Archive for the ‘Nursing shortage’ Category


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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Enough with the Scare Tactics: Some Follow-Up on the IOM Report on the Future of Nursing

October 21, 2010

flying pig/aturkus, via Flickr

Shawn Kennedy, AJN’s interim editor-in-chief, already posted here about the importance of the recently released Institute of Medicine Report on the Future of Nursing. Its implications are particularly profound at a time when we have a scarcity of primary care providers—and also at a time when the Affordable Care Act (i.e., health care reform) has designated more resources to nursing education and to generally making better use of nurses’ expertise. A number of bloggers have written about the IOM report, several of them expressing chagrin about the predictably naysaying American Medical Association response. Rebutting the AMA, the Center for Health Media and Policy at Hunter College had this to say. One working NP who weighed in on this topic is Stephen Ferrara, who noted (almost two weeks ago, in fact, though we missed it until now) the real world implications of the current situation for NPs in New York State, in a succinct post on his blog, A Nurse Practitioner’s View:

The bottom line is (at least in NY where I practice), without a collaborating physician on record, the 14,000 or so NPs are unemployed and can’t legally do anything that we were trained or educated to do. It is time to remove these non-evidence based barriers and retrospective reviews and allow us to function as true partners on the health care team. Collaboration among providers would still continue to happen and I promise pigs wouldn’t start to fly. Fourteen states have already transitioned to to an autonomous model of practice model for NPs. Lawmakers must not cave to special interests and make the tough decisions that will enable greater access to care.

Of course, the IOM report wasn’t just about letting nurses practice what they were trained to do. It also dealt with nursing education and a number of other related issues. And we’ll be covering its many implications in upcoming issues. In the meantime, we’d love to hear the perspectives of more working RNs and NPs. Are you happy with the role of nurses in the health care system, just as it is? If so, why? If not, why not?—JM, senior editor/blog editor

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IOM Report: The Evidence Shows the Future of Health Care Rests on the Backs of Nurses

October 8, 2010

By Shawn Kennedy, AJN interim editor-in-chief

This past Tuesday, I attended the release of the highly anticipated (at least by nursing) report by the Institute of Medicine (IOM) on the future of nursing. Spearheaded and supported by the Robert Wood Johnson Foundation (RWJF), the report provides a review of nursing’s role in health care and details what changes need to occur for the future—not just of nursing, but for the future health of the health care system.

While the findings support what nursing has been claiming all along—that nurses have a critical role in health care and the health care system needs nurses to practice to the full extent of their capability—what is especially important about this report is that it is backed by the IOM’s multidisciplinary panel and an “objective evaluation of evidence according to the robust evaluation processes of the National Academy of Sciences,” said John Rowe, a committee member and professor at Mailman School of Public Health at Columbia University.

The panel at the public briefing for the release of the report included some health care heavyweights who voiced strong support for the findings:

Harvey V. Fineburg, president of the IOM: “One thing shouts out—nurses are critical to the nation’s health and central to the goals of high quality care.”

Risa Lavizzo-Mourey, president and CEO of the RWJF: “This is not a report about nursing but a report about a key missing piece to fixing health care; it establishes the centrality of nursing in providing safe, high quality, patient-centered care.”

Donna Shalala, president, University of Miami: “This report will usher in the golden age of nursing. Nursing has to be allowed to practice to the full extent of its scope of practice and to be a full partner with other professions in redesigning the U.S. health care system. It’s not about one profession substituting for another but about true collaboration.”

Later, in an interview I conducted with ANA CEO Marla Weston, she made a point of saying that allowing nurses to fully practice “isn’t just about NPs—nurses in all settings need to be allowed to practice according to their education and professional scope.  Nurses in institutional settings are often limited by bureaucratic policies and procedures.”

Prior reports by the IOM have spurred transformation of health care delivery—think of the 1999 report on medical errors, To Err is Human: Building a Safer Health System, and how that initiated a focus on creating a culture of safety and brought about new standards for hospital safety. I’m hoping the same will happen now with this report.

What the MDs say. And I hope our professional colleagues will be open to the report’s findings, though I have some doubts. The American Medical Association issued a statement that, after initially noting that “health care professionals will need to continue to work together,” goes on to reveal that the AMA believes in  “a physician-led team approach to care—with each member of the team playing the role they are educated and trained to play.” Further, it says, “increasing the responsibility of nurses is not the answer to the physician shortage.”

In that they are correct—the report is not about nurses taking on the functions of physicians; it’s about nurses doing nursing and yes, some nursing and medical tasks and procedures are the same. Physicians need to change their entrenched way of thinking that they and only they know what’s best for patients (case in point: see “No Country for Old Women,” a recent blog post by AJN associate editor Amy Collins about her grandmother) and for health care. Otherwise, we will all fail those we purport to serve.

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After the Angels: In Search of A ‘Knowledge-Based’ Professional Identity

September 14, 2010

If you’re looking for angels, you’ve come to the wrong place. So says GuitarGirlRN in her latest blog post.

One stereotype of nursing (and it’s perpetuated by nurses as well as by those not in the medical or nursing fields) that bothers me is that of nurses as “angels of mercy.”

We’re expected to smile while up to our elbows in bloody shit and vomit, be pleasant to rude and sometimes violent people, put up with crap from doctors, managers, patients, their families, nurse techs, and janitors yet keep our cool, never cry, never sweat, never lose our tempers with each other, always be prepared and be right there when we are needed.

by shioshvili/via Flickr

Her point is that nurses are human; they do the best they can with scant resources, but they aren’t superhuman. They aren’t saints, they have lives of their own, and they can’t always be all things to all people. Back in 2005, noted author Suzanne Gordon wrote, with Sioban Nelson, an article for us called “An End to Angels.” In it, they presented the idea that nursing is a profession with a serious image problem, one that undercuts recruitment efforts and ill prepares new nurses for the reality of their work. The arguments in the article are subtle and thought provoking, and impossible to summarize. Here, anyway, is the introduction:

Nurses often disagree on the causes of and possible solutions to the current nursing shortage. Mandatory staffing ratios versus Magnet hospitals? Sign-on bonuses for nurses versus more unionization of RNs? The aging of the nursing workforce versus working conditions? Still, most nurses agree that the profession needs a contemporary image to attract new recruits and reinforce the idea that nursing is a profession grounded in science, technology, and knowledge. To present a modern image and solve the crisis, dozens of different groups have produced advertising campaigns and promotional messages to attract new recruits to the profession.

A close analysis of the words and images used in these campaigns reveals that, instead of creating a modern, accurate version of today’s nurse, many simply repackage nursing’s traditional stereotype of women born to be good, kind, and self-sacrificing-not educated to provide care based on science and practical skill. Although many studies-conducted by nursing, medical, and public health researchers-have documented the links between nursing care and lower rates of nosocomial infections, falls, pressure ulcers, deep-vein thrombosis, pulmonary embolism, and death, most promotional campaigns are conspicuous for their failure to promote these data. Even when ads feature a mix of men, women, and minorities, what is often communicated is a sexist, archaic message: nursing is virtuous work.

The subtitle of Gordon and Nelson’s article is “moving away from the ‘virtue script’ toward a knowledge-based identity for nurses.” So, five years on, how is the nursing profession doing with this? Do you feel you have a “knowledge-based” professional identity? Is that how patients, physicians, nursing instructors, administrators, your friends and family, and the general public see you?—JM, senior editor

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International Recruitment of Nurses: A Look at the Industry and Voluntary Codes of Ethics

June 7, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Pasig River, Manila, Philippines, by ibarra_svd / Bar Fabella, via Flickr

A significant number of foreign-educated nurses (FENs) come to the United States each year to work; although the exact number is unknown, consider that in 2009 alone, more than 14,000 FENs passed the NCLEX exam for licensure to practice here. Many come because they’ve been actively recruited by firms acting as agents for hospitals and nursing homes; others come on their own. Some are recruited from developing countries that, because of severe internal nursing shortages, can ill afford to send qualified nurses abroad. And some FENs learn that what they expected—or were led to expect—doesn’t match what they actually find when they arrive.

In the June issue of AJN, you’ll find a comprehensive study examining the international nurse recruitment business, an industry that’s gone through rapid growth in the last decade. Supported by a grant from the John D. and Catherine T. MacArthur Foundation, Patricia M. Pittman and colleagues conducted interviews with industry executives and focus groups with FENs. Read the rest of this entry ?


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