workforce Shortages

4. Key Trends
ANM Healthcare found it a 2015 study that 62% of nurses older than 54 were considering retirement now that the economy has improved.
Turnover is increasing nationwide – now at 17.2% for RNs and 19.2% for Surgical Specialties (NSI Nursing Solutions 2016)
32.9% of hospitals now report vacancies of more than 10% for RNs (NSI, 2016)

5. 76m 78m 59m 46m Gen Y or Millennials Boomers Gen X Veterans 1981-2000
Gen X
Veterans
76m
78m
59m
46m
5% Workforce
Declining
30% Workforce
32%
Workforce
33% Workforce
Growing – will be 50% by 2020

6. Millennials or Gen Y Born 1981-2000
Digital natives – 6th sense
Optimistic
Civic minded
Collaborative
Need feedback
Loyal to teams/leaders
Want career coaching – desire “a plan” for their future
Satisfied with nursing as a career but least satisfied generation with their current employers.
Have a very unique perspective about the need of organizations to “accommodate them”.
Most likely generation to return to graduate school.
SLIDE 6

11. Generation Y – Highest Stress Level
Stress in America
APA 2012

12. Work-Life Balance Boomers – Work First Gen X- Work 50% Life 50%
Gen Y – Life First

13. Younger Nurses More Likely to Pursue Higher Education
AMN Healthcare conducted a nursing workforce survey in Close to 9000 RNs responded. ¾ of nurses under 40 reported that they plan to seek a higher degree in the next 3 years. 36% plan to seek an advanced practice degree.
AMN Healthcare (2015) Survey of Registered Nurses. Available at
Rose O Sherman 2016

14. The Triple Aim

15. Movement to the Quadruple Aim

16. AACN Healthy Work Environments
AACN, nd Edition

18. Assertion #1
There is a direct link between work environment and patient safety
Therefore, if we are not addressing our work environment, we are not addressing patient safety

19. Assertion #2 Healthy work environments do not just happen
Therefore, if we do not have a formal program in place addressing work environment issues, little will change

20. Assertion #3
Creating healthy work environments requires changing long-standing cultures, traditions and hierarchies
Therefore, though everyone must be involved in the creation of healthy work environments, the onus is on organizational, departmental and unit leaders to ensure that it happens

21. Challenges to the Case for Healthy Work Environments
Creating the “case” for a healthy work environment…
Are There Challenges?
Challenges to the Case for Healthy Work Environments
Link to patient safety not universally recognized
Relationship issues seen as “soft”
Hierarchy and power structures
Difficult to measure improvements
Tradition
Not a “sexy” issue

22. Call to Action
Nurses and all health professionals Embrace, develop, follow through
Healthcare organizations Adopt, implement, evaluate, role model
AACN and the community of nursing Promote, develop, publicize

23. It Starts with Us
“Creating a healthy work environment is more than a thing to do. It is a way of being that relies on the strength of the entire team. The culture becomes compromised when any part of the team fails to support a standard.”
AACN 2016

24. The Risk of Burn Out

25. What is Burnout?
Burnout syndrome is a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress. This exhaustion is typically work-related and is triggered by discrepancies between the expectations and the actual requirements of the job. Burnout syndrome has become a common worldwide phenomenon, especially among members of high-stress professions, such as firefighters, police officers, teachers and all types of health-care professionals. Critical Care Collaborative July 2017

26. New Study Critical Care Collaborative July 2016
Up to 45 percent of critical care physicians reported symptoms of severe burnout syndrome, while those specializing in pediatric critical care were at 71 percent.
Approximately 25 to 33 percent of critical care nurses manifest symptoms of severe burnout syndrome, and up to 86 percent have at least one of the three classic symptoms.
The high burnout syndrome rate in critical care professionals can be attributed to the especially stressful environment in the ICU due to high patient morbidity and mortality, challenging daily work routines, and regular encounters with traumatic and ethical issues.
Burnout syndrome in critical care health care professionals may result in posttraumatic stress disorder, alcohol abuse and even suicidal thoughts.
In nurses, burnout is associated with reduced quality of care, lower patient satisfaction, increased number of medical errors, higher rates of health care associated infections, and higher 30-day mortality rates.

27. Signs of Burnout Chronic fatigue
Forgetfulness – Inability to concentrate
Physical issues – Increased use of sick leave
Anxiety or depression
Anger
Cynicism and disengagement from work

28. Work Engagement
The Gallup Organization reports that only 30% of the US workforce is engaged in their work.
Nursing Advisory Board (2014) reported only 32% of RNs are engaged in their work.

29. The Energy Bus
Gordon, J. (2007). The Energy Bus. New Jersey: Wiley Publishers

30. Strategies to Promote Engagement
Promote identification with the mission, vision and values of the organization.
Build a sense of community on units.
Help staff find joy in the work.
Build trust and a sense of psychological security.
Provide recognition and an opportunity for growth.

31. Promote Civility and Stop Bullying

32. The Evidence on Bullying and Incivility
Bullying decreases job satisfaction and morale and increases absenteeism (Chipps & McRury, 2012)
Almost 21% of nursing turnover can be related to bullying (Johnson & Rea, 2009)
60% of new RNs who quit their first job in nursing within 6 months report that it is because of being bullied
Replacing one nurse can cost up to $88,000 USD (Jones, CB, 2012)  According to a study by the US Bureau of National Affairs, there is a loss of productivity of $5-6 billion/year in the US due to bullying in the workplace.
In a study on workplace bullying, most of the respondents reported being bullied by the charge nurse, manager, or director (Johnson & Rea 2009).
One in six nurses (13%) reported being bullied in the past six months (Sa & Fleming 2008)
Bullying of nurses leads to erosion of professional competence as well as increased sickness, absence, and employee attrition (Hutchinson et al., 2010; Johnson, 2009)
Bullying victims may suffer stress-related health problems, such as nausea, headache, insomnia, anxiety, depression, weight changes, and alcohol and drug abuse (Townsend, 2012)
Nurses who survive bullying early in their careers tend to carry their learned behaviors with them. They accept the bully culture as part of the job and eventually may choose to bully other nurses (Townsend, 2012)
The Joint Commission (2008) acknowledges that unresolved conflict and disruptive behavior can adversely affect safety and quality of care Assessing the work environment for the presence of incivility and bullying is a leadership imperative. Ignoring a culture in which this exists will continue to drain our financial resources and ultimately harm our

33. What Leaders Can Do
Examine your own behavior and how you contribute to civility or incivility.
Take a temperature check in your unit to see how staff treat one another.
Don’t listen to or tolerate rumors and gossip.
Encourage staff not to jump to conclusions about the intent or motives of other staff, patients or families.
Stop the blame game and encourage a solutions orientation to problems.
Encourage acts of kindness among staff.
Go out of your way to say thank you and promote this behavior in staff.
Look for common ground in dealing with conflict.
Encourage the practice of forgiveness.
Make it safe for staff to ask questions and discuss problems.

34. For Help - http://www.stopbullyingnurses.com/