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Craig Becker, THA President

Workforce Issues, Policy on Agendas

The Tennessee Hospital Association and Tennessee Nurses Association host their annual meetings in October. Both organizations are scheduled to look at key workforce issues facing nursing, as well as health policy, public health agendas, and the development of a climate of quality and safety for patients and staff.

THA kicks off the month with their annual meeting and educational and technical exposition from October 1-3 at Gaylord Opryland Resort & Convention Center. On October 1, the group is concurrently hosting a Nursing and Workforce Summit –– “Building a Culture of Retention: Promising Practices for Nursing.” Later in the month, TNA hosts “The Power of One” from October 24-28 at the Franklin Marriott Cool Springs in Franklin, Tenn.

THA President Craig Becker said he expects close to 1,500 attendees from across the state to converge on Nashville for the organization’s 70th annual meeting. The theme, “Elements of Change,” is particularly appropriate in the current climate.

“We think there’s going to be a huge groundswell of healthcare reform … not just who gets covered but how providers provide the care,” he said.Chris Clarke, RN, BSN, senior vice president for clinical services for THA, is equally excited about the Nursing and Workforce Summit. With the ongoing nursing shortage predicted to worsen, Clarke said it’s not only important to train and recruit new nurses but to find effective ways to retain those already on staff.

She said the crux of this summit, along with a leadership institute for nurse managers planned for next spring, is to reexamine the level of support being offered to nurses.

At the end of the month, the Tennessee Nurses Association plans to explore even more topics that impact the profession of nursing.

Sharon Adkins, MSN, RN, executive director of the TNA said an important part of the convention is deciding the focus of the association’s legislative agenda for the coming year and bringing before the House of Delegates resolutions impacting the health of Tennessee’s citizens. Although those decisions haven’t yet been made, Adkins said she anticipated topics of interest would include increased anti-smoking efforts, access to care issues and the role of unlicensed individuals in providing care.

Programming for the convention will include a focus on advance practice nursing, quality and safety issues and educational offerings ranging from women’s health issues to SIDS to the continuum of palliative care. On Saturday, October 25, Susan Cooper, MSN, RN, commissioner of the Tennessee Department of Health, will update delegates on the “Health of Our State.”

Both the TNA and THA have a full slate of educational programming planned for the 2008 meetings. Following are insights from scheduled presenters.

Ann E. Rogers, PhD, RN, FAAN –– Staff Nurse Fatigue and Patient Safety:

Rogers has been selected as the keynote speaker for THA’s Workforce Summit on October 1. An associate professor at the University of Pennsylvania School of Nursing, she has been a sleep researcher for more than 20 years. In 2001, she began to apply that knowledge to research into staff nurse fatigue.

The presentation comes from data collected in a 2001/02 study of the same name, which was published in Health Affairs in July 2004. Rogers and colleagues looked nationally at 895 full-time RNs who filled out a diary every day for 28 days detailing work hours, breaks, sleep, time off and more.

“We have 22,000 days of data,” said Rogers. “Until we did this study, we had no idea how many staff nurses were working 12-hour shifts.”

She added the longer shifts became popular in the 1990s and 2000s and that nurses love them because they allow more days off. However, Rogers said, the collected data pointed out areas of concern.

“The issue isn’t just the 12-hour shifts, but virtually every nurse ended up staying, on average, 45-50 (extra) minutes four out of five shifts they worked,” she said, adding that only one nurse of the 895 managed to get out of work on time every day during the 28-day period.

Furthermore, she said, two-thirds of the shift nurses didn’t get a break free of patient care and 10 percent had no break whatsoever during their entire shift. When the nurses did get a patient-free break, it was on average 27 minutes for a meal. Adding to the fatigue, many nurses did not receive enough sleep prior to beginning shifts.

Rogers found, “In 20 percent of all the shifts we looked at (over 11,000), the nurses showed up with less than six hours of sleep.” She added that 80 percent of participating nurses came in with less than six hours of sleep at least once during the 28 days and often many more times.

“The data showed us nurses who work 12-hour shifts are three times more likely to make an error than those who worked shorter shifts,” she said.

In December 2006, as part of a Congressional mandate, the Veterans Administration Health System, which is the largest employer of nurses, began limiting their RNs to working no more than 12 consecutive hours.

“Some state nursing associations and professional nursing associations are beginning to take a stance, but those are position papers … not law,” Rogers said. She added, that she truly understands there are many factors at work including nurse satisfaction and the necessity of getting shifts covered. However, she continued, those concerns have to be balanced with what is best for the health of nurses and safety of patients.

“People are beginning to pay attention, but it always takes awhile for research to change behavior … change takes time.”

Donna M. Herrin, MSN, RN, NEA, FACHE –– Staff Nurse Planning

As incoming president of the American Organization of Nurse Executives, Herrin is keenly aware of the work to be done on a national level to address nurse staffing issues. As senior vice president and chief nurse executive for Methodist Healthcare in Memphis, Herrin has hands-on experience in bringing big ideas down to a local level as she and colleagues plan for the future in an area that has been hard hit by workforce shortages.

“We, as a community and a region, felt like we had to get very active in planning the future,” she said.

At the THA Workforce Summit, Herrin plans to share lessons learned from a collaboration of leaders in both the clinical and academic setting. The Nursing Institute of the Mid-South (NIMS) was created to look for solutions to issues facing the nursing profession.

Already, NIMS has had several “quick wins,” Herrin said. One of the first programs, she continued, is an “across-the-board implementation of an online placement program that connects students with clinical placements.”

She added a main priority was also to “orchestrate the care delivery model in a different way.” To that end, she continued, “We’ve already sponsored a couple of education sessions regarding new care delivery models.”

Herrin said NIMS is looking at issues “both through the eyes of the provider and the academic institution. The Institute holds equally those two partners at the table.”

She also plans to discuss the successes of the Nurse Leader Institute at Methodist. One of the key objectives has been to increase the number of board certified nurses.

“Over the past five years, we’ve increased that number from about 25 to over 400,” she said. “When nurses are board certified, there’s good evidence that the quality of care improves from a patient perspective, but also retention improves and job satisfaction increases. We’ve certainly seen a lower turnover rate.”

Herrin noted, “Nationally and even internationally, the shortage of healthcare providers is going to get significantly more complex.” Although she was quick to say that funding and big picture ideas are important on the federal level, she believes change will happen closer to home.

“If there’s really going to be actions put into place, that’s going to happen at a local level,” she stated.

She added that while a lot of attention has been paid to nursing shortages, there are looming gaps in other healthcare fields, as well. However, Herrin said, many strategies being pursued to improve nursing recruitment and retention could also positively impact other health disciplines.

“Anything you can do to improve the work environment is good for everyone,” she concluded.

Jan Towers, PhD, NP-C, FAANP – Nurses & Health Policy

Based in Washington, D.C., the director of health policy for the American Academy of Nurse Practitioners certainly believes in the importance of being active and informed. It’s a message she plans to share with TNA attendees.

“They need to be active politically … not just voting … but going to town meetings … asking questions,” Towers said.

Today, she added, it’s easy to be informed with a multitude of Web sites and media outlets. With a new administration coming in at the national level, Towers encouraged nurses to make sure their voices are being heard.

“What we find a great deal is that people ask the opinions of physicians, hospitals, insurance companies … yet, nursing carries the huge bulk of patient care. We need to be heard; yet we know we’re not being sought out as frequently. We know everyone likes and appreciates nurses … we know we’re respected … but it seems to be a little harder for nurses to get to the table,” she said.

Writing letters to elected officials at all levels, talking to candidates or their representatives and being active in professional associations are all ways Towers said nurses could make sure their voices resonate in Tennessee and the nation’s capital.

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