By Ginger Christ, The Plain Dealer firstname.lastname@example.org
Eight years as a local emergency room nurse was enough.
The high-stress career, coupled with staff shortages, pushed a local nurse to look for a different career in medicine.
“It was too stressful and not worth it to me any longer. I felt like I was working so hard, often without breaks or lunch, but it was never enough. I felt like my truly sick patients’ safety was at risk,” she recently told the Plain Dealer. For job security in her new position, she requested her name not be used.
Another, Judy Duleba, has been a registered nurse for 40 years but admits she now looks “forward to retirement with a great sense of relief.”
“The things that have kept me going are the actual patients themselves; often what I do improves their lives,” Duleba said.
But the changing expectations of her profession make it a challenging – and stressful – one to stick with, Duleba said.
These concerns are echoed by nurses across Ohio who say they love what they do, but who are overburdened by low staffing levels, greater numbers of patients and added responsibilities.
Some nurses consider leaving the profession, while others find ways to manage the stress. But they all worry what these issues mean for patients and the quality of care they receive.
“I love my job but want to be able to do it safely and provide the highest quality service that I can,” said a hematology/oncology nurse at the Clinic’s main campus who is frustrated by the nurse-to-patient ratio in the system. “It may not sound like much but that one patient difference can make a big difference in the level and amount of safe, quality care that the nurse is able to provide their patient.”
Often, he said, nurses in his unit are pulled to work on general internal medicine floors because of staffing shortfalls.
Nationwide, 82 percent of nurses consider workplace stress the biggest risk to their health, according to the American Nurses Association’s Health Risk Appraisal. And about 57 percent say they work extra hours – before or after work or during lunch or breaks – to handle their workload, according to the ANA survey, which was completed by 10,688 nurses and nursing students.
Yet the number of patients continues to grow and, with it, the burden on nurses. People are living longer thanks to medical advances, and some are coming in with increasingly more complex medical issues. In addition, hundreds of thousands of patients in the state gained insurance coverage under Obamacare and Ohio’s Medicaid expansion.
“Our patients are more complex, and they’re sicker,” Kelly Hancock, executive chief nursing officer for the Cleveland Clinic Health System and chief nursing officer for Cleveland Clinic Main Campus, told The Plain Dealer.
The Clinic saw 1.9 million unique patients in 2016, a 4 percent increase from the previous year. Meanwhile, UH saw a 9 percent increase in its number of unique patient visits, or 97,000 more patients, from 2015 to 2016. At MetroHealth, there were 20 percent more unique patients visits, or 46,000 more patients, during the same period.
By 2020, Northeast Ohio will have a nursing shortage of 3,500, according to the Center for Health Affairs Northeast Ohio Nursing Initiative’s Nursing Forecaster.
To fill that gap, hospitals are working with local colleges to prepare new nurses to enter the workforce, hosting recruiting fairs and hiring support staff to help with some aspects of patient care. But at the same time, hospitals also are trying to operate more efficiently.
Brian Burger, president of the Ohio Nurses Association and a nurse practitioner at Beacon Orthopaedics and Sports Medicine in Cincinnati, said one of the biggest contributors to burnout is the nurse-to-patient ratio. Hospitals need to factor in how much care a patient will need when deciding how many nurses to staff a unit, he said.
“Just managing it by strict ratios isn’t enough; you need acuity as well,” said Burger, who for a decade worked as a nurse in the neuro-intensive care unit and in the emergency department of the University of Cincinnati Medical Center. “A nurse having more patients leads to medical errors. It leads to hospital re-admissions. It leads to more money than just being proactive and having more staff in the hospitals.”
On top of seeing more patients, nurses now, in many cases, are expected to work at top of license, meaning work to the fullest extent of their training.
“You cannot expect nurses to take on a bigger role and still maintain all of the other tasks and responsibilities that were previously absorbed into our role,” said Gina Marie McKee, who has taught nursing at various colleges in Northeast Ohio for the past 29 years.
McKee, who advised a hospital in its transition to top of license, said health systems need to hire and prepare more support staff to take on bigger roles in patient care, as well.
Classroom experience doesn’t always translate the full realities of the job, leaving many recent graduates overwhelmed and frustrated when faced with heavy patient loads.
As a result, as many as 25 percent of new nurses leave their position within the first year, according to the National Council of State Boards of Nursing, further exacerbating the nursing shortage.
“Students in school are not carrying the load they will,” said Kathleen Gravens, nursing program director at Lakeland Community College. “In general, we do not have the ability to let students handle that load.”
Lakeland, for example, had to get rid of its nursing practicum, similar to an apprenticeship, because there weren’t enough experienced nurses at area hospitals available to act as mentors to students.
“There aren’t enough preceptors, and there are too many nursing schools,” Gravens said. “We’re now facing another nursing shortage, so hospitals need those nurses on the floor.”
Both the Clinic and University Hospitals say they add more staff as needed to maintain safe nurse-to-patient ratios and are constantly re-evaluating staffing levels. But when there’s economic pressure on a health system, often support staff are let go to maintain nursing levels, leaving nurses to pick up tasks such as transporting patients and cleaning rooms.
“We do not like to decrease the numbers of caregivers at the bedside. Typically, support staff would go before nurses would go. What happens then is much of the ancillary support work then falls to the nurse,” said Jean Blake, chief nursing officer for University Hospitals Health System and UH Cleveland Medical Center.
To help nurses deal with the stress of their jobs, UH gives employees access to the UH Connor Integrative Medicine Network for yoga, massage and acupuncture sessions. If a unit experiences some kind of extreme circumstances, the team is sent a care package with lotions, treats and coffee. And the health system offers counseling as needed.
“Anyone that’s part of the care team is subject to burnout. You have to remember that nurses are on duty 24/7,” Blake said. “Nurses are the constant for the patient. They see the patient at their worst. They see them progress or decline during their hospital stay.”
Likewise, the Clinic has a Caring for Caregivers group, which offers employees strategies for dealing with burnout and offers support services to units experiencing something unusually traumatic. The Clinic also annually surveys employees on engagement and specifically asks about stressors.
“There are long hours, long shifts, not only physically but mentally,” Hancock said. “We try to be everything to our patients. Oftentimes, I think we forget to take care of ourselves before we take care of others.”
Reposted from: https://www.cleveland.com/healthfit/index.ssf/2018/05/my_truly_sick_patients_safety.html