Tuesday, 25 February 2020

Nurses shedding light on the ugly side of the flu

The 2017-2018 flu season is breaking all records. The Centers for Disease Control and Prevention (CDC) noted that the “overall hospitalization rate is higher than the overall hospitalization rate reported during the same week of the 2014-2015 season; the most severe season in recent years.” The most recent CDC report showed an additional 17 flu-related pediatric deaths, bringing the total to 53 this season with little relief in sight.

ER Nurse shares her humble thoughts
There is no doubt that the frontline nurses and healthcare workers are bearing the burden of this record-breaking year. One nurse, feeling the daily frustrations of fighting what appears to be losing battle, recently took her thoughts to the masses in a video that went viral.

Nurse Katherine Lockler posted a video to her Facebook page after a long shift in the ER, candidly expressing what most nurses and providers think on a daily basis but often are afraid to say.

Her simple but sassy message hoped to shed some light on the ways the public is not helping the current epidemic. In her six-minute video, she shares how simply the flu is passed but also how most are just not washing their hands. When working in an office, it’s easy to pass germs without knowing it. Germs can be everywhere, from the desks to the doors. This is why some offices decide to contact companies, like https://greenfacilities.co.uk/, to perform a deep clean in their office. This can limit the number of potential flu germs in the office. However, employees should also wash their hands regularly and keep anti-bacterial gel with them for extra protection against the flu.

Lockler reminds folks that the last place you may want to go if you do not have a true emergency is the hospital which is essentially “a cesspool of funky flu” these days. She sarcastically shares how folks are coming to the emergency room unnecessarily to visit friends and family — all unwittingly becoming potential new flu victims.

Although she shares her message in a humorous, saucy way, Lockler’s points are well taken and true. If we have any hope of containing this seasonal epidemic, we all need to do our part to prevent the spread. As she points out, do not unnecessarily expose family members, cover your coughs and sneezes — for which she does a fantastic demonstration — and especially wash your hands often.

Lockler also goes on to share the true experience of working in the ER during this busy season. She notes the overcrowding, limited resources and lack of breaks for nurses, while all being exposed themselves at high rates. It’s easy to forget that choosing a career in healthcare may also mean signing yourself up to a life of catching all of the various contagious conditions, but luckily there is physicians disability insurance so that you don’t suffer financial hardship if you have to take time off work.

She ends her video — which has been viewed more than 9 million times — asking the public to be kind and thank the healthcare workers who put themselves in harm’s way to care for others.

Nurse fired for calling in sick
So, with unprecedented numbers of infected patients, it is no surprise that healthcare workers are becoming sick themselves. Despite mandated vaccinations at most facilities, healthcare workers will inevitably get sick, especially in light of what appears to be an ineffective vaccine this year.

Recently, an Ohio nurse came forward stating she was fired for calling out while ill with the flu. Theresa Puckett, a University Hospital PRN (as needed) nurse was told she violated the hospital’s attendance policy due to calling out at the end of 2017 and being sent home early on a second shift.

Since she had missed two shifts in a 60-day period, she was terminated. Although she had a doctor’s note to not return to work, it was not considered excused under their policy.

In a strange paradox, the hospital had recently initiated visitor restriction “for the safety of our patients, staff and public.” They were restricting anyone who exhibited flu-like symptoms, yet Puckett apparently was supposed to present herself to work. Although the hospital adamantly maintains that they were well within their right to terminate Puckett, it certainly seems that their message is conflicting.

As the flu season continues to rage on, nurses and other healthcare workers will continue to do what they do — care for sick people, try to care for themselves and continue to try to educate the public so they can care for themselves as well.

So, wash your hands frequently, cover your coughs and sneezes, and try to minimize your exposure to prevent further spread. Be well and remember to thank a nurse!

Friday, 21 February 2020

Taking Your Nursing Career to the Next Level With Continuing Education

Choosing to become a nurse is not only about having a rewarding career. Most of the time, the job entails caring for patients and doing your best to help improve their lives. While you could eventually get swept up by daily routines, it is also essential to begin prioritizing your career and how you can move forward and maximize your potential.

Since education brought you this far, continuing education will also be your ticket to more opportunities in the field of nursing. According to the US Bureau of Labor Statistics, the healthcare industry will grow by 18% until 2026. This is excellent news because it means that there will be more jobs available for nurses.

Career flexibility through education
The field of nursing opens doors to a variety of professionals with different educational backgrounds. If you are looking for continuing education, there are also several paths you can take. For example, you can begin by earning a certificate in skills such as nurse leadership, similar to what is offered on this website. A certificate program can be your entry point in determining which direction you wish to take in your career.

Another approach is pursuing a master’s degree in nursing. What’s great about furthering your education is that most institutions offer the option of online or in-person programs where you can choose which fits best with your current work and family life.

In choosing a course or educational program, it is also essential that you determine whether it has the right accreditation. You also need to look carefully at the curriculum to ensure that you earn knowledge and skills in subjects that are relevant to your intended career path.

What are the benefits of continuing education for nurses?
There are some nurses that indeed succeed in their careers with only a bachelor’s degree. But, if you want to increase your chances of pursuing other opportunities, continuing education is an excellent starting point. Some of the benefits are:

• Higher pay
Getting a master’s degree and completing certificate programs will qualify you for better pay.

• Advancing your professional career
There is no doubt that doors will open after you pursue continuing education. Some medical centers also require practicing nurses to further their knowledge and skills in a specific area. If you are also eyeing a leadership position, you will have better chances of getting promoted if you have the right credentials.

• Flexibility in choosing a career path
If you are looking to get promoted, continuing education will provide you with more flexibility in pursuing a satisfying career path in the healthcare industry. For example, there are courses tailored for nurses who eventually want to become educators themselves. Whatever you envision for your future, the best approach is to acquire the skills and education to qualify.
The healthcare industry is a vast field. For nurses, there are many jobs and career paths available. If you want to take your career to the next level, the first step is furthering your educational qualifications.

 To learn more please visit World Nursing Congress 2020  

Tuesday, 18 February 2020

Winning at Student Retention: How to Succeed as a Nontraditional Nursing Student

Winning at Student Retention: How to Succeed as a Nontraditional Nursing Student

Nursing student retention is a major question at nursing school programs across the US. What factors help a student stay in or drop out of a program, and how can you stay on the winning side of the retention statistics?

The Surge in Nontraditional Nursing Students

If you’re not coming to nursing school straight out of high school, join the club! The nursing student body is attracting a growing number of what are referred to as “nontraditional students.” According to Marianne R. Jeffreys, author of Nursing Student Retention: Understanding the Process and Making a Difference, nontraditional students tend to fall into one or more of the following categories:
  • Age 25 years of age or older
  • First-generation college students
  • Attend school on a part-time basis
  • Members of ethnic or racial minority group
  • Speak English as a second language
  • Have dependent children
  • Have a GED
  • Commutes to campus
  • Changing to nursing from a former career
  • Taking remedial, refresher, or update courses
  • Male students
Despite the need for nurses from varied backgrounds to treat an increasingly diverse patient population, nontraditional students face a number of challenges. Quite often, a nontraditional student is driven to drop out owing to time and/or financial constraints, family/childcare responsibilities, work commitments, and other conflicts that interfere with their ability to fulfill course work requirements and achieve academic success.
However, there are a variety of options available to students in such situations. Many programs seek to reactivate lapsed students by offering tuition waivers and make use of special grants to increase student retention and head off the drop-out process. Look for a school that is making use of such grants to create peer-mentoring networks, test prep workshops, and other special activities—measures that have been proven to enhance your experience and increase your chances of success in the program. Taking advantage of these opportunities can help you to meet the challenges of your course-load, reduce stress, give you greater confidence, and increase your chances of passing the NCLEX.

Get the Support You Need—and Deserve

If you are a nontraditional student, keep in mind that your background and situation make you very attractive to the nursing profession! Nontraditional students are in great demand at all levels of nursing education; with your background and abilities you can make a unique and vital contribution.
According to a recent CUNY study, “support by faculty, friends, and family was the key determinant of first semester nursing students’ ability to remain in the nursing course.” Keeping this in mind, take confidence in your value to the profession, don’t be shy, and put yourself out there:
  • Make an effort to ask questions in classes and go to faculty for help: it is always better to ask a question than to leave it unasked! If there is something you don’t understand, speak up in class—and if you have more questions than can be managed during a lesson, schedule time to meet with your instructors for help after class.
  • Worried about financing your degree? Talk to your financial aid advisor to apply and negotiate for student loans—they’re not just for recent high-school grads. And, if you’re in a BSN program, don’t forget that a nurse externship enables you to collect a salary while gaining hands-on experience with patients—and will also hone your competitive edge in the job market.
  • If your school offers a peer mentoring program, take advantage of it. According to the journal Nursing 2020, “students who are peer mentored have better rates of retention and are more successful.” Connecting with a peer mentor can help you to master a challenging course, develop better study habits, bring you closer to your classmates, and increase your self-confidence—all of which can lead to a higher GPA and NCLEX score!
  • Make the most of your school’s academic support services. Keep in mind: regular meetings with your faculty advisor can make an enormous difference—for instance, did you know that counseled students have higher retention rates than non-counseled students?

Pursue Success in Your Classes

Nursing is a demanding, rigorous discipline, but those demands can be met. Here are some basic steps you can take toward success in obtaining your degree and license:
  • Practice self-efficacy: Self-efficacy reflects confidence in the ability to exert control over one’s own motivation, behavior, and social environment. Stanford University’s Albert Bandura says of self-efficacy, “After people become convinced they have what it takes to succeed, they persevere in the face of adversity and quickly rebound from setbacks. By sticking it out through tough times, they emerge stronger from adversity.” Push negative thoughts out of your head and motivate yourself to succeed; form targets and commit to meeting them; be persistent—approach hardships and setbacks as challenges to be overcome with increased energy and efforts.
  • Double down on your studying skills (check out the University of North Carolina’s helpful guide, Study Smarter Not Harder). Did you know that time management, organizing, and planning are better indicators of academic success than your total number of study hours? Using your time effectively is the key.
  • Attendance is vital. Did you know that your nursing program’s attendance policies may be stricter than the policy of your parent institution? You also need to take into consideration that in a nursing program, in addition to your classroom hours, attendance requirements also include specific nursing course components such as skills laboratory and/or clinical hours.
  •  “Attending” while you attend class and read your textbooks and notes is also essential: how involved are you during class and when reading? Speaking of notes, have you developed good note-taking skills? Did you know that most studies indicate it is more effective to take notes by hand instead of using a laptop?
  • If you have outside obligations that are making it hard for you to focus, talk to a peer mentor or a faculty advisor—sooner rather than later—about adjustments you can make that will help you to concentrate and remain alert.

How Family, Children, and Work Affect Student Retention

Marianne Jeffreys remarks, “People have lives that constitute more than nursing school. The reality is that environmental factors can influence student retention, persistence, and success more than academic factors.” When it comes to academic success, personal “environment” plays a key role in student retention. For example, are you living with family or raising children? Working a full- or part-time job? Do you have a long commute to and from school? For the traditional student, college adjustment and social integration into the college residential life-environment play a substantial role in academic success. For the nontraditional student, “environment” is largely composed of off-campus life: where you live (and with whom), the financial constraints you live under, family/work obligations, transportation issues, and other factors that affect your life both on- and off-campus.
One hurdle to look out for is the late-semester crunch. Studies have found that the challenges a nontraditional student faces on a day-to-day basis can be lighter or heavier depending on the time of year. Earlier in the semester, for instance, family, relationship, and work responsibilities can exert a moderate, but manageable pressure on the demands of school. Later in a semester, though—for example, when exams are pending—those same responsibilities can feel a lot more burdensome. This is a good time to seek out faculty and peer mentor guidance for help managing time and juggling the various “hats” you wear while fulfilling responsibilities at home, work, and school.
And what about children? An increasing number of students have dependent children; how do they manage? Research has shown that even single parents are more resilient than might be expected. In one study, almost 60% of students with children reported that they found child care to be supportive of their goals and aspirations in nursing, while others stated that their child-care arrangements did not influence course retention at all. As Jeffreys adds, “notably, all of these students remained in nursing courses throughout the semester and successfully passed the course.”
Working while attending school is becoming a fact of life for both traditional and nontraditional students. Even traditional students now often work 30 hours a week or more. And, once again, the perceived impact of employment responsibilities on schooling can be subject to that late-semester crunch. What may seem manageable earlier in the semester can start to feel increasingly restrictive later on. When setting your hours of employment, also keep in mind that the number of hours you work can have a significant impact on academic achievement and student retention: a 40-hour work week can make school substantially harder than a 30-hour work week. Plan out your budget, and don’t take on more hours than you absolutely need.

The Role of Encouragement and Emotional Support

Families can offer forms of support that can compensate for lack of financial wherewithal. Emotional support and expressions of pride and encouragement regarding your educational and career goals can make all of the hardships worthwhile. In her book, Marianne Jeffreys cites a study of over 1100 culturally and generationally diverse undergraduate commuter nursing students that showed family emotional support was one of the most powerful influences on their ability to remain in a nursing course. If you feel that your family or significant other could be more supportive of your efforts, supplement your own inner resources by talking to your advisor or peer mentor. And remember your friends: the support of good friends can give you a boost during crucial moments.
As nursing schools are becoming increasingly reliant on nontraditional students, the issues such students face are attracting ever more attention from administrators and faculty. In addition to the student retention measures already in place, programs will continue to seek out ways to attract—and retain—nontraditional students and support them in their progress toward their degrees. And, whether you are a nontraditional or a traditional student, make your voice heard! Talk to faculty, administrators, and peer mentors to contribute your own suggestions about ways to pave the path to success to graduation.

Monday, 17 February 2020

The Pitfalls of Maintaining RN Licensure in Multiple States

Maintain multiple RN licenses – The Easy Way.  If you have been a traveling nurse for a few years you likely have several RN State licenses.  Knowing what to do when it’s time to renew these licenses can be daunting.  Do you simply let it expire? Keeping all of your licenses active as a Travel Nurse can become expensive.

Understanding Inactive Status for RN License

The best option to maintain multiple RN licenses is to place your license on an inactive status. This should be done with each state before it expires. Each state has specific requirements for reinstating a license.  Placing your license in inactive status can forego financial and paperwork headaches down the road.

Let it expire or Place on Inactive Status

Here are a few state examples of the difference between placing a license on inactive status vs. allowing the license to expire.


If you allow your license to expire, you may have it reinstated by submitting a renewal form to the OSBN office with the appropriate late fees. If you do not renew your license within 60 days of its expiration date; it will need to be reactivated (with additional fees) and undergo a national criminal background check.
The process of reactivating an Oregon nursing license that has been expired more than 60 days.
Generally, you are eligible for reactivation if your Oregon nursing license has been expired for more than 60 days. Provided you are otherwise qualified. Specifically, you must meet the OSBN’s education, practice and legal requirements: You must have worked as a nurse, at the level for which you are seeking license or above, for at least 960 hours during the last five years.
Please note: Continuing education cannot be used to meet the practice requirement.
  • All licensure and renewal applications are run through the Oregon Law Enforcement Data System and may be run through the National Council of State Boards of Nursing Information Systems and Disciplinary Databank. 
  • Complete a national criminal background check.  Fee $52.00
  • Reactivation (licenses that has expired 61+ days) $265.00


  • Expired license more than one year, but less than three years.  Send in application with fees.
  • Expired license for more than three (3) years Send in application with fees, and include a copy of a current/active license from another state.  Fingerprints are also required for and additional fee.
  • RN expired license re-issuance (this fee plus renewal and late renewal fees) $70.00
  • RN license renewal (annually on birthdate) $97.00 **
  • **RN late renewal penalty (this fee plus the renewal fee if late) $50.00
  • RN verification of licensure/education $25.00


Texas is one of the more difficult states to renew an expired license. Texas not only requires late fees, but an exam and ethics course.
If your nursing license has expired, submit copies of continuing education certificates, any application for renewal received after the expiration date shall be charged a late fee.
  • Fees can be up to $190.00
  • If your Texas RN license has been expired for more than four years, and you have practiced as a registered nurse in another state within the last four (4) years, then you must comply with Rule 217.6 (d) which includes:
It is your responsibility to submit both of the completion certificates (NJE and choice of prep course/workshop/course). All requirements must be met before re-instatement of license. 


You must submit a written request for a paper application AND submit a self-addressed stamped business size envelope. Include a paper application. This takes an average of 29 days from the time the application is received until the license is issued. Total amount due if not requesting a temporary license ~ $200.
  • Submit documentation regarding citizenship/nationality/alien status
  • Fingerprints required
In conclusion, some states have a lot of requirements and fees while other states are much easier to get reinstated.  Additionally, many states also have specific CEU’s that must be maintained.  It’s recommended to contact the BON and request that your license be placed on ‘Inactive’ status. Generally a license on inactive status simply requires a standard renewal fee and compliance with the state CEU requirements.
Most importantly, its good to note that Licensing timeframes can vary from state to state. Keep this cheat-sheet close as you look at job possibilities and states for travel nurses to license in.
If you are a new travel nurse, read over our Travel Nurse Guide for additional guidance and industry specific information.

Monday, 10 February 2020

Great Warmer Winter Travel Nurse Assignment Locations

Great Warmer Winter Travel Nurse Assignment Locations

One of the perks of being a travel nurse is the ability to spend your winters in warmer weather!  Now is the time to start looking for that warmer winter travel nurse assignment.  Finding the perfect travel nurse assignment isn’t always easy so we have put together some great information on 5 states that are great for winter travel nurse assignments.   They are listed below in no order

Florida: Winter Travel Nurse Assignment 

Florida is a great option for a warm winter travel nurse assignment because during winter the average daily temperature is 70.7 °F.  It offers not only warm weather but also many beaches to go to on your off days!  Florida offers the second longest coastline in the United States, 8,436 miles 663 of that is beaches!  What better way to spend your cold winter months than on the warm sunny beaches?  Florida also offers many amusement parks to visit.  So many so that they are the top tourism state because of their amusement parks.  There is a lot to do in Florida and since it is warm there all year you aren’t limited by weather!  If you are thinking Florida would be a great choice for your next travel nurse assignment click here for openings in Florida!

Texas: Winter Travel Nurse Assignment 

Texas is another great option for winter travel nurse assignments!  It offers the 7th longest coastline in the United states with 3,359 miles.  It offers many beaches as well.  Texas offers mild winters with average daily temperatures ranging from 55 degrees to 72 degrees.  These temperatures can make for great days to walk or sit and enjoy the beaches.  Texas also offers many amusement parks as well.  Most known is probably Six Flags Over Texas located in Arlington Texas.  Six Flags Over Texas sits on 212 acres and offers 13 rollercoaster and 3 water rides.  Six Flags also offers a kid’s area with rides just for the kiddos, so if you have little ones with you this is a great option as well.  If Texas seems like the ideal place to take your next travel nurse assignment click here for open jobs in Texas.

Arizona: Winter Travel Nurse Assignment

Arizona offers something different than the other states on this list, as it isn’t a beachy state.  It is known more for its desert climate.   Arizona is the only state that contains part of the four North American deserts. The Great Basin, the Chihuahuan, the Mojave and the Sonoran deserts each touch part of the state, making up its diverse landscape. 

Arizona’s elevation varies depending on where you are in the state, because of this the winter temperatures vary as well.  Winter temperatures average anywhere from 40 degrees to 75 degrees from November through February.  Warm up starts in the middle of February. Arizona does see an occasional frost as well.    Arizona has 194 named mountain ranges.  If you enjoy hiking or you want to try it Arizona would be a great option for you.  If Arizona seems to be a good fit for your winter travel nurse assignment click here for job openings in Arizona

California: Winter Travel Nurse Assignment 

California is an excellent option for winter travel nurse assignments.  Because California’s size is so large the climate ranges from polar to subtropical.  Because of this the average state temperature during the winter months is 60.5 degrees.  California’s coastline is the 5th largest in the United states with 3,427 miles of coastline.   Like most of the other states on this list they offer many beaches to visit.  They also offer many tourist places to visit including; The Golden Gate Bridge, Yosemite National Park, Disney Land, Big Sur, Universal Studios and many others as well. California also offers mountain ranges, deserts and forests to visit.  So, there truly is something for everyone in California.  If you think you would like to spend this winter in California for your next travel nurse assignment click here for open jobs.

Hawaii: Winter Travel Nurse Assignment 

When you think of Hawaii you instantly think of gorgeous beaches and great weather!  Making Hawaii an amazing option for a winter travel nurse assignment.  With 1,052 miles of coastline, Hawaii offers the 18th longest coastline in the United States.  This is amazing considering the size of the state itself.  Hawaii also offers less extreme temperatures and humidity because of the almost constant trade winds from the east.  Because of these trade winds the average winter temperature is 83 degrees.   There are many things to do while in Hawaii.  You can visit the Pearl Harbor and USS Arizona Memorial, Volcanoes National Park, Princeville Botanical Gardens and the list goes on.  Hawaii offers things to see and explore like no other state on this list.  If you think Hawaii may be where you would like to go for your winter travel nurse assignment click here for open jobs in Hawaii.

Have you spent your winter in one of these warm weather states?  Comment below and tell us what you enjoyed about spending the colder months in a warmer climate.

Thursday, 6 February 2020

Patients feel impact of home care nursing shortage

Patients feel impact of home care nursing shortage

The nursing shortage. For years, those three words have invoked concern, fear and even panic among nurses, healthcare leaders and recruiters.
Though the phrase is usually mentioned regarding hospital settings, a home care nursing shortage is being felt specifically by families who have children with complex medical needs.

Though the home care nursing shortage is widespread, some locations have been hit harder than others, such as rural areas.

Complex pediatric patients and their families are often on the receiving end of the shortage’s devastating effects, said internist and pediatrician Garey Noritz, who serves as director of the Comprehensive Cerebral Palsy Program at Nationwide Children’s Hospital in Columbus, Ohio.

Contributing factors to home care nursing shortage
According to Noritz, a professor of pediatrics at Ohio State University, the home care nursing shortage is severe because of several key factors, including:

  1. Significant pay disparities between hospital-based versus home care nursing jobs (hospitals pay more).
  2. A shortage of nurses overall, and the availability of higher-paying positions elsewhere.
  3. Isolation in home care nursing because of a lack of socialization with colleagues.
  4. Complex pediatric patients are hospitalized frequently and, when they are admitted, their assigned home care nurse is temporarily out of work, which means a loss of income.
“It’s not difficult to hire RNs, but it can be challenging to find experienced RNs to care for children with special needs,” said Nick Provost, president of New Jersey Total Care of Paramus, N.J. “Many nurses don’t stay in home care. It can be a revolving door. The pay rates are lower in home health due to the lower reimbursement rates that kicked in since 2014 in New Jersey with the Affordable Care Act.”

Pediatric patients pay the price
So how does the home care nursing shortage impact young patients? Noritz said a lack of nurses typically leads to longer hospital stays for medically complex children.

“It impacts our ability to get these kids home,” he said.

In a report published in January 2019 by the journal Pediatrics, researchers conducted a 12-month study of multiple home care sites in Minnesota involving medically complex children, all of whom were discharged with home health.

“The average child going home for the first time with an order for in-home nursing care spent nearly 54 additional days on average in the hospital due to the lack of in-home nurses to provide care after discharge,” said Roy Maynard, MD, FAAP, medical director at Pediatric Home Service based in Roseville, Minn., a provider of high-tech home care for children with medical complexities in Minnesota and Wisconsin.

Maynard was the lead author of the study, which concluded that a lack of home care nurses was the most frequent cause of delayed discharge of patients and increased costs.

A cost analysis in this study revealed “delayed discharge resulted in an added cost of approximately $170,000 per patient and an overall increased cost of $5 million to the healthcare system in Minnesota alone,” said Maynard, a former executive committee member for the American Academy of Pediatrics Section for Home Care, and a retired neonatologist and pediatric pulmonologist at Children’s Hospital in Minneapolis.

Findings also discovered the pediatric population with tracheotomies and ventilators is increasing.

“One reason for the increased number of children with medical complexity is better cardiac surgical techniques for children,” the study stated. “More kids are saved. However, they’re dependent on tracheotomies and ventilators. Their survival rates have increased, they’re living longer and their quality of life has improved — but they’re not liberated from their dependence on medical technologies.”

Insurance and time challenges
Getting in-home nursing care approved by a patient’s insurance — and in a timely manner — can be challenging, as well. “Once approved, the second hurdle is finding nurses available to staff all of the hours that have been approved,” Noritz said.

The lack of approved hours by insurance, along with the home care nursing shortage, requires parents pick up the slack. “The typical number of hours approved for patients on a ventilator is only eight hours per day,” Nortiz said. “This requires us to always train the parents.”

The impact on the families of children with medical complexity also is significant. “This causes increased stress on the family as they try to provide care to their child,” Maynard said. “Many parents are unable to work. A parent cannot work if they have to be home providing care. This decreases their earnings and increases financial burdens.”

In a 2018 study published in the Journal of Hospice and Palliative Care Nursing, researchers wrote that nursing shortages are mostly discussed based on how they impact the hospital setting rather than the impact on parents and families.

In fact, family members provided an average of 73.5 hours per week of nursing care for their ill children, said the study, which was led by Meaghann Shaw Weaver, MD, MPH, who serves as chief of the division of pediatric palliative care at the University of Nebraska Medical Center in Omaha.

Impact on the elderly
The lack of in-home nurses also adversely affects the elderly, said Ron Ordona, DNP, FNP-BC, chairman of the Gerontological Advanced Practice Nurses Association’s House Calls Special Interest Group and a primary care medical house call provider for home-bound seniors with Senior Care Clinic Medical House Calls, based in Lincoln, Calif.

Ordona, who is board certified in gerontology and family practice, said there is a great need for home-based primary care providers for home-bound elderly patients.

“A 2018 report prepared for the Association of American Medical Colleges projected a primary care shortage of between 14,800 and 49,300 physicians by 2030. Nurse practitioners can help fill the gaps as primary care providers, including the provision of home-based primary care for home-bound elderly patients,” said Ordona, clinical faculty at Boise State University and volunteer clinical faculty and founding donor at UC Davis Betty Irene Moore School of Nursing.

The shortage of in-home nurses and home-based primary care providers for the elderly leads to the exacerbation of chronic conditions, Ordona said.

“This creates stress for family members and assisted living staff, and results in an increased use of the emergency department for primary care access, costing an average of $2,500 to $5,000 per visit,” Ordona said.

Strategies to resolve the shortage
Ordona suggests three ideas to address the home care nursing shortage:

  1. Expose undergraduate nurses and graduate/advanced practice nursing students to community-based care.
  2. Allow full practice authority for APRNs.
  3. Remove barriers for NPs for signing home health orders, which delays care for patients.
Maynard proposed recognizing home care nursing as a specialty, paying nurses for what they do, and not for where they work.

Home-based nurses provide complex care to patients with ventilators, for example, just like ICU nurses do,” he said.

Additional suggestions from Maynard include offering flexible scheduling and if a patient is hospitalized, finding another place for their nurse to work so they can make ends meet.

There is a critical need, according to Noritz, to increase salary rates for home care nurses. “The competition from hospitals is stiff. They can pay nurses more,” Nortiz said. “Also, finding ways for in-home nurses to connect with each other is important, so they don’t feel so isolated.”

Provost said increasing reimbursement rates for in-home nursing care from Medicaid, Medicare and private insurance would help increase pay rates for nurses.

Despite the challenges for nurses providing in-home care, it’s very rewarding work, agreed Noritz and Ordona.

Nurse-to-Patient Ratio: How Many is Too Many?

Nurse-to-Patient Ratio: How Many is Too Many?

One of the most important topics being discussed within the field of nursing is rising nurse-to-patient ratios. In general, nurses across the country are being asked to care for more patients at a time, and individual states or healthcare centers are left to deal with this growing problem.

In most states, individual healthcare facilities have the ability to set their own safe staffing standards. Currently, 14 U.S. states have passed some form of safe staffing laws (American Nurses Association, n.d.) However, in 13 of those states, the laws only require there to be a general plan in place to manage the ratio as opposed to regulate it. The outlier, California, became the first state to pass a law mandating an average nurse-to-patient ratio in 2004 (Mark et al., 2013). Their standard is one nurse for every five patients on average in medical-surgical units.

Despite California being the only state to have a law on the books, more states are recognizing how important safe nurse staffing levels are to both patient care and the success of the nursing field. In recent years, there has been a new wave of support behind state- and federally-mandated nurse staffing minimums. Studies have shown benefits to both nurses and patients in California in the years after the state law was enacted, and lawmakers in Pennsylvania and Massachusetts recently considered codifying minimum nurse staffing standards, as well.

A balanced nurse-to-patient ratio can lead to many positive outcomes. Nurses, patients, and even healthcare facilities have experienced success when using a safe nurse staffing method.

When nurses have fewer patients to care for at one time, they’ve shown higher levels of job satisfaction. A study published by labor union AFL-CIO showed that, in contrast to nurses studied in New Jersey and Pennsylvania, California nurses felt their workload was reasonable and led to providing better care (AFL-CIO: Department of Professional Employees, 2011). They also reported receiving adequate support services, such as nursing assistants. They even had time to take quick breaks during their shift.

When nurses are without this support and feel unreasonable expectations placed upon them, they could experience a phenomenon known as nurse burnout. In 2018, as many as 62 percent of nurses felt symptoms of burnout in their jobs, according to the RN Network (Cornwall, 2018). Nurses suffering from burnout have a harder time providing quality patient care and often report strained relationships at work.

The quality of patient care decreases as the number of patients in a nurse’s care increases. A study published in the New England Journal of Medicine found that unsafe staffing levels were “associated with increased mortality” for patients (Needleman et al., 2011).

Aside from risk to the patient, satisfaction is a concern as well. Where nurse-to-patient ratios weren’t effectively balanced, patients reported viewing nursing staff and the facilities where they worked poorly. Research published in the BMJ noted that patients’ thoughts on their care in a hospital were associated with nurse staffing and quality of care (Aiken et al., 2018).

It may not seem like it, but employing more nurses can actually be cost effective for healthcare facilities. A study published in Medical Care found that hiring more nurses and having a lower nurse-to-patient ratio shortened hospital stays for patients and helped save in medical costs (Dall et al., 2009).

As mentioned above, quality nursing care also improves the overall perception of a hospital facility, as well as outcomes for the patients. The better nursing care provided, the better the perception of the facility.

What You Can Do About Safe Staffing
Even in an adequately staffed hospital, there could still be days with an imbalanced nurse-to-patient ratio. A nurse could call out sick or more patients than normal could be admitted. In either case, a higher nurse-to-patient ratio means that nurses have to step up to the challenge of caring for more patients. We talked with a pediatric nurse with years of experience, and she explained how drastic the situation is between a manageable nurse-to-patient ratio and a high ratio.

“When you have a light patient load, you likely have time to do a full set of vitals and systems assessments, administer all medications, and inquire about any requests or needs before leaving each patient’s room,” Dawn D., RN said. “When you have a larger patient load, you need to decide what takes the greatest priority; which patient needs your attention first?”

You likely won’t have a say in the nurse-to-patient ratio at your facility. That’s why, according to Dawn, it’s important to be a team player. 

“It’s uncommon for every nurse on your shift to have a difficult patient load,” she said. “When you see a coworker struggling to keep up, offer to help. In turn, your coworkers will likely do the same for you when you are having a busy day.”

There are also other ways for you to make an impact outside of the hospital. Nurses are playing a larger role in politics as more states take notice of the impact of nurse-to-patient ratios. In Tennessee, the Tennessee Nurses Association created a Political Action Committee (PAC) called the Tennessee Nurses Political Action Committee (TNPAC) to help lobby the state legislature for nursing improvements. They also provide legislative updates to members as bills pertaining to the healthcare industry and nursing move through the Tennessee General Assembly. Individually, you can educate elected officials and raise awareness of nursing issues in your community, as well as take a leadership role in your state’s nurse’s association.

Being active in finding a solution to rising nurse-to-patient ratios could make the difference at your hospital and in your community. If you’re looking to step into a leadership role and make a positive impact, enroll today in King University’s online RN to BSN program. Grounded in Christian faith, our program will teach you strategies to become a better nurse, enabling you to provide better care to patients. With transfer credits, you can complete this program in as little as 16 months, and thanks to our online format, you can accomplish your education goals while balancing your busy life.