Surveyed nurses rate employers low in perceived support and concern about their well-being.
Nurses need much more support than they are getting from their leadership and employers, a new American Nurses Foundation survey reveals.
Nurses continue to be stressed, exhausted, and feel lack of support from their employer, according to the comprehensive survey of more than 12,500 nurses nationwide last November as part of the Pulse on the Nation’s Nurses Survey Series. For example:
84% recent of nurses say they are stressed or dealing with burnout.
57% report feeling exhausted.
32% of nurses with less than 10 years of experience indicated being either not or not at all emotionally healthy.
61% of nurses under 35 indicated feeling anxious in the previous 14 days.
19% intend to leave their position in the next six months; another 27% are considering leaving.
Workplace violence in various forms is also a top issue, with 53% of nurse respondents saying verbal abuse has increased, the report says. Another concern is that 43% of nurses say they either don’t have a reporting mechanism in place at their healthcare system or they are unsure if they have one, according to the survey.
Perceived support
Respondents said they continue to feel unsupported or not supported enough by their employers—particularly those employed in large and mid-sized acute care settings, and the younger generation of nurses.
The nursing survey applied the Survey of Perceived Organizational Support (SPOS), a validated measure of the general belief held by an employee that the organization is committed to them, values their continued contributions, and is generally concerned about their well-being.
The foundation tracks five indicators regularly to measure how nurses perceive the support they receive. They scored their employer support on a range of 0 to 5, with 5 being the highest:
My organization really cares about my well-being – 2.8
If I did the best job possible, my organization would notice – 2.7
My organization takes pride in my accomplishments at work – 2.9
My organization values my contributions to its well-being – 2.8
My organization responds to my complaints – 2.6
Indeed, a generational divide is evident throughout the data. Overall, nurses 25-34 provided the lowest scores across all SPOS indicators, followed by nurses 35-44 and under 25. The pivot toward higher SPOS scores begins with nurses 45-54.
“This is consistent with reported feelings, with younger nurses feeling less supported and less valued,” the report reads.
“The insights we’ve gleaned from Millennial and GenZ nurse respondents, as well as nurses of color, demonstrate that employers must dramatically shift their approach to supporting nurses, taking into account that different demographics of nursing have unique needs,” says Kate Judge, the foundation’s executive director.
“Nurses leaving the profession, leaving acute care, and being burned out puts our health as a nation at risk,” she says.
That may seem evident as nurses have staged several strikes in the last year at health systems across the country, citing staffing concerns, including:
More than 7,000 nurses at two of New York City’s busiest hospitals walked out for three days last month.
Some 15,000 Minnesota nurses went on strike for three days in September.
About 800 nurses at St. Vincent Hospital in Worcester, Massachusetts, ratified a new contract after a 301-day strike.
One survey respondent expressed frustration: “Employers see nurses as expendable. There's no retention plan in place, and I feel like the unit wouldn't care if I left nursing altogether.”
Another shared, “I have seen more nurses recommend other career choices to friends and family. I have seen many caring people step aside from nursing, because they have found it is no longer worth it.”
Perception gaps
Besides the generational divide evident throughout the data, the survey also revealed a considerable gap between nurses and nurse leaders.
When nurses were asked whether they feel their team is better prepared for a future variant, surge, or pandemic, only 30% said “yes,” with 29% “maybe” and 41% “no.”
When the same question was asked in an October 2022 survey fielded by the American Organization of Nursing Leadership (AONL), 65% of nurse leaders said “yes,” they felt their team was better prepared for a future variant, surge, or pandemic.
“The divide has real consequences,” the report says, “that go beyond work culture.”
'It truly has proven to be an additional layer of support to enhance patient care and outcomes,' nurse executive says.
What began as an innovative way to monitor and care for COVID-19 patients at the height of the pandemic is evolving into a growing virtual nursing program at Atrium Health.
The North Carolina-based health system, now part of Advocate Health, launched its virtual nursing program in March 2021 when, like other health systems, nurses struggled to meet staffing demands.
Nurses loved it, patients loved it, and the health system noticed positive outcomes: decreased medication errors, decreased falls, increased patient satisfaction, and more, says Patricia Mook, MSN, RN, NEA-BC, CAHIMS, FAONL, vice president of nursing operations, professional development and practice.
Mook spoke with HealthLeaders about how Atrium Health’s virtual nursing program benefits both nurses and patients and how a care model prompted by COVID has become a permanent part of the health system.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: How did Atrium Health begin its virtual nursing program?
Patricia Mook: We began by gathering together some innovative nursing staff who had previous history with working with virtual patient observation and asked, “How can we support our nurses at the bedside at a time when we don't have enough nurses because of the pandemic and be able to virtually watch these patients?” We very quickly put up a pilot and it was absolutely fantastic.
We found lots of benefits. We were able to keep nurses who couldn't really function physically at the bedside but had great skill, so we put them behind the camera to be our virtual nurses. We were able to help new nurses do their work at the bedside with an experienced nurse behind the camera.
We saw staff engagement, a decrease in medication errors, a decrease in falls, and an increase in patient satisfaction. We also see this as a retention tool for nurses; it’s a reason for nurses to want to come to work at Atrium.
HL: What are the virtual nurses’ responsibilities?
Mook: The virtual nurse behind the camera observes about 10 patients and can do an admission assessment; they’re able to do hourly rounding; they can do RN/MD rounding with the medical doc when they come in the room; they can do medication teaching; discharge instructions; and work with families on family instruction.
They can monitor vital signs that are being taken in the room because the camera is so sensitive that they can zoom in on the technology in the room to monitor what's going on there. They have the ability to assist pharmacy with medication reconciliation. There are a lot of things that they're able to do.
In addition, sometimes nurses have medications or even administer blood that requires a second nurse check, and the nurse behind the camera can be that person and provide that check. There are so many ways that the nurse behind the camera can help the patient and help the nurse, physician, pharmacist, or any care provider who comes into the room.
HL: How does virtual nursing create efficiency for the floor nurse?
Mook: Every single time you go into the room of an infectious disease patient, you have to put on your gloves, your cap, your mask, and your paper gown, and that takes a good two minutes to get it all done. If you look at studies, the number of people who go in and out of the room is a lot.
When a nurse who's at the bedside doesn't have to go in and out of the room every hour, we calculated that they saved probably two hours of going in and out of rooms. It saves a lot of time and it saves energy. It's more efficient.
Patricia Mook, MSN, RN, NEA-BC, CAHIMS, FAONL
HL: What benefits does virtual nursing offer patients? What do they like about it?
Mook: If they had a need, somebody was right there with them in an instant because the virtual nurse could zoom in to that patient, click on the button, and say, “How can I help you?” We were able to help them feel safer when they were alone in the room. During COVID, patients often weren't able to have visitors, so this was a person who was there to comfort them quickly.
One of the reasons we think we saw an improved patient satisfaction score was most of our patients during the pandemic were on isolation and the only face they saw was the nurse on the camera who didn't have to wear a mask. We were very encouraging of that nurse behind the camera to keep a smile on their face for their patients because that really was the only facial expression that patients would see the entire time they were in the hospital because everybody was masked. And that facial expression means so much to patients, so we saw a higher patient satisfaction score on the patients who were being seen with virtual nursing.
Finally, response time to call bells was a tremendous improvement for our patients, which also led to safety and patient satisfaction advances.
HL: What have been some of the outcomes that you’re seeing with virtual nursing care?
Mook: We are still collecting and analyzing data, so we don’t currently have specific information to share. The virtual nurse allows for early recognition of any changes in patient status, so attempting to get up would certainly be among those things we’re watching for. It has also provided us an earlier notification of when the rapid response team needs to engage, and in instances where the patient has coded.
The patients are truly winners here. We’ve seen a 56% reduction in the number of call bell responses and scores for patient experience have risen dramatically. It’s also useful in helping avoid mistakes; if you have a novice nurse on the floor, having an experienced nurse “in the room” with them via video can be a huge comfort and ensure that all elements of care are provided appropriately. It truly has proven to be an additional layer of support to enhance patient care and outcomes.
HL: How widespread is virtual nursing now across Atrium Health?
We’re currently covering 20 beds at Atrium Health Pineville Progressive Care unit and 30 beds at Atrium Health Cleveland. We’re looking at additional locations to expand, with a focus on med-surg and med-tele units.
We’re also working on electronic dashboards and other options to improve analytics and data collection.
Annual Gallup poll has ranked nursing as America’s most-trusted profession for 21 consecutive years.
Nurses’ ability to ensure their patients’ well-being is among the reasons why they rate the highest in honesty and ethics, says a nursing regulatory official.
In Gallup’s recent annual poll outlining the most-trusted professions in America, nurses ranked first for the 21st year.
Nearly 80% of U.S. adults say nurses have “very high” or “high” honesty and ethical standards—far more than any of the other 17 professions rated, according to Gallup.
Two other health-related professions—medical doctors and pharmacists—rank second and third behind nurses, with 62% and 58% of Americans, respectively, rating them highly.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: Long before COVID, nurses were the most trusted profession. As a nurse yourself, what are some of the reasons for that?
Maryann Alexander: Nurses are strong patient advocates and excellent listeners, and even though their care is based on science, they incorporate empathy and compassion into the plan of care for every patient.
However, what really sets nurses apart is the time they spend with patients. They are the ones that are with the patient when they arrive at the hospital, throughout the stay, and on the day they are discharged. A nurse is often the first to recognize a change in the patient’s condition. They learn more about the patient than just their medical problems and intervene to address the social determinants of health. They get to know the family and caregivers and answer questions.
The first thing that patients say when they are uncomfortable, have questions, are anxious, or feel like something is not right is, “Call my nurse.” They have trust in the nurse to competently address their concerns and ensure their well-being. This is the heart of nursing.
HL: How does nurses’ training factor into being so trusted?
Alexander: To be trusted, you have to be competent. Nursing education’s focus is on the development of knowledgeable, safe, and competent clinicians who deliver high-quality care and are experts in assessment, management/treatment, patient education, prevention, and wellness.
Second, another component of nursing education is the development of a caring attitude. This includes being a patient advocate, listening to the patient and family, and having empathy and compassion.
HL: In 2020, COVID placed nurses and their patients in the most difficult of circumstances, yet their ethics rating soared. What is your perspective on that?
Alexander: The pandemic did not change one’s integrity or ethics. Nor did it change the principles I mentioned: competence, quality care, advocacy, and compassion. If anything, the pandemic demonstrated and highlighted all the qualities that make up the nursing profession and have earned the profession that title.
HL: The nursing profession is facing intense challenges right now, with burnout, staffing shortages, and rising hospitalizations. How do you see the profession five years from now, and will it still be the most trusted?
Alexander: This is not the first time in history that nurses have faced these and other challenges, but underlying the profession, at its very heart, is the belief of how important the work of nursing is, the determination to problem-solve, and the need to ensure that every patient has nurses they can trust.
NCSBN is cognitive of the many challenges facing nursing today and in the future. We know that the workforce needs to be assessed to determine whether there is a sufficient supply of nurses to meet the ever-increasing demand for their services. That is why we continue to conduct our national nursing workforce study every two years.
Our most recent study to be released in April of this year highlights how critical the situation is. However, I know that nursing has great leadership, and I am confident we can work together to ensure that nurses will meet the challenges of today and remain the most trusted profession for decades to come.
'Commonsense' legislation expands treatment options, one bill sponsor says.
Two new pieces of bipartisan legislation would give nurse practitioners (NPs) a “huge step forward,” in removing barriers to healthcare, says their national organization’s president.
The first would authorize NPs to certify federal workplace injuries and oversee treatment of injured workers.
Though federal employees can choose an NP as their healthcare provider under the Federal Employees Health Benefits Program, current law prohibits federal workers from being treated by NPs or physician associates/physician assistants (PAs) for workplace-related injuries.
The Improving Access to Workers’ Compensation for Injured Federal Workers Act would amend the Federal Employees Compensation Act to allow injured workers to receive treatment for work-related injuries from state-licensed NPs and PAs.
The legislation was introduced in both the U.S. Senate and House of Representatives by Sens. Sherrod Brown (D-Ohio) and Susan Collins (R-Maine) and Reps. Tim Walberg (R-Mich.) and Joe Courtney (D-Conn.).
“This commonsense bill would expand much-needed treatment options,” Walberg said. “Across the country, nurse practitioners and physician assistants provide critical care, especially in rural and underserved communities where there may not be a physician within a reasonable distance. Current federal law imposes an additional burden on federal employees who may have to travel great distances to receive care from an approved provider.”
Shoes for diabetics
The second newly introduced legislation would authorize NPs to certify their patients’ need for diabetic shoes.
Under the Medicare program, NPs are authorized to be reimbursed for the treatment of patients with diabetes, yet they are not authorized to certify their patients’ need for diabetic shoes.
The Promoting Access to Diabetic Shoes Act would authorize NPs to certify their patients’ need for diabetic shoes.
The legislation was introduced in both the Senate and House by Sens. Brown and Collins, along with Reps. Earl Blumenauer (D-Ore.) and Darin LaHood (R-Ill.).
“Therapeutic shoes are a proven method for preventing costly and painful complications related to diabetes, yet current Medicare regulations force patients to endure a time-consuming process to obtain them,” said Collins, founder and co-chair of the Senate Diabetes Caucus. “Our bipartisan legislation would allow nurse practitioners and physician assistants to certify their patients’ need for this important treatment method.”
This legislation streamlines healthcare delivery, ensuring that patients with diabetes receive the care they need when they need it from their provider of choice, Kapu said.
“Requiring a physician to certify that a patient requires diabetic shoes—after the patient’s NP has already made that determination—leads to delays in treatment and increases costs to the Medicare program by requiring the participation of an additional provider,” Kapu said.
71% of long COVID claimants to workers' compensation insurer were unable to return to work for six months or more.
The effects of long COVID are keeping needed employees out of the workforce, a recent study indicates.
Some 71% of claimants with long COVID were still receiving treatment and unable to return to work for six months or more, according to data from the New York State Insurance Fund (NYSIF), the largest worker compensation insurance fund in the state.
The study analyzed more than 3,000 COVID-19 workers’ compensation claims received by NYSIF between January 1, 2020, and March 31, 2022.
Other study data revealed:
About 18% have been unable to return to work for more than one year.
The percentage of long COVID among female workers (37%) was 11% higher than in male workers (26%).
Nearly one-third of all workers compensation claims in 2022 were for long COVID.
Most claimants in this group are under 60 years of age—the primary age for people in the workforce.
Essential workers may have long COVID rates higher than the data suggests.
The total number of people affected by long COVID likely is undercounted by this study, because it focused on patients requiring medical attention or out of work for 60 or more days, the study’s authors said.
The numbers aren’t capturing people who have gone back to work and didn’t seek medical attention, but are toughing it out at work, while dealing with symptoms such as brain fog, the authors said.
Indeed, brain fog associated with long COVID is the most common reason patients are unable to return to work, one COVID doctor said.
“Some patients forget where they are when they are out walking or driving,” Shammash said. “It can be debilitating and a major reason long COVID patients haven’t returned to work.”
Between 7.7 million and 23 million Americans are estimated to have been affected by long COVID, according to the Government Accountability Office.
roadly reflective, these findings begin to fill information gaps about the labor market, including an underappreciated reason for the many unfilled jobs and the declining labor participation rate since the emergence of the pandemic,” the authors wrote.
“They also highlight the emerging challenges that employees of all ages and employers across all sectors face as a growing number of people return to work while still reeling from the effects of COVID-19.”
Long COVID symptoms
The post-COVID syndrome known as long COVID is associated with multiple organ systems, tissue damage, and wide-ranging symptoms that can vary in duration, type, and severity.
Of the four major patterns detected, one featured heart and kidney problems; another included respiratory problems, anxiety, and sleep disorders; a third consisted of musculoskeletal symptoms; and the fourth was dominated by nervous system symptoms.
Given long COVID’s potentially debilitating effects, the Biden Administration has organized a governmentwide response to address long COVID, and federal agencies now recognize the condition as a disability under the Americans with Disabilities Act of 1990.
“We are in high demand and that is because we have 99 million Americans today that are lacking access to primary care and wait times are longer than ever before,” she says.
“NPs are stepping up to meet those needs in terms of access. You’re seeing the rise in NPs because we're helping to meet that demand and that's across all settings—rural settings, urban settings, in the hospital, the clinic, through telehealth, mobile sites, skilled nursing facilities, and schools.”
NPs’ focus on preventive healthcare also is a driver in demand, Kapu says.
“Nurse practitioners are focused on meeting the patient where they are and engaging people in healthcare. We're very focused on the reduction of healthcare disparities, increasing access to care, and healthcare equity,” she says. “The reason for that is, if we have high-quality healthcare immediately available where we're working with individuals and families on a regular basis, and providing screenings, immunizations, and regular chronic disease management, this helps to prevent urgent care visits and emergency department visits.”
With nearly 90% of nurse practitioners educated and trained in primary care, “We're focused on healthier lives for everyone everywhere,” Kapu says.
2. Nearly 100 million people live in primary care shortage areas, and the numbers are rising.
Primary care shortages are more severe in rural areas, where more than 130 hospitals have closed in the past decade, with nearly 20 in 2020 alone, according to AANP.
A recent AANP survey found nearly 50% of patients waited longer than one month—and 25% waited more than two months—for a healthcare appointment in the previous 12 months.
A 2020 study on the importance of building a strong rural workforce noted that NPs in 2016 represented more than 25% of providers in rural areas—an increase from 17.6% in 2008. During this time period, the percentage of physicians practicing in rural areas declined 12.8%.
With the decline of physicians practicing in rural areas, NPs are purposefully stepping into those underserved areas, Kapu says.
While, as the study says, NPs represent 25% of the primary care providers in rural practices, that percentage is even greater in the states that allow NPs to practice to the full extent of their education and clinical training—Full Practice Authority (FPA), she says.
FPA is the authorization of NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing, rather than requiring them to hold a state-mandated contract with a physician as a condition of state licensure.
“For those states that allow NPs to practice to the full extent of their education training, we’ve seen an increase in the NP workforce, and we’ve seen an increase in people working across all settings,” Kapu says.
“Arizona is a great example of a state that moved to FPA in 2001,” she says. “Within five years, they saw their workforce of NPs double across the state, and they saw a significant increase in NPs working in healthcare provider shortage areas.”
April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president, AANP
3. NPs are taking on leadership roles in research and the diagnosis and treatment of illnesses.
NPs are leading the effort to diagnose and treat illnesses of all types, as well as participating in research to develop new treatments and combat emerging diseases, Kapu says.
“We've seen NPs rise in terms of their clinical expertise, so organizations and associations are seeking out NPs to help with putting out studies and articles or present the findings of their research on a national level through publications and presentations,” she says.
AANP emboldens its members to take on leadership roles by offering ongoing courses in developing leadership skills.
“It's so important that NPs have a voice not only in their practice setting but that they have a voice in their healthcare system, in their state, and on a federal level,” Kapu says. “So, we encourage NPs to take leadership positions, certainly on boards, in health policy, and health systems management. The perspective of the NP is very important.”
Indeed, at the recent 2023 AANP Health Policy Conference, attendees heard from Jennifer Kiggans, an NP serving her first term in the U.S. Congress as a representative from Virginia.
“We think it’s wonderful that NPs are stepping into different types of leadership roles,” Kapu says.
4. More states are giving patients full and direct access to NPs.
More states—26 plus Washington, D.C., so far—are granting FPA, which gives patients full access to NPs without requiring a practice agreement with a physician.
Momentum for FPA increased during the pandemic, when states temporarily suspended practice agreements and allowed NPs to practice at the top of their education, giving patients direct access to care.
Though some states allowed that executive order to expire, four states— Massachusetts, Delaware, Kansas, and New York—elected to adopt FPA permanently.
“[These] states put into place those executive orders and that continues to show that we provide high-quality care,” Kapu says. “The momentum is definitely there, because several states have legislation in action now to move their state toward full practice authority.”
FPA makes a difference in the health of a state’s residents, she notes.
“The states that have the healthiest outcome are states that have full practice authority,” Kapu says.
“Many of the states that have the lowest healthcare outcomes are states that still have restricted, outdated laws in place that are completely unnecessary, such as retrospective chart review or collaborative contracts where you have to pay fees,” she says. “Those fees can be a barrier to an NP being able to practice in the community.”
5. Mental health NPs are increasing access to mental health services.
With 158 million people living in Mental Healthcare Health Professional Shortage Areas, NPs are leading the charge to meet this demand for care.
Nearly 100 new psychiatric mental health nurse practitioner (PMHNP) programs have been added to U.S. schools of nursing in the past 10 years, producing more than 13,000 new providers, according to the American Association of Colleges of Nursing Enrollment and Graduation Reports 2012-2022.
The number of NPs treating Medicare beneficiaries for psychiatric and mental health conditions grew 162% between 2011 and 2019, compared with a 6% decrease in the number of psychiatrists treating Medicare patients, according to a 2022 study.
“We have nurse practitioners who are educated, trained, and national board certified as mental health NPs, and they are providing those vitally needed services, but there are still barriers [to practicing],” Kapu says.
“Anything we can do to increase the amount of workers out there to provide mental healthcare and anything that we can do to reduce unnecessary barriers are the only ways that we're going to be able to address the mental health challenges that we're seeing today.”
A standardized handoff can prevent inconsistent and inaccurate discharge summaries, a new study says.
Transition of patients from hospital to a skilled nursing facility (SNF) often results in treatment delays, medication errors, and patient harm, but a standardized handoff can improve communication and correct those problems, a new study says.
Systems to improve nurse-to-nurse communication in different handoffs, such as during shift change and unit transfer, are effective in acute-care settings, but efforts to improve communication during the nurse-to-nurse handoff from hospital to SNF have not been widely implemented, according to the study by Wayne State University.
One out of 5 hospitalized patients are discharged to a SNF and are vulnerable and at high risk for functional and clinical decline, making a seamless transition critical, study authors wrote.
Patients’ transfer forms and discharge summaries from hospitals often contain mismatched, missing, inconsistent, and inaccurate information, including patient histories, allergies, instructions for care, and medications lists, the study says.
For example:
22% of the hospital-to-SNF handoffs needed clarification about antibiotic prescriptions
42% of prescriptions for narcotic medications were missing
Patients transferred to SNFs had to wait at least 24 hours to receive critical medications
As a result, medication discrepancies increase SNF nurses’ workload and cultivate a “sense of mistrust” of the information received from the hospital, the study says.
Ensuring accurate information
The literature supports the significance of standardizing handoff to ensure clear and accurate information is exchanged, the study says.
For example, effective handoff tools include The SBAR (situation, background, assessment, and recommendation), I-PASS (illness severity, patient information, action list, situational awareness and contingency plans, and synthesis by receiver), and checklists have successfully improved handoff during the shift-to-shift and unit-to-unit report, the study notes.
“These structured communication tools have demonstrated effectiveness in ensuring complete, accurate, and organized patient information is discussed, avoiding confusion and delays, reducing preventable adverse events and medical errors, and encouraging seamless nursing workflow,” the researchers wrote.
However, standardized handoff tools should be developed based on the unit’s needs, the study says.
How the study worked
Before the study began, researchers conducted a one-month chart review of 76 SNF patients, which revealed 56 events of delayed controlled medications and IV antibiotics administration in that month because they were not promptly sent or called into the pharmacy, according to the study.
SNF staff nurses were interviewed about handoff structure and processes and researchers also observed randomly selected hospital-to-SNF handoffs. Data gathered were used to create the standardized handoff tool used in this project. Existing handoff tools were not used because they are not comprehensive enough for SNF needs.
A chart review after the six-week study indicated the wait time of prescriptions availability during the hospital-to-SNF transition was decreased by 79% for controlled medications, with an associated 52.9% reduction in late administration. Wait time for IV antibiotics decreased 94%, with a 77.8% reduction in late administration.
“Handoff communication conveys patient information and transfers the responsibility of care from one nurse to another or from one setting to another,” the study says. “The communication between healthcare settings should pass on important patient information that the receiving facility will utilize to seamlessly continue the patient’s care.”
Neonatal nurse practitioner (NNP) training programs don't include enough underrepresented groups, affecting care of the tiniest patients, study says.
Racially diverse nurse practitioners offer valuable perspective in caring for underrepresented patients, yet "glaring health disparities" exist in neonatal ICUs because neonatal nurse practitioner (NNP) training programs lack racial minorities, a recent survey says.
Indeed, nurse practitioners (NPs) of color in general are underrepresented in the workforce, with less than 7% being Black, according to employment recruiter Zippia.
Nurse researchers Desi M. Newberry, DNP, NNP-BC, of Duke University School of Nursing, Durham, North Carolina, and Tracey Bell, DNP, NNP-BC, of Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, designed a survey to determine the racial/ethnic composition of NNP faculty and students in accredited NNP programs in the United States. The findings from 23 responding accredited education programs were then compared to available data on the racial/ethnic composition of newborns admitted to US NICUs.
There was no significant difference in the racial and ethnic composition between neonatal nurse practitioner faculty and students, as indicated in this data of 198 NNP faculty and 403 NNP students:
FACULTY
83% White
7.4% Black
5.6% Asian
2.8% Latin American
0.9% "other" race/ethnicity
STUDENTS
79.4% White
6.5% Black
4.5% Asian
5.7% Latin American
1.7% "other"
However, there were discrepancies in the rates of underrepresented groups among NNP students compared to national data on newborns admitted to US NICUs.
All racial/ethnic groups showed significant difference, particularly:
19.5% of NICU admissions were Latin American, compared to 5.7% of students
18% of newborns admitted to NICUs were Black, compared to 6.5% of NNP students
"Underrepresented infants are born prematurely at higher rates and have increased rates of mortality and morbidity,” Newberry and Bell said in their study.
Despite recommendations to increase diversity among nurses and other healthcare providers, an "ethnic discordance" remains between NICU providers and patients, they wrote.
“The discordance between neonatal nurse practitioner students and neonates in the neonatal intensive care unit is important in addressing disparities,” the study says.
Diverse nurses offer a valuable perspective to nursing care by bringing shared life experiences with their patients and the ability to understand the culture and establish partnerships and communication with their minority patients, the authors wrote.
Most nursing schools are working to diversify their student population to address and rectify ethnic discordance. For example:
Chamberlain University, with the largest school of nursing in the country, has developed a research-based framework—the Social Determinants of Learning™—to advance nationwide efforts in creating a more diverse pipeline of students entering the nursing profession.
Frontier Nursing University in Versailles, Kentucky, has tripled its student of color population in the last decade by changing to a holistic admissions process and adding measures to ensure the inclusion or admission of students from a diverse backgrounds and rural and underserved areas.
Recognizing and addressing the barriers faced by underrepresented nursing students and faculty will "increase the diversity of NNP students and faculty and ultimately practicing NNPs," Newberry and Bell conclude. "The ability to diversify the NNP workforce will result in improved neonatal outcomes."
Flexibility and innovative practice models can enhance retention of nurses reaching retirement age.
Most nurses aged 55 and older have such passion for their work that providing schedule flexibility and different practice models to focus on their strengths could go a long way in keeping them in the workforce, a new study says.
“Understanding what predicts, mitigates, and prevents the retirement of expert senior nurses is paramount given the current environment of the nursing workforce,” writes the study’s lead author, Kim Slusser, MSN, RN, vice president of Patient Care Services, Smilow Cancer Hospital, part of Yale New Haven Health.
Slusser spoke with HealthLeaders about her study’s findings that could help healthcare organizations retain their seasoned nurses.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: What, generally, is the perception of the current nursing profession by nurses over 55?
Kim Slusser: They're very concerned about the nursing shortage and that it puts a stress on them and their ability to perform the things that they know make a difference for patients, just like we all are. But for this group of nurses, as we found in the study, the whole joy of their work as a nurse is what keeps them in the workforce, so all of these stressors that we're feeling right now from a nursing shortage can put that at risk.
In our study, they talked a lot about rising patient acuity and how that continues to be a challenge for healthcare systems. They, over the years, have seen that acuity increase yet, because of their experience and their expertise, we rely heavily on these nurses to do so much for us beyond patient care.
These are the people we're asking to precept new nurses, who are the charge nurses on units who manage the patient flow and how assignments are made, the troubleshooter for everyone. In academic hospitals, they are the resource to residents and interns who rotate onto their unit. These are things they enjoy doing, but with the rise in patient acuity, staffing challenges, and having all of these competing roles, it adds a lot of stress to the work every day.
HL: What are some challenges unique to them in today's workplace?
Slusser: Wearing a lot of hats in addition to taking care of patients. They also talked about the physical demands as you get older and how they used to be able to work long shifts but how that gets harder over time.
Many of them would like to continue to work because it's such a part of their identity—it’s what brings them so much value—so they're looking for ways to be able to do that in ways where physical demands would not take such a toll on them.
They brought up a lot of things such as more flexible hours. Some of the nurses we interviewed said they’ve stayed in nursing because they’ve been able to have flexible work assignments. Other recommendations are a lesser- or no-patient assignment. We need to see how they contribute to the next generation of nurses in a different way than the way we are asking them to do today.
HL: So many nurses over 55 opted to retire or quit during the pandemic, but others chose to stay on. Why?
Slusser: Their absolute love of what they do, that they feel they are making a difference, which brings them a lot of joy, and commitment to their career.
They did say that flexible scheduling was helpful in the decision to stay, so when you can put things like that in place, you have a better chance of retaining these nurses that are so valuable for our care delivery and the training of our future nurses.
HL: What are the benefits of retaining retirement-age nurses?
Slusser: They bring such a richness of experience to the organization. They are the people who we rely on to train more novice nurses. So many of the nurses, at least in this study, have worked for the same organization for a long time, so they have a commitment to the organization and they can foster that hospital’s culture.
Even beyond clinical experience, these nurses know how to develop relationships with patients, how to develop relationships with other clinical team members like physicians, social workers, and pharmacists. It takes a long time to be confident in your practice as a nurse, and these nurses have developed that confidence in their practice and they're able to help instill that in newer nurses coming onboard.
HL: What are specific accommodations that nurse leaders can make to encourage seasoned nurses to stay?
Slusser: We have to think differently about how our entire nursing workforce works. In this study, we focused on the nurses near or at retirement age, but we've learned with the younger generations of nurses that they want similar things. They want flexibility in their schedules. They want non-traditional shifts, as well, so it’s a win-win for the entire nursing workforce that many of the things that our nurses from this study wanted are similar things that we found in younger nurses.
We can become more creative and offer our scheduling, shifts, and even our roles part time. During peak times of clinical care activity, does everyone have to come into work at the same time? Right now, we’re traditional in how most of our hospitals schedule their nurses, so it’s going to require nursing leaders to take a step back and look very creatively.
Nurses can help inform how to do that well; hospitals that have strong nursing shared governance groups can lean on the nurses to help accomplish that so that the nurse leaders don't have to come up with these ideas all on their own.
Another recommendation of nurses in the study was to find a way to coach, precept, and educate more novice nurses in a way where they don't have to continue their other responsibilities such as maintaining a full patient assignment or being the charge nurse on the unit. There are ways we can relieve them of some or all of those duties so they can focus on coaching.
It is more expensive to take nurses and reduce their responsibilities to give them more time to coach novice nurses, so as nurse executives, we have to figure out a way to measure the return on investment for doing that. How can we measure that from a patient-outcomes perspective, retention of nurses, job satisfaction of nurses, and their confidence, which makes them a stronger clinician?
I do think there's cost avoidance if we stand up programs like this, especially around reducing turnover. Back in 2020, the nursing turnover rate was as high as 18% in some places, and turnover for new graduates was anywhere from 17% within their first year up to 30% within two years. If we can keep nurses in their profession by having nurses near retirement focus on coaching them, there could be a huge return on investment.
In FPA states, the NP workforce tends to be more diverse and better racially and ethnically aligned with the state's overall population, a new West Virginia study says.
Granting full practice authority (FPA) to nurse practitioners (NPs) is a “costless” way to help communities of color address healthcare access disparities, say authors of a new West Virginia University study.
More than half of US states have granted FPA, which is the authorization of NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing, rather than requiring them to hold a state-mandated contract with a physician as a condition of state licensure.
Though NPs of color are underrepresented in the workforce—less than 7% of NPs are Black, according to employment recruiter Zippia—states permitting FPA tend to have NP workforces that are more diverse and more racially and ethnically aligned with the state’s overall population, the study says.
“We also found evidence that Black and Asian nurse practitioners serve more Black Medicare beneficiaries after receiving FPA,” according to study co-author Alicia Plemmons, a John Chambers College of Business and Economics assistant professor and coordinator for scope of practice research at the Knee Center for the Study of Occupational Regulation. “Full practice authority is a costless way of helping communities of color address healthcare access disparities.”
The study addresses three healthcare industry concerns:
1. The worsening shortage of US primary care providers, particularly in marginalized communities.
2. The importance of enabling patients from communities of color to choose primary care providers who share their racial and ethnic background.
3. The debate over allowing nurse practitioners to exercise FPA.
“In every state, NPs may all meet with patients, but that’s where the similarities stop,” Plemmons says. “Some states require physician supervision for NPs, while others simply require collaboration agreements. Some limit NPs in diagnosing patients or developing treatment plans, others limit making specialist referrals or ordering imaging services. Probably the most contentious restriction is prescribing medication.”
Reflecting patient demographics
The study compared the backgrounds of NPs, patients, and overall state populations nationwide, focusing on Black, Asian, and Hispanic communities and found that FPA states had higher concentrations of NPs from communities of color.
Representation varied among different communities, according to the study, but the data for Black NPs and patients in FPA states stood out: Black NPs in FPA states served 2.8% more Black Medicare beneficiaries than Black NPs in non-FPA states.
That’s significant because a nursing workforce that reflects its patient demographic makes healthcare more comfortable for every patient, several studies, including a Joint Commission report on cultural diversity, have shown.
But finding a doctor, especially a Black doctor, isn’t always easy, particularly in diverse, poor, or rural communities where doctors generally won’t work—but NPs will.
Regardless, many states continue to limit NPs’ FPA, often on the basis of physician concerns about quality of care. The American Medical Association and other physician groups argue collaborations are needed for patient safety.
