5 Reasons There Are Not Enough Nurses.

Some industries are rebounding from the recession better than others. In April, the U.S. Bureau of Labor Statistics reported that the healthcare industry recorded the biggest increase of any employment sector, adding 37 000 jobs in March 2011. Positions mostly filled by nurses, the largest segment of the healthcare workforce. And yet, the American Association of Colleges of Nursing (AACN) is still predicting a huge nursing shortage to hit the country in less than ten years.

In job-starved America, what is stopping us from graduating enough nurses to meet the demand?

  1. Nursing school enrollment is not increasing quickly enough. Though enrollment increased from 2.2 percent from 2007 to 2008, according to the Council on Physician and Nurse Supply, 30 000 more nurses need to graduate annually— an expansion of 30 percent.
  2. Schools are turning away qualified applicants. Because enrollment hasn’t expanded, the AACN reported that 67 563 qualified applicants were turned away from nursing programs in 2010. In the survey, the AACN also found that faculty shortages were the number on reason for not accepting qualified applicants at two-thirds of (responding) nursing schools. Read about one aspiring nurse’s experience here.
  3. There are not enough high-level nurses to fill faculty positions. Matthew McHugh, assistant professor of nursing at the University of Pennsylvania, believes that this is where the real bottleneck lies. He said in a phone interview that 65 percent of nurses graduate from an associates degree program, and only 20 percent of those nurses go on to get a bachelors degree, leaving only a small pool of nurses in a position to seek the advanced degrees required to teach. “Addressing the nursing shortage means opening up the pipeline to move students to the potential to be in a teaching role,” he said.
  4. Pay discrepancy discourages advanced-practice nurses from becoming educators. Judy Beal, chief academic officer for nursing and health sciences at Simmons College in Boston, estimates that a new nurse with a PhD can make two to three times more money working in a clinical setting than he or she can in a teaching job. “We as the profession are going to have to at some point bite the bullet and say ‘we’ve got to pay our faculty more,'” she said.
  5. Current nurse educators are aging— and retiring. Beal, 59, estimates that she is the mean age for nursing faculty and that 40 percent of the nurse educators at Simmons plan to retire in the next five to ten years, herself included.
According to Beal, the recession is “the calm before the hurricane.”
“We really are not going to be able to provide the number of nurses that we are going to need to care for all of these aging baby boomers, who are going to live many many years longer than our parents,” Beal said. She just hopes there will be enough nurses to take care of her, when the time comes.
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A Short History of Restraint Use.

Leather Restraint

“The great stumbling-block of the American superintendents is their most unfortunate and unhappy resistance to the abolition of mechanical restraint,” said British asylum superintendent John Charles Bucknill in 1876.

In the mid-19th century, after a long history of poor conditions, England started reforming its insane asylums. Cases like that of James Norris, a former seaman who spent ten years shackled to his bed with an iron harness, lead the reformers to push for the near-total abolition of restraint use. The British believed that in a well-run asylum with properly trained physicians on staff, they would rarely be necessary.

Since the first state-run mental hospital in the United States wasn’t established until 1822, Americans didn’t have the same negative history during the British reformation. Rather than seeing restraints as evidence of mistreatment, American physicians believed that restraints were a valuable tool to keep patients safe. They also believed that patients of a democratic nation were less tolerant of authority, and that the American insane were more violent than their British counterparts.

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TED Stalking.

As some of you may have noticed, I have a little thing for TED talks.

Maybe not just a little thing. Maybe more of a raging love affair. So when I found out that the Harvard Kennedy School and the Harvard School of Public Health were hosting a TEDxChange event, I was pretty excited, considering that this might be the closet I would ever come to actually attending a TED talk.

The live webcast, co-hosted with TED by Bill and Melinda Gates, took place on September 20, the 10th anniversary of the Millennium Development Goals. And other than Kennedy School students in front of me whispering about homework problems, it was pretty perfect.

The talk opened with Hans Rosling saying “come with me to the wonderful world of statistics,” to laughs from the audience. But in true TED style, Rosling makes statistics wonderful, narrating moving bubble graphs of child mortality like an announcer at the race track. He used the graphs to show that it’s unfair to talk about Africa as a whole when there are such huge discrepancies between Kenya, Ghana, Egypt, and the Democratic Republic of the Congo. He also added the shallow line of Sweden’s child mortality rate over the years to show that development is a long term investment.

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A Watched ED Never Boils.

I may be bad luck. I’m back in the Emergency Department of the Brigham and Women’s Hospital to report on psych patients, but there are none.

No typical ones anyway. There is one suicidal patient with acute depression waiting to be transferred to an in-patient facility. But, as Nurse Nina Ribeiro, 24, says “this is not your typical psych patient.”

Rather than aggressive and argumentative, this patient is quiet and gentle, sleeping in her darkened room while her “sitter” — a designated nurse’s assistant who literally babysits psych patients — does her homework at a desk outside of her room.

“That’s an element of her depression. She’s accepting, she needs compassion,” explains the dark-eyed and upbeat Ribeiro.

But its not just the patient’s docility that makes her atypical — she’s spends only a few hours in the hospital before being transferred to a psychiatric facility. Ribeiro estimates that typical psych patients wait for 12-24 hours before being another facility is found.

How did this patient luck out? Boston Emergency Services Team, or BEST.

BEST sends clinically trained psychologists to assess psychiatric patients and find programs for them. Tonight, the atypical patient was placed in a psych facility by BEST psychologist Gary Joslow, 66, who spends 40 minutes to an hour assessing a patient before recommending a program and finding a place. He finds they don’t always need the in-patient care the doctors recommend, so he looks at a larger pool of resources when placing a patient.

The depressed patient was lucky to have Joslow find her a place so quickly, but she was a bit sad anyway — she didn’t want to leave Ribeiro behind. The two hugged in the hallway before the EMTs wheeled the patient out, and docile or not, it’s best for everyone when psych patients are in facilities with the resources to take care of them.

A Non-Emergent Case.

And I’m back in the Emergency Department.  One might think I am accident-prone, which I am, but I am here today to see another nurse. It’s a little after 8:00 am (actually, 8:21 to be exact) and I’m waiting to interview an ED nurse about to come off his 12-hour overnight shift.

We were supposed to meet at 8:00 am, but he seems to be running a bit late. That, or the hard-of-hearing woman at the front desk didn’t page him like she said she did. I hope she did. Nurses are starting to filter out of the ED. Two giggling women in light blue scrubs walk through the waiting room, towards the sliding glass doors, one of them exclaiming “I need to go home!”

I bet. Last time I was here I only stayed for a few hours and was completely beat by the time I got home. I’m amazed this nurse even agreed to be interviewed–on camera no less–in post-night-shift condition. Now where is he…

8:35 am. I’m debating whether or not to have him paged again. Is that legitimate? To have him paged a second time just to make absolutely sure he got the first page?

The sign at the front desk is keeping me in my seat. “Patients are seen based on urgency, not necessarily in the order that they arrived. Thank you.”

I can see how my video-interview project for my blog might not be considered an emergency. Five more minutes. If he’s not out by 8:45 am, I’ll have him paged again. Until then, I’ll just engage in some light people watching.

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Nurses: More Important Than Doctors.

I’m just kidding. The study is really about whether more patients die in the hospital when nurses are on strike, and the findings suggest that they do.

Now, is it just that only really sick people go to the hospital during a nurse’s strike, driving up the mortality rate, or are nurses actually an integral part of the hospital? This is the question asked yesterday by Freakonomics co-author and University of Chicago Economics Professor Steven Levitt on the New York Times Freakonomics Blog.

Despite mentioning that in Superfreakonomics Levitt and his co-author, journalist Stephen Dubner, wrote that when doctors go on strike patients tend not to suffer, or even fair better, Levitt writes that the statistic might be driven by the type of patients that show up at the hospital. If only very sick patients went to the hospital during strikes, then one would expect the mortality rate to increase during any kind of hospital strike, not just during nurses’ strikes.

Well, unless the population at large sees nurses as the most crucial part of the hospital and only change their medical care-seeking behaviour when the all-important nurses go on strike.

That seems unlikely. People seem to be more afraid that we are heading into a doctorless world then a nurseless one. Anyway, this is all a moot point, because the authors of the study say expressly in the abstract that they controlled for “patient demographics and disease severity.”

Using a variety of observable characteristics, the authors of the study determined that patient demographics don’t change during a strike.

So maybe I’m not kidding. Maybe nurses are more important than doctors.

It’s Probably Best to Lose Big Anyway . . .

As I mentioned last week, the U.S. healthcare system invests a lot of money in end-of-life care. Actually, the U.S. invests so much, the healthcare system is the most expensive in the world.

Now, it might be okay for the U.S. to be spending like crazy on healthcare if that meant that it DELIVERED the best care to its citizens. But it does not. According to the recently released Mirror, Mirror study by The Commonwealth Fund, the U.S. healthcare system ranks last when compared to six other developed nations.

To let the horror of this information really wash over you, click here for the interactive “web feature,” and here for the podcast.

Now, some people may wonder how this can be possible. I don’t know. The “desire to cure death” argument is fairly persuasive. Other interesting possibilities I found this week:

  • The U.S. healthcare system is based on misinformation. Think the government had a hands-off approach to healthcare before “socialist” Obama came along? Think again.

Well, I guess the problem is people haven’t been thinking again. Or even a first time.

As long as healthcare is such an irrationally partisan issue, “facts” will have little place in the debate. At least when it comes to healthcare, the U.S. is the best loser.