Module 9 - Workforce and Workplace Issues in Nursing_S_048189a2fba105295fac6f6e06ee8dbd.pdf

At the end of the session, the participants shall be able to; Discuss the importance of workforce in nursing. Identify the workplace issues in nursing. Workforce in Nursing: Nurses comprise the largest component of the healthcare workforce. They are the primary providers of...

At the end of the session, the participants shall be able to; Discuss the importance of workforce in nursing. Identify the workplace issues in nursing. Workforce in Nursing: Nurses comprise the largest component of the healthcare workforce. They are the primary providers of hospital patient care, and deliver most of the nation's long- term care. The nursing workforce is composed of actively employed registered nurses (RNs), licensed practical or licensed vocational nurses (LPN/LVNs), and advanced practice registered nurses (APRNs). New roles in a transformed health system Growing number of patient centered medical homes, accountable care organizations and integrated delivery systems. The Centers for Medicare & Medicaid Services (CMS), actively funding demonstration projects. Goal: provide patients with more comprehensive, accessible, coordinated and high quality care at lower costs. Interventions Focused on; Emphasis on primary, preventive and “upstream” care. Care is integrated between: medical sub-specialties, home health agencies and nursing homes health care system and community-based social services An Electronic Health Records (EHRs) used to monitor patient and population health—increased use of data for risk-stratification and hot spotting. Interventions focused on both patient- and population-level. Payment based on value, not volume. What will it take to optimize contributions of nurses? Redesign the nursing curriculum to educate nurses with new competencies; Retrain existing nurses with new skills and knowledge; Revamp licensing examination and requirements to reflect the new curriculum; and Restructure the state regulatory system to allow flexible deployment of the nurse workforce.”  The patient-centered medical homes (PCMHs) and Accountable Care Organizations (ACOs) emphasize care coordination, population health management, patient education, health coaching, data analytics, patient engagement, quality improvement, etc. Care and the workforce shifting toward ambulatory settings and community care. New job titles and roles are emerging. Increase focus on integrated care delivery models creating “boundary spanners”.  Increasing number of staff focused on roles that shift focus from visit-based to population-based strategies. Two examples: Panel Managers Health Coaches Assume responsibility for patients between Improve patient knowledge about disease visits. or medication and promote healthy Use EHRs and patient registries to identify behaviors. and contact patients with unmet care needs. May be medical assistants, nurses, health Often medical assistants but can be nurses or educators, social workers, community other staff health workers, pharmacists or other staff  Need to redesign education system so nurses can flexibly gain new skills and competencies Retrain and upgrade skills of nurses – they are the ones who will transform care Training must be convenient – timing, location, and financial incentives must be taken into consideration Need to prepare faculty to teach new roles and functions Clinical rotations need to include “purposeful exposure” to high-performing teams and ambulatory settings.  To develop evidence to support regulatory changes, especially for new roles Better evaluation of pilot workforce interventions to understand if interventions improve health, lower costs and enhance satisfaction To establish a national clearing house to provide up-to-date and reliable information about scope of practice changes in other states Remove regulatory barriers to let nurses utilize skills to max benefit of patients  Insurance reimbursement rules Regulation of entry-level nursing education NCLEX Federal and state appropriations to spur innovation What policy changes would better support the way that you want to deploy nurses?  Adequate and sustainable payment models to retool and redeploy the workforce are lacking Many workforce innovations are supported by one-time funds. If payment models don’t change rapidly enough, it will affect the sustainability. Adequate fund to conduct research and evaluations necessary to develop evidence base needed to support workforce redesign.  Nurses are the largest licensed health profession (about four times as many nurses as physicians) Nursing care linked to quality and satisfaction measures that will increasingly be tied to value-based payments Nurses provide whole-person care across health and community-based settings Nurses are the ultimate “flexible” workforce taking on new roles in transformed health system 5 times larger than physician workforce  Lack of nurses prepare to work in nursing administration. Acute shortage of nurses. Less relationship between nursing service and nursing education. Lack of authority in administrative structure. Strange relationship between nurses and other auxiliaries and also with physicians. Lack of teamwork spirit. Lack of resources, both material and financial.  Restructuring Managed care system Quality indicators and accountability for outcomes New demands/technology advancement High tech and high touch dilemma Community/global perspective  Identity crisis Lack of proper explanation Language barrier Constant interruptions Patient concerns Volume control Hospital nurse staffing and nursing sensitive outcomes Nurse’s workload and job dissatisfaction  MATERNAL AND INFANT NURSING PEDIATRIC NURSING MEDICAL SURGICAL NURSING PSYCHIATRIC NURSING Employment issues are defined as any issue which may have an impact on wages, terms and other conditions of employment. Delays in registration Employment discrimination issues Employment harassment issues Mandatory overtime Job dissatisfaction Employment occupational health and safety issues. Employment retention and turnover issues Employment performance appraisal issues Employment recruitment issues  Issues related to staffing Staff retention Nursing shortages Demand for nurses Staff turnover Workload Issues regarding malpractice in nursing management Collaboration issues  Controlled substances Abscond of the patient Deaths and Caring patients with dying AIDS Autopsy and Pregnancy termination organ donation Surrogate Sex determination mother  Advance directives Do not resuscitate (DNR) order Patient’s property Reporting  Documentation of all unusual incidences Report all unusual incidences Know your job description. Follow policies and procedures as established by your employing agency. Keep your registration updated. Perform procedures that you have been taught and that are within the standard scope of your practice. Protect patients from injuring themselves. Remain alert and focused. Establish and maintain rapport with patients and family. Seek and clarify orders when the patient‘s medical condition changes. Practice safety with physician‘s verbal orders.  Remove side rails from patient‘s bed unless there is an order or hospital policy to do so. Allow patients to leave the hospital or nursing home unless there is an order or a signed release. Accept money or gifts from patients. Give advice that is contrary to physician orders or the nursing care plan. Give medical advice to friends and neighbors. Attempt to practice medicine. Witness a patient‘s will. Take medications that belong to patients. Worked as a licensed practical/vocational nurse in a state in which you are not licensed.