We’re Working Nurses to Death.

By: Jason Silverstein

Nurses do the work that neither hospitals nor patients could live without, which comes at an ever-increasing physical and emotional cost, as they are expected to aid sicker patients for longer hours with less support.

Otherwise, nursing could easily be the best job in the United States—the Bureau of Labor Statistics estimates more than 400,000 new jobs will be created by 2024. In five states, the average pay clears $85,000, with nursing jobs in California crossing into six figures.

Those numbers are no surprise to those who are aware of how much older the nation’s old are, and how much sicker they are, too: By 2030, there will be 70 million people over the age of 65, of which an estimated 14 million will have Alzheimer’s and more than 50 million will have at least two chronic health conditions.

But just as the need for nurses is increasing, so too is the price for devoting one’s life to the direct care of strangers. Nearly a quarter of hospital and nursing home nurses aren’t satisfied with their jobs, according to one study, and more than a third feel burned out. “Burnout is an occupational hazard in nursing,” says Jeanne Geiger-Brown, dean at Stevenson University’s School of Nursing and Health Professions. “It is hard to generate a lot of caring about other people, because you are so depleted yourself.”

Burnout, of course, is caused by overwork, but what causes overwork is more complicated and reveals how the cost-cutting priorities of hospitals force their nurses to pay an emotional tax.

“What’s causing the overwork is the increased acuity of patients,” says Susan Letvak, a professor at the University of North Carolina at Greensboro School of Nursing. “You are only in a hospital if you are so acutely sick that you can barely move. The minute you can move, you are kicked out the door.”

“The push is to get everybody out of the hospital as fast as we can,” echoes Bernadette Melnyk, dean of the College of Nursing at the Ohio State University and the university’s Chief Wellness Officer. Melnyk and her colleagues recently published a paper that shows depression among nurses is associated with both burnout and medical errors.

Getting people out of the hospital “quicker and sicker,” as a few Harvard health policy researchers explain, is a response, in part, to Medicare’s prospective payment system, which pays a fixed amount for a diagnosis no matter the length of stay, and the need for open hospital beds. If that formula seems designed to create higher rates of readmission, well…yeah. Even so, there’s also a financial incentive to avoid having people readmitted.

How does the quicker and sicker approach add up for nurses? Physically, it means the shifts themselves are much harder, especially since shifts are often twelve hours to begin with, which itself is a risk factor for burnout and mistakes in a place where patient alarms are constantly sounding. “It’s not healthy for the nurses, it’s not safe for the patients,” Melnyk says.

Emotionally, the quicker and sicker model means the long hours are engineered to be less fulfilling. “It’s not very satisfying to just put bandaids on people who are really quite ill,” Geiger-Brown says.

When the hospital is successful at turfing patients to home or anywhere else, you might expect nurses to benefit somewhat: Fewer patients on a given day could mean a slower shift and a chance for a break. But that’s not how it often plays out.

“Minimum is maximum staffing,” Letvak says. “We don’t have any easy days anymore. If the [patient load] is low, which happens all the time, they send the nurses home, instead of them having a light afternoon. How few do we need? That’s all that you’re getting. Every time you are at work, it is a bad day. There really isn’t a chance of having a lighter day anymore.”

Yet nurses should have the lightest days possible—like air traffic controllers, they do a job in which we accept no room for mistakes. Suppose you know that the ideal number of patients for a nurse is four—would you want to be number five?

While it may seem like a water is wet revelation to say nurses should care for fewer patients rather than get sent home, take a look at the work of Linda Aiken and her colleagues at the University of Pennsylvania. They have shown just how many lives are on the line when nurses are overworked. Give a nurse just one patient beyond four and the chances of that patient dying shoot up 7 percent and the chances of that nurse getting burned out climbs an astonishing 23 percent.

Overworking nurses extinguishes their lifesaving impact. Aiken and her team have shown elsewhere that every ten percent increase in the proportion of nurses with bachelor’s degrees lowers the risk of death for patients by five percent. A study by a different group found that a 10 percent increase in registered nursing staff saves five lives for every 1,000 people discharged. (If five saved lives doesn’t sound like a lot, try replacing “five” with five names of your loved ones.)

And while nurses care for a sicker and older population in an environment that is a burnout and depression generator, they may avoid mental health care for themselves, fearing that a hospital concerned first-and-foremost with the bottom line will use a mental health diagnosis against them.

“Think about the legalities,” says Letvak, who teaches on law and policy. “If a nurse made an error and something were to come out that they had depression, and then you can see the research that links depression and errors, that nurse just exposed herself to potential liability.”

Reposted from: https://tonic.vice.com/en_us/article/43nkjd/nurses-overworked-stressed-burnout?utm_source=vicefbus

Almost half of Ontario youth miss school because of anxiety, study suggests.

At five years old, Shannon Nagy told her mother she wanted to die. In Grade 6, she missed almost the entire school year because more often than not, she couldn’t get out of bed.

Nagy, now 20, was diagnosed with anxiety, depression, attention deficit hyperactivity disorder and borderline personality disorder and was never able to finish high school. She spent most of her childhood immersed in a mental health care system that she said “did more harm than good.”

Her struggle to get help and the impact that struggle had on her education is a trend captured in a new survey commissioned by Children’s Mental Health Ontario, released Tuesday.

It found of the 18- to 34-year-olds surveyed across the province:

  • 46 per cent had missed school due to issues related to anxiety.
  • 40 per cent had sought mental health help.
  • Of those, 50 per cent found the experience of getting help challenging.
  • 42 per cent did not get the help they needed or are still waiting.

Parents are also impacted when their child has to wait as long as 18 months for mental health care, said Kimberly Moran, CEO of CMHO, the association that represents Ontario’s publicly funded Mental Health Centres and advocates for government policies and programs.

“Parents miss work and certainly myself as a parent, I have to take time to look after my daughter,” Moran said.

The Ministry of Health and Long-Term Care and Ministry of Children and Youth Services did not respond to requests from the Star for comment, with Monday being a holiday.

The study, conducted by research firm Ipsos, surveyed 806 people in October and suggests that a quarter of parents have had to miss work to care for their child due to issues related to anxiety.

When her 11-year-old daughter tried to die by suicide while on a year-long wait list for mental health care, Moran took a four-month leave of absence and then worked part-time. Six years later, she still takes about 10 per cent of the year off to help her daughter.

Half of the parents surveyed found getting their child mental health help was challenging because wait times are long, they don’t know where to go, or service providers don’t offer what their child needs, don’t exist in their community, are too far away or aren’t available at convenient times.

Anxiety is one of the “big front-runners” when it comes to mental illness in youth, said Lydia Sai-Chew, CEO of Skylark Children, Youth and Families, which offers free counselling and mental health services in Toronto. Wait times at Skylark for in-patient programs can be up to six months.

“The difficulty with wait times is that the youth gets more stressed, but so does the family,” Sai-Chew said. “Anxieties build up. They don’t have the strategies and it just gets worse.”

For 13 years, Michele Sparling of Oakville has juggled owning a business and taking care of her son who was diagnosed with anxiety and depression when he was 10 years old.

“If your child is home from school, you’re not leaving them alone,” Sparling said. “You’re worried when you have to step out for a moment. When a fire truck goes through your neighbourhood, you think ‘not my kid, not my kid.’

“That worry is constant.”

She said her family struggled to get her son the help he needed. In between driving him to and from appointments in Toronto, she got used to telling clients she might have to end a meeting at a moment’s notice if a crisis occurred. She watched as her son had to miss school, and continues to care for him now as he struggles with mental illness in university.

“This is not just about this one person, it’s about the bigger picture, the lost potential,” Sparling said. “I think we’re doing young people such a disservice.”

CMHO is asking the province to invest $125 million in community-based mental health centres, staffing and services for children and youth.

Reposted from: https://www.thestar.com/news/gta/2017/11/14/almost-half-of-ontario-youth-miss-school-because-of-anxiety-study-suggests.html