In light of the economic constraints affecting healthcare in the last five years, there have been reductions in nursing staffs across the country, and the scenario is no different in Memphis. However, unlike what's happening in most of corporate America, the decreasing staff numbers have not come from reductions in force (RIFs) but from simple attrition.

When nurses leave a job, they are not being replaced as readily. That was not the case a few years ago when a staff opening for a nurse was typically filled within a couple of weeks. Now the process is much lengthier, with many more steps involved for approval due to a tighter economic bottom line. And often the position is simply not refilled.  

In an informal survey of area nursing professionals by the Memphis Medical News, one thing becomes clear: a decrease in staffing results in additional duties for the remaining nursing staff. The patient load is the same, or even increased. January and February usually see higher patient loads due to flu and upper respiratory infections. And there are fewer hands to carry the load. This change in staffing levels is bringing about another trend in nursing: nursing managers are tending to pick up some of the direct clinical care as needed in order to manage the workload.

Additionally, to optimize nurse staffing, hospital quality-improvement teams now can generate data to correlate nurse staffing levels with patient outcomes in emergency departments preoperative services and prenatal services as part of NDNQI®, a quality-improvement solution of the American Nurses Association (ANA). That data can assist the teams in developing staffing plans and strategies to improve outcomes, such as reductions in patient falls and infections that result from hospitalization.

“Optimal nurse staffing is a critical component in improving the quality of patient care and preventing avoidable complications," said ANA President Karen A. Daley, PhD, RN, FAAN. "The expansion of the NDNQI®, staffing measures to these new areas will give hospitals a complete view of their performance when developing their staffing plans."

Another change in nursing is the result of changing technology. A nurse in a hospital setting is involved in regular patient care, as was true before. But now the required documentation of that care is changing with the implementation of the ICD-10 system. This switch in electronic coding of medical records is more time-intensive on two levels. First, nurses are required to undergo training in order to successfully use the new system, which is federally mandated to be in place by Oct. 1, 2015 (originally scheduled for Oct. 1, 2014). Secondly, the new system is far more detailed, requiring more code specificity and more time on the part of nurses to perform the coding tasks correctly. The good news is that with ICD-10, nurses will capture much more useful patient information. 

Additionally, some of the pressures of the job have been affected by the reduced staffing levels. Nurses are often working 12-hour shifts, vs. what were once standard eight-hour shifts. The physical demands are more taxing due to the extended timeframe. And for nurses who are parents, other issues, like finding 12-hour child care, become stressors.

But along with the difficulties come new opportunities. Many nurses recognize the value of increasing their knowledge base, whether for patient care or technological proficiencies. As the expectations of hospitals expand, more nurses are finding value in additional education, as it opens more opportunities for advancement. One trend is that as staffing levels are declining, top-rated nurses are being offered higher-level positions. Nurses with years of nursing and case management experience, as well as advanced degrees in nursing, are being promoted as a means of retention.

In general, more nurses are moving away from two-year degrees in favor of four-year degrees. They are also seeking additional certifications in specialty areas. The result is a nursing workforce that is increasingly academically trained, vs. primarily being clinically trained. 

Certification and increased education are valued more and more, And with this additional education, nurses are better able to assist physicians. This is leading to another trend, a change in the healthcare providers. Some care that was once rendered solely by a physician is now being offered by physician assistants and nurse practitioners. In the last three months, Baptist Hospital has begun having nurse practitioners oversee 11 of its Walgreens clinics in Shelby County. (The Tennessee Board of Nursing defines an advanced practice nurse (APN) as a registered nurse with a current registered nursing license, a master's degree or higher in a specialized area of nursing and national certification as a nurse practitioner, nurse anesthetist, nurse midwife, or clinical nurse specialist.) The result goes back to economics, with this arrangement being a more economical method for doctors and hospitals to provide primary care and a more cost-effective option of treatment for the consumer. 

For example, if a patient goes into one of the Baptist/Walgreens clinics with symptoms of an upper respiratory infection, nurse practitioners can not only diagnosis the condition and offer over-the-counter medications, but they can also prescribe antibiotics. In another scenario, if a patient’s history includes long-term smoking, the nurse practitioner might diagnosis the condition as COPD and refer the patient to a specialist, in this case a pulmonologist, for ongoing treatment of a chronic disease.

In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched a two-year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a report that would make recommendations for an action-oriented blueprint for the future of nursing. Through its deliberations, the committee developed four key messages:

Nurses should practice to the full extent of their education and training.

Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

Nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the United States.

Effective workforce planning and policy making require better data collection and information infrastructure.

ANA is the only full-service professional organization representing the interests of the nation's 3.1 million registered nurses through its constituent and state nurses associations and its organizational affiliates.

ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying Congress and regulatory agencies on healthcare issues affecting nurses and the public. The Tennessee Nurses Association is the professional association representing Tennessee’s 88,000 registered nurses.

For more information:

Advanced Practice Nurse programs www.nursing-school-degrees.com/States/tennessee-np.html#schools

Future of Nursing report www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

American Nurses Association www.nursingworld.org

Tennessee Nurses Association www.tnaonline.org