Archive for the ‘Nursing shortage’ Category


AJN in April: Deep Breathing for Dialysis Patients, Isolation Care, Sleep Loss in Nurses, More

March 27, 2015

AJN0415.Cover.OnlineOn our cover this month is Pablo Picasso’s Le Rêve (The Dream). We chose this portrait of a woman in a restful pose to highlight the importance of proper sleep to a person’s overall health and well-being. Unfortunately, not many Americans are able to get the proper amount of rest. The Institute of Medicine (IOM) estimates that 50 to 70 million U.S. adults have chronic sleep and wakefulness disorders—and nurses are not immune.

Between long shifts and the stressful nature of their jobs, nurses are especially vulnerable to not getting an adequate amount of quality sleep. Fatigue from lack of sleep may diminish the quality of nursing care. Sleep loss has been linked to impaired learning, memory, and judgment and is also associated with a slew of chronic diseases. This month’s CE feature, “The Potential Effects of Sleep Loss on a Nurse’s Health,” describes the acute and chronic effects of sleep loss on nurses, strategies nurses can use to improve the quality of their sleep, and institutional policies that can promote good rest and recuperation.

This feature offers 2 CE credits to those who take the test that follows the article. You can further explore this topic by listening to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes).

Deep breathing for dialysis patients. Chronic kidney disease (CKD) generally has a poor prognosis and often causes poor sleep quality, reduced quality of life, and is associated with high rates of hospitalization. It’s no surprise that an estimated 25%–50% of patients with CKD suffer from depression. This month’s original research CE, “The Efficacy of a Nurse-Led Breathing Training Program in Reducing Depressive Symptoms in Patients on Hemodialysis: A Randomized Controlled Trial,” examines the efficacy of a nurse-led breathing training program in reducing depression and improving quality of sleep in patients on maintenance hemodialysis. This feature article offers 2.5 CE credits to those who take the test that follows the article. Read the rest of this entry ?


Workplace Discrimination: A Survey among Newly Arrived Foreign-Educated Nurses

January 27, 2014

By Sylvia Foley, AJN senior editor

Table 2. Outcome Metrics by Recruitment Model

Table 2. Outcome Metrics by Recruitment Model

This country has often relied on foreign-educated nurses (FENs) to ease nursing shortages—and  with more shortages predicted for as early as next year, it’s likely we’ll do so again. A positive workplace environment is a known predictor of staff retention; yet little is known about how FENs experience their jobs. To learn more, Patricia Pittman and colleagues surveyed more than 500 FENs. This month’s original research CE, “Perceptions of Employment-Based Discrimination Among Newly Arrived FENs,” reports on their findings. This abstract offers a brief overview.

Objective: To determine whether foreign-educated nurses (FENs) perceived they were treated equitably in the U.S. workplace during the last period of high international recruitment from 2003 to 2007.
Background: With experts predicting that isolated nursing shortages could return as soon as 2015, it is important to examine the lessons learned during the last period of high international recruitment in order to anticipate and address problems that may be endemic to such periods. In this baseline study, we asked FENs who were recruited to work in the United States between 2003 and 2007 about their hourly wages; clinical and cultural orientation to the United States; wages, benefits, and shift or unit assignments; and job satisfaction.
Methods. In 2008, we administered a survey to FENs who were issued VisaScreen certificates by the Commission on Graduates of Foreign Nursing Schools International between 2003 and 2007. We measured four outcomes of interest (hourly wages, job satisfaction, adequacy of orientation, and perceived discrimination) and conducted descriptive and regression analyses to determine if country of education and recruitment model were correlated with the outcomes.
Results: We found that 51% of respondents reported receiving insufficient orientation and 40% reported at least one discriminatory practice with regard to wages, benefits, or shift or unit assignments. Read the rest of this entry ?


Are Hospitals Doing Enough to Help Newly Licensed RNs?

November 18, 2013


Staff retention is a big issue in hospitals. There can be advantages in hiring newly licensed RNs, but some hospitals and workplaces may pay insufficient attention to helping new nurses with the challenging transition from classroom to clinical practice. In our November issue, some of these issues are brought more clearly to light by an original research article called “Hearing the Voices of Newly Licensed RNs: The Transition to Practice.”

“The first few months of employment is a crucial time in a nurse’s career,” write the authors of this small study. According to interviews with newly licensed RNs conducted by the authors, the following factors can make a big difference:

  • The quality of the preceptor—is the preceptor knowledgeable, adequately experienced, and nonjudgmental?
  • Professional growth and the development of confidence over time in terms of time-management, communication skills, and learning from experience.
  • A sense of being nurtured by the program, the preceptor, and peers.
  • The thoroughness and effectiveness of orientation.

Read the article, or listen to an author podcast on our Web site. What worked in your own transition to practice? What didn’t work? Or how do you help others with this transition? We’d love to know. —Jacob Molyneux, senior editor

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Staffing: Hot Topic as Usual for Nurses

May 31, 2012

Karen Roush, MS, RN, FNP-C, clinical managing editor

Our recent Facebook post on an article on nurse staffing at the NPR Shots blog (“Need a Nurse? You May Have to Wait”) got a lot of responses. Staffing is a hot topic for nurses—from both a personal  and a patient care perspective. And I say “hot” because it never fails to raise emotions.

Everyone agrees that adequate nurse staffing is essential for safe, high quality patient care and nursing job satisfaction. Research has shown that it significantly improves patient outcomes.

Yet we—nurses, as well as the larger health care community—continue to debate how to determine what “adequate staffing” is and how to best achieve it. Acuity-of-care measures? Unit-by-unit mandated staffing plans? State-mandated staffing ratios? What do you think?

We’ve published numerous articles and news pieces on this topic in recent years; here are a few examples:

News, reports, and analysis (open access articles)

“Nurse Staffing Matters—Again”

“California Mandated Nurse–Patient Ratios Deemed Successful”

“Nursing Shortage—or Not”

Feature. Requires subsciption or purchase; abstract only

“Nurse Staffing and Patient, Nurse, and Financial Outcomes”

And here are some blog posts that deal either directly or indirectly with issues related to nurse staffing.

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Are Job Prospects Improving for New Nurses?

May 17, 2012

Image via Wikimedia

Back in 2010, we ran a post by our then clinical editor, Christine Moffa. It was called “Prospects for New Nurses: Thoughts On Graduating During a Downturn” and it generated quite a few comments. Below is a sampling of excerpts. Some people were pretty distressed, wondering whether they should take jobs that separated them from their families, facing criticism from people who expected they should find a job easily. After all, they were nurses! And we all know they are always in demand.

We’ve been hearing anecdotally that the prospects for new nurses are getting better overall. Is this your experience?—JM, senior editor

“It costs a lot of money to train nurses, especially new grads. Many employers want experienced nurses. The best piece of advice given to me was to stay with same healthcare system/unit floor I worked with as a student nurse. Even that prospect, however, seems to be circling the drain for the same reason I hear over and over again: EXPERIENCE REQUIRED!!! Relocation may not be an option for some people….I’m sure I will eventually get a job, but it’s the uncertainty of my future that frustrates me. It’s quite aggravating to have worked so hard in school only to be disappointed in the end.”

“I just graduated in March and am really worried about getting a job. Thankfully I will be able to stay at my current job as a RN- I worked there as a LPN for almost a year.”

“I won’t give up; but I’m definitely discouraged. It has been a year since I graduated. I have followed all of the advice in the book – I’m volunteering, I’m looking for a job in a SNF, I network everywhere possible, I go to hospitals and shake hands with nurse managers, I follow up, I’m persistent with hiring managers to no avail. I’m desperate for some good advice regarding my circumstances and I’m not really sure where to turn.”

“No one has everything they need to be the perfect candidate, and many are far from it, because we are fallible human beings. We must keep the knowledge that we CAN do this! Someone will look at us and say, for whatever reason, that they want us. It will happen!”

“The difference between this downturn and previous year’s downturns are that there are 50% more new grads entering the market than previous years.”

“Certainly the recession is a major factor, but the lack of nursing leaders willing to demand that hospital administrators provide optimal staffing levels,is the primary problem. Only when nurses are able to provide the level of care that they have been educated to give, will retention improve. This would only be feasible with lower nurse: patient ratios. It seems that when most nurses achieve top positions in large hospitals, the staff nurse and the true quality of patient care is forgotten.”

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New Nurses: Committed to Their Current Jobs—Or Biding Their Time?

March 5, 2012

By Sylvia Foley, AJN senior editor

It’s no surprise that the recent economic recession caused many older nurses to return to the workforce or to delay retirement and work longer hours, thus easing the projected nursing shortage—at least for the time being. But nurse researcher Carol S. Brewer and colleagues wanted to understand how the recession affected new nurses’ work attitudes and behaviors, in particular those related to turnover. What they found has many implications, both now—although the recession is reportedly over, we’re still in an economic slump—and as the economy recovers.

To learn more, Brewer and colleagues compared data for two cohorts of newly licensed RNs. The first cohort consisted of 983 new nurses licensed between August 2004 and July 2005 who were surveyed before the economic downturn; the second cohort consisted of 1,765 new nurses licensed between August 2007 and July 2008. The survey tool included questions on attitudinal variables in four areas: personal characteristics, work attributes, work attitudes, and job opportunities. The researchers report the results in this month’s CE–Original Research feature, “New Nurses: Has the Recession Increased Their Commitment to Their Jobs?”

Among the key findings:

  • Commitment to the profession was high in both cohorts. Most (82%) of the RNs in each cohort strongly agreed with the statement that within one year they planned “to have a job that requires an RN license.”
  • Income and job satisfaction levels were about the same in both cohorts.
  • Nurses in the 2007–2008 cohort were significantly more likely to be searching for a new job, although they also  reported a significantly greater intent to stay with their current employers than the 2004–2005 cohort did.
  • The 2007–2008 cohort perceived significantly fewer job opportunities, both locally and nonlocally, than did the 2004–2005 cohort.

The researchers concluded that

despite some improvements in working conditions, newly licensed RNs may just be waiting for the recession to end before changing jobs. Health care organizations’ efforts to improve RNs’ working conditions and wages, and to implement or support existing programs aimed at increasing retention, should be continued.

For more study results and an intriguing discussion about what it all means, read the article (for easier reading, open the PDF). And if you’re a newly licensed RN (or if you’re not, but this topic resonates for you), please weigh in here—how has the continuing economic slump affected your job satisfaction and intent to stay?

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On the Road to the Future of Nursing

November 29, 2010

By Shawn Kennedy, interim editor-in-chief  

by wfyurasko/via Flickr

I’m writing this on the train to Washington, DC, heading to the National Summit on Advancing Health through Nursing, which is taking place November 30 and December 1. This is the next step of the Robert Wood Johnson Foundation’s Initiative on the Future of Nursing (see my October 8 blog post) and will launch the Campaign for Action—the plan for implementing the recommendations of the Institute of Medicine’s report, The Future of Nursing. (You’ll be able to access the webcast and a live chat of webcast users on November 30 here.)

If you haven’t read anything about this initiative, do so. If you’re a nurse and plan to be working for the next 10 years, the recommendations from this report, if implemented, will affect you in some way. Expect to see changes in the following areas, to name just a few:

  • how and where nurses practice
  • undergraduate and graduate curricula
  • licensing and certification criteria
  • reimbursement policies

Other nursing initiatives have come and gone, some more successful in achieving their goals than others. AJN will cover the progress of this initiative as it attempts to evolve from a written report to an active process that creates sustainable change. As a start, in the December issue, now available at, AJN brings you a guest editorial by Susan Hassmiller, director of the Initiative on the Future of Nursing. There’s also a summary and analysis of the report in AJN Reports, and a podcast interview with Marla Weston, CEO of the American Nurses Association, discussing the recommendations. And I’ll be posting updates here on the blog.

The weight of the IOM, the Affordable Care Act mandating health reform, the aging of America, and the numbers of Americans living with chronic diseases—all have come together to create the “perfect storm” for significant change. This is perhaps the best opportunity nursing will have in our lifetime to become a decision maker in shaping health care delivery in this country. Here’s hoping . . .

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