From predictive algorithms to revisiting past care models to virtual nursing, nurse leaders are digging in and finding solutions to the current staffing crisis.
Nurse staffing created some of the most difficult trials for nurse leaders during 2021, but it also sparked their ingenuity as they searched for solutions.
As the pandemic continued its deadly spread across the United States, nursing shortages, which had been a challenge even before COVID-19 arrived, intensified. Nurses on the cusp of retirement opted to go, while others left because of burnout, contract labor opportunities, opposition to vaccination mandates, or to take care of family.
Indeed, nearly 30% of RNs are at risk of leaving their organization and millennial nurses are most likely to quit, according to a national analysis by Press Ganey.
"ANA is deeply concerned that this severe shortage of nurses, especially in areas experiencing high numbers of COVID-19 cases, will have long-term repercussions for the profession, the entire healthcare delivery system, and ultimately, on the health of the nation," ANA President Ernest Grant, PhD, RN, FAAN, wrote in the letter.
Despite the dire conditions, nurse leaders at hospitals and health systems began getting creative and looking at alternative ways to safely staff their organizations.
"We wanted to use predictive analytics to help us staff-to-demand and reduce variations in staffing in situations we could predict and in unpredictable variation as well," says Mary Agnew, DNP, RN, NEA-BC, senior vice president and chief nursing officer (CNO) of Tower Health, based in West Reading, Pennsylvania.
The process began with exhaustive and painstaking data-gathering, for which Tower Health worked with management consulting company Kaufman Hall.
Tower Health began its work with Reading Hospital, the health system's flagship hospital, gathering data from payroll, staffing grids, the historical census—including the hourly census—for the previous three years for each individual unit, bed capacity, nonproductive time, turnover rate, vacancy rate, hours used for FMLA (Family and Medical Leave Act), nurse-to-patient ratio, and all other essential information to put into a workforce optimization engine, Agnew says.
"You really have to gather everything," she explains. "Your staffing is impacted by dozens of other variables other than hours per patient day."
The tool then created a model for each unit and identified what core staffing the hospital system would need to fulfill scheduling demands, Agnew says.
The next part of the equation was deciding what portion of their workforce would be flexible.
"You have your core workforce, which is lean, and then your flexible workforce, which is there for unpredicted variations," she says.
Predictive analytics provided a completely different way of scheduling, and when managers and directors saw how the new patterns improved staffing, Agnew says, they became believers.
LPNs—alternately referred to as licensed vocational nurses (LVNs)—have been phased out over the last decade by health systems seeking higher-educated nurses who can provide a wider scope of duties.
Although 14% of LPNs remain in U.S. hospitals, many (38%) took their skills to nursing and residential care venues, according to the U.S. Bureau of Labor Statistics.
Claire Zangerle, DNP, MSN, MBA, RN, FAONL, NEA-BC, chief nurse executive for AHN, based in Pittsburgh, Pennsylvania, saw LPNs as a key puzzle piece in remedying nurse staffing and last summer began a pilot program placing LPNs on nursing teams.
The decision was met with some reluctance from her own teams.
"I said, 'Look, this is an option that we have. We can't get the nursing assistants, we can't get as many RNs as we'd like, but we have a group of people that we could reach out to,'" she recalls.
"We have LPN schools around our region, and we also have two nursing schools that we can matriculate LPNs into RNs if they want to," Zangerle says. "We have to give everybody the opportunity to do the work if they want to do the work and we have the structures in place to support that work."
AHN piloted the program in one or two large nursing units at each of its hospitals.
"We're doing pilot work with what used to be called team nursing but we're calling it blended nursing because we have an initiative throughout our enterprise called blended health between our provider organization and our payer organization," she says.
Patients are cared for by a blended team led by an RN and consisting of an LPN and a nursing assistant who divide up duties based on their skill sets, Zangerle says.
"A nurse can oversee more patients if the nurse has the support at the elbow that they need, and the LPN and the nursing assistant assigned as a team gives them that support," she says.
Zangerle sees the blended model as permanent for AHN.
"Objective and subjective data tells us it's working and it's a formula that's good for us. It's not on every unit, it won't work on every unit, and we don't need it on every unit," she says. "It's usually on the busy med surg units, it's good on rehab floors, it's good in orthopedics."
"All the data and predictions show us that it's not going to get better in the next decade, and we need to have alternative approaches," she says. "This is a highly viable alternative approach."
Virtual nursing solves more than just staffing problems
MercyOne Des Moines' innovative virtual nursing program uses videoconferencing technology and dedicated devices in each patient room, allowing the hospital's virtual nurses to assist bedside nurses by monitoring the unit from a remote digital center.
The model not only has helped ease the hospital's nurse staffing, but it has yielded so much more: improved quality; decreased falls; decreased medication duplication; decreased missed care; and zero catheter-associated urinary tract infections (CAUTI) rates, says Linda Goodwin, MSN, MBA, FACHE, senior vice president of clinical operations, integration, and innovation, who piloted the program in her former position as MercyOne's chief nursing executive (CNE).
The virtual nurse, who is responsible for 18 patients, participates in daily interdisciplinary rounds via teleconferencing, in which the patient's care team videoconferences into meetings, compares notes, and confers with each other, she says.
The virtual nurse, located in the virtual nursing digital center several miles away, then facilitates all care communications, such as calling for test or lab results, reviewing charts, handling discharge duties, and anything else the care team needs, Goodwin says.
Dietary, care management, and pharmacy also are part of the growing virtual nursing program, Goodwin says, adding, "It isn't just a nurse model anymore; it is a multidisciplinary model."
Busy floor nurses taking care of five or six patients particularly welcome the assistance and support virtual nurses provide because they see fewer falls and other harm because the virtual nurse has a constant eye on each patient; they can hand off discharge duties to virtual nurses; and they experience fewer interruptions, Goodwin says.
Goodwin credits the program's success to the forward thinking of Kathleen Sanford, DBA, RN, now executive vice president and chief nursing executive (CNO) of CommonSpirit Health, of which MercyOne is a part.
"Way back in 2011, Kathy made a prediction that the nursing shortage was not going to end, and we would have to adopt new innovative approaches to providing nursing care," Goodwin says.
The virtual model has become so favored at MercyOne that more nurses are requesting it, Goodwin says.
"The only limiting factor is getting virtual nurses hired," she says, "and then being able to spread it as quickly as we want."
19% of international nurses work in intensive care units (ICUs) or in critical care, compared to 15% of all U.S. nurses, new survey says.
International nurses are filling roles in high-need, and, often, high-risk, and high-stress environments at a greater rate than all U.S. nurses in the workforce, says a new survey conducted by O’Grady Peyton, the International Staffing division of AMN Healthcare.
The 2021 Survey of International Nurses tracks the roles and experiences of international nurses working in the United States at a time when the nation is facing a profound health crisis.
About 8% of all nurses providing care in the United States are internationally trained, which equates to about 300,000 nurses, the survey says. Most (77%) are from one of three countries: the Philippines, Jamaica, and India, while 10% are from Africa.
Key findings include:
19% of international nurses surveyed work in intensive care units (ICUs) or in critical care, compared to 15% of all U.S. nurses.
8% of international nurses work in hospital emergency departments (EDs), compared to 5% of all nurses.
11% international nurses surveyed work in psychiatric care settings, compared to 4% of all U.S. nurses.
"At a time of prevailing nurse shortages, international nurses are providing a vital supplement to the workforce, filling some of the most demanding and critical patient care roles during the pandemic," Sinead Carbery, president of O’Grady Peyton. "Many hospitals would be on the brink of collapse without them."
Nearly 90% of international nurses providing care in the United States have treated COVID-19 patients, with most (56%) treating 21 or more COVID patients, the survey says.
Some 17% reported having themselves contracted the coronavirus.
Filipino nurses, in particular, have paid a high price working on the frontlines during the COVID-19 pandemic. Though Filipino nurses comprise only about 4% of all U.S.-practicing nurses, 24% of nurses who died of COVID-19 as of April 2021, were Filipino, according to the survey.
Levels of training
While 56% of all U.S. nurses hold a Bachelor of Nursing (BSN) degree or higher, that number is considerably greater for international nurses, with 90% holding BSN or higher, 12% holding a Master of Science in nursing (MSN), and 1% a Doctor of Nursing Practice (DNP), the survey says.
"International nurses are both highly trained and typically have multiple years of experience before arriving in the U.S.," Carbery said. "They are not simply filling open positions — they are contributing to the high quality of care U.S. patients receive."
Widespread acceptance—and burnout
International nurses are widely accepted by their patients and healthcare colleagues, they indicated in the survey:
86% are accepted by patients.
87% are accepted by other nurses.
85% are accepted by physicians.
A significant minority (36%) said they have "often" or "many times" experienced discrimination based on their country of origin or ethnicity.
Most (56%) said they are paid equitably compared to U.S. nurses, while 80% said their hours are equitable.
However, as with all nurses, international nurses are subject to high levels of burnout, the survey said, with 81% indicating they sometimes, often, or always experience feelings of burnout.
Regardless, 79% said they are somewhat to very satisfied with their jobs. Of the respondents, 81% said they would choose to work in the United States again if they had their careers to do over, while only 5% would not (the remaining 14% were neutral).
85% of surveyed nurses strongly believe national licensure—allowing nurses to practice across state lines—would have benefited the country during the pandemic.
A new report finds that 66% of nurses surveyed expressed some level of consideration to leave their profession, signaling long-term impacts to healthcare.
Nearly 37% of nurses identify as being burned out, stressed, and/or overworked.
Only 32% of nurses are very/completely satisfied with their occupation, compared to 52% prior to the pandemic.
29% of nurses say their desire to leave the profession is dramatically higher now versus pre-pandemic, noting the nursing shortage and inadequate staffing levels as top contributors to the low satisfaction.
"On one hand, this research shows us that the pressures for nurses under COVID-19 are significant and likely long-lasting," said Henry "Hank" Drummond, PhD, MDiv, BA, RN, Cross Country Healthcare's senior vice president, chief clinical officer.
"On the other hand, the data is very clear in outlining specific areas that we can improve," he said in a press release.
The survey also identified changes that the surveyed nurses indicated would benefit the profession, such as:
97% said pay rate increases and other incentives would attract and retain nurses.
58% answered that telehealth should be a cornerstone of care delivery.
85% percent responded that cross training must be improved to adapt to crisis events.
85% strongly believe national licensure—a multistate license that would allow nurses to practice across state lines—would have greatly benefited the country during the pandemic.
"Our nurses are the backbone of the healthcare system and if too many leave or decide not to pursue a career in nursing, the consequences would be catastrophic," said Safiya George, PhD, APRN-BC, FAANP, dean and professor at Florida Atlantic University’s Christine E. Lynn College of Nursing.
"Our nurses need solutions, many of them outlined in this research," George said, "that will ease burnout and reduce stress, as well as help them enjoy long-term and satisfying careers."
Nursing must look ahead because the workplace of yesterday will never return, thanks to the pandemic, CNOs say.
From containing costs to staff well-being to a changing workplace, acute-care nursing is entering a new reality, and chief nursing officers (CNOs) must adapt and embrace new ways of making it work, according to the consensus of chief nursing officers at the HealthLeaders CNO Exchange.
These three areas garnered much of the discussion during the two-day Exchange, which wrapped up today in Austin, Texas:
Traveling Nurses
Where hospitals once operated with a small percentage of their staff as temporary agency nurses, the pandemic and the staffing shortages it has created, has “seismically changed” that, one CNO said.
Travelers are no longer an anomaly, but a requirement for CNOS trying to safely staff their hospitals, and the CNOs must now think in terms of 13-week contracts when orientating, teaching safety protocols, and moving travelers in and out of the right units, the CNO said.
One CNO suggested allowing a hospital’s nurses to travel, but to also keep them employed by the hospital so they return to their home base. That strategy would enable CNOs to retain staff that understand their work and culture, she said.
The financial cost of travelers, some of whom may make $250 per hour, is a concern, because, although the CNOs generally don’t blame nurses for wanting to boost their salary, such a fee structure is unsustainable to a hospital, they said.
A salary cap is placed on travelers, as suggested by some state-level politicians, would be ineffective unless it’s a federal cap, one CNO explained. Most travelers are from out of state, so if individual states adopted a cap, travelers in those states would simply depart for states with no cap, leaving hospitals in the capped states with drastic staffing shortages.
Mental health and well-being
Bringing mental health support to nurses, rather than requiring them to make the effort, is crucial to helping them fortify and maintain their well-being, many of the CNOs said.
One CNO recounted how the single most-effective step her hospital took during the worst surges of the pandemic was bringing mental health counselors onto the units to guide nurses through the unprecedented surge of deaths they were experiencing.
“They were more able to cope,” the CNO said, adding, “They were not accessing services when they had to go them, so we brought it to them.”
Relaxation rooms, snack carts, and other nurse appreciation perks are only part of what nurses need for their well-being, a CNO said.
“The pandemic has identified all the areas you need to fix,” and the solution to nurses’ well-being is to set about fixing those problems, she said.
Figuring out flexible schedules, making sure nurses truly do get their breaks, and streamlining some work processes will also bring nurses the relief they’re seeking, the CNO said.
The changing workplace
Technology is quickly changing the way care is delivered, and the new generation of nurses is more comfortable with that, because they’ve grown up in a more tech-advanced world than previous generations.
“We need to be willing to listen to the new generation of nurses and translating their new ideas to actions,” one CNO said. “We haven’t lived in society they have, and we can’t see the opportunities they see in order to work smarter.”
Patients of the future also are well-versed in technology and will have different expectations than older patients when it comes to their healthcare experience, CNOs said.
That means nurses must possess all the skills—including technological—to take care of those patients of the future.
The health system's specially designed rapid response team has curtailed violence and created a safer workplace for its employees.
When an altercation—verbal or physical—begins at Inova hospitals, it is quickly met with a rapid-response team specially trained to de-escalate and safely contain the fracas.
The Safety Always for Everyone (SAFE) team, Inova's major response effort to de-escalate issues and provide support for team members while also assuring safe care to patients, has resulted in fewer incidents and a staff much more confident in their workplace safety, says Kathy Helak, MSN, BSN, RN, FACHE, CPPS, Inova's assistant vice president for Patient Safety.
Violent incidents can occur in different ways, Helak says. They range from disrespectful verbal confrontations where an individual—usually a patient—directs profanities, threats, or slurs toward healthcare workers to physical altercations where they hit, kick, punch, or spit on them.
Inova, a five-hospital health system based in northern Virginia, put the SAFE team in place about two years ago, after frontline team members reported that they felt uncomfortable addressing altercations by themselves.
"They didn't necessarily feel that they had the right skills and they needed additional resources," Helak says.
After researching best practices across the country, Inova created a plan.
"We know that having a team of experts that can immediately respond when something does happen with a patient or family member is best, so we immediately pulled together a multidisciplinary team that included nursing expertise, security expertise, colleagues from mental health areas, our communications team, and we worked to really design what we thought would be the best approach to providing this type of intervention," Helak says.
"What was so exciting at the time when we did this was how engaged all those folks were to be able to provide a stronger approach to [give] immediate relief for our frontline team members," she says. "Everybody was motivated to do whatever we needed to do to make sure that our frontline team members felt safe."
Inova developed an around-the-clock SAFE plan, piloted it, accepted feedback, and fine-tuned it based on that feedback. It's now adopted in all the health system's facilities.
Keeping everyone out of harm's way
The SAFE team is comprised of security officers specially trained in how to de-escalate confrontational situations, the nursing supervisor, mental health experts to help de-escalate the situation, physicians, and other team members, as needed, to provide their expertise, Helak says.
When a healthcare worker feels they are in an unsafe situation, they can call a special number that alerts the SAFE team, which responds immediately, she says. The team then uses their skills to de-escalate the situation, get control of it, and keep both the patient and healthcare workers safe so no harm comes to anyone involved, she says.
The intervention doesn't end when the altercation has been resolved, Helak says.
"Following those situations, we often do what we call a debrief, to look at whether there is anything we could learn from this situation so that we could prevent it from occurring next time or if we missed any cues that could have helped us de-escalate the situation before it got out of hand," she says.
Fewer altercations, more comfort
Rapid response has helped the health system's team members feel safe and secure while doing their jobs, particularly since they can be summoned on a moment's notice, Helak says.
Additionally, the number of time that security must be called because of a concerning interaction has been reduced, she says. That's because a patient who encounters the SAFE team is less likely to have behavioral issues for the remainder of their hospital stay, she says.
"It really does allow us to establish the expectations with patients or with their family regarding our desire to provide a very therapeutic environment for the patient to be well taken care of," she says, "but we have expectations in terms of how they need to behave while they're here."
Zero tolerance
Emotions run high in hospitals, making violent outbursts more common than in other settings. But whereas it used to be considered just "part of the job," that is no longer the case, Helak says.
"We here at Inova believe that this is totally inappropriate, and that we are not going to tolerate any of our team members being subjected to any kind of verbal abuse or physical abuse that compromises their ability to feel state and then compromises their ability to be able to take care of their patients," she says.
"Over the last few years, we have really worked very hard at Inova, as part of our commitment to zero tolerance, to encourage our team members, regardless of the type of interaction, to speak up to report it," Helak says. "And we are engaging in improvement efforts to make sure that we have evidence-based approaches to preventing these types of situations from occurring and helping employees feel safe."
New policy brief issued by leading nurse organizations says disseminating incorrect information jeopardizes public health.
Nurses who circulate COVID-19 misinformation verbally or in writing—including social media—could jeopardize their license, according to a new policy brief issued by leading nursing organizations.
Because COVID-19 is a potentially deadly virus, providing misinformation to the public regarding masking, vaccines, medications and/or COVID-19 threatens public health, according to the NCSBN.
"Misinformation, which is not grounded in science and is not supported by the CDC and FDA, can lead to illness, possibly death, and may prolong the pandemic," the policy statement reads.
The policy statement defines misinformation as "distorted facts, inaccurate or misleading information not grounded in the peer-reviewed scientific literature and counter to information being disseminated by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA)."
It addresses misleading or incorrect information pertaining to COVID-19, vaccines, and associated treatment.
“Nurses are urged to recognize that dissemination of misinformation not only jeopardizes the health and well-being of the public but may place their license and career in jeopardy as well,” because they may be disciplined by their board of nursing, the brief states.
"It is an expectation of the U.S. boards of nursing, the profession, and the public," says a NCSBN press release," that nurses uphold the truth, the principles of the American Nurses Association Code of Ethics for Nurses, and highest scientific standards when disseminating information about COVID-19 or any other health-related condition or situation."
An engaged nursing staff increases safety, decreases mortality rates, and saves money.
Cultivating strong engagement in a nursing staff requires nurse leaders to listen, ask questions, and walk in their nurses' shoes, says Heidi Clark, RN, BSN, chief nursing officer (CNO) at Cox Barton County Hospital, Lamar, Missouri.
The growing number of studies on nurse engagement identify several outcomes, such as safety, decreased mortality rates, decreased falls, quality, and patient experience.
Engagement also affects a hospital or health system's bottom line. Fifteen of every 100 nurses are considered disengaged, with each disengaged nurse's lack of productivity costing an organization $22,200 in lost revenue annually, according to a 2016 study published in the American Nurses Association's Online Journal of Issues in Nursing.
Drivers of engagement, Clark says, are independent to each employee.
"I've learned through the years that everybody has a purpose or a strong point. It may be their bedside manner, or for others it may be their path or skill level," she says. "You have to find out what their strong point or their passion is and then help them to build upon that."
"Once you tap into what's important to them, you need to get them to come forward to feel empowered—that what they're suggesting can make a difference and will be listened to," she says.
CNOs should start by being easily accessible to their nurses, she says.
"Be observant, and be out there [on the floor]," Clark says. "I still float out and provide patient care. Knowing firsthand what their challenges are allows me to connect to them when they come to me and they're complaining about something with the EHR being difficult or time-consuming or not having a supply or piece of equipment they need."
Nurse leaders who don't have time to work alongside their staff can show solidarity and support by attending morning shift huddles, rounding, including one-on-one rounding with staff members, and asking questions, she says, such as what equipment they need to do their job or what struggles they're having.
Caregivers will rarely readily provide a list of dissatisfactions, so asking questions is crucial, Clark says. Instead, nurses need to know that leaders are interested in what they think.
"Once you get them talking and they start to see the changes because of things they brought forward, you will see them coming forward with more things," she says.
Nurse leaders should also make sure nurses are aware of the changes they've created, Clark says.
"Whether it's in your weekly updates or in staff meeting minutes, make sure you let them know, 'These are the things that we've accomplished in the last month,' or 'These are the things you've brought forward and we're working on it.' Or if we can't change something, they need to know why," she says. "You have to have momentum to show you're continuing to move forward, even if it's small steps."
'Fulfilled in what they're doing'
Besides benefiting the organization and patient, outcomes of nurse engagement benefit the individual nurse, as well, Clark says.
"It helps them to be fulfilled in what they're doing," she says. "We've seen several who are pursuing continuing education certifications because they are becoming more engaged, and they want to be able to improve or increase their educational abilities so that they can participate in programs like the clinical ladder or be able to move into another role."
Generally, some of a nurse's engagement is the responsibility of the individual—"I would like to say it's 50-50," Clark says—but the challenging circumstances of COVID-19 have tilted most of the responsibility to the hospital, she says.
"With our staff nurses, especially bedside staff, being so overworked through COVID, it has to be more upon the administrative and the supervisory level to get out there and really promote engagement," she says. "They are already giving 110%."
Encouraging engagement has "definitely" been made more difficult by the pandemic, particularly when they're given sicker patients, higher patient ratios, and the responsibility to help patients communicate with their families outside the hospital, along with the required charting and quality measures, she says.
But the nurses' commitment remains, she says.
"Many of them are very proud," Clark says, "of what they've been able to do."
"We have heard the amounts charged to hospitals rose precipitously when the most recent wave of the COVID-19 crisis swept the nation and the agencies seemingly seized the opportunity to increase their bottom line. But this is not the first time the agencies have engaged in this sort of conduct," the letter reads. "As the first wave of COVID-19 swept the nation in 2020, they similarly inflated their prices to hospitals. Hospitals have no choice but to pay these exorbitant rates because of the dire workforce needs facing hospitals around the country."
After a short reprieve, expensive contract labor for nursing has increased as COVID-19 cases have risen with the Delta variant, and in some cases, to a higher level than during the surge seen in mid-2020, some hospitals report. The use of traveling nurses has further driven up the demand and cost of contract labor.
"This model is unsustainable for many health systems," the letter says.
The lawmakers asked Zients to enlist one or more of the federal agencies with competition and consumer protection authority to investigate this conduct to determine:
Is this activity the product of anticompetitive activity?
What is the ownership structure of these staffing agencies and is there evidence of price collusion or other anti-competitive pricing patterns?
Does this activity violate consumer protection laws?
Are these increased rates translating to higher pay for contract nurses?
What impact have these price increases had on rural and underserved areas?
Have nurse staffing agencies increased their own percentage of profit during the COVID-19 pandemic? If so, by how much?
How much of the COVID-19 relief funds are directly or indirectly going to pay these contracts?
How may the 100% cost share for FEMA reimbursement be contributing to the ability of the staffing agencies to extract higher payment?
"We urge you to ensure that this matter gets the attention from the federal government it merits," the letter concludes, "to protect patients in dire need of life-saving healthcare treatment and prevent conduct that is exacerbating the shortage of nurses and continuing to strain our health care system."
The pandemic has fundamentally altered pediatric care delivery across the United States, new study says.
Pediatric advance practice registered nurses (APRNs) not only face mental health concerns from COVID-19 like their counterparts who treat the adult population, but they experience some stressors unique to their specialty,according to a new study led by Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, clinical professor at Baylor University's Louise Herrington School of Nursing.
Although the effects of COVID-19 in children have not been as severe as they have been with adults, or even as prior outbreaks of communicable diseases, such as polio, the pandemic has fundamentally altered pediatric care delivery across the United States, Peck says in the study.
Pediatric APRNs and agencies are experiencing significant disruption in care provision, patient presentations, clinical practices, immunizations, and revenue streams, the study says.
Furthermore, some pediatric APRNs have transitioned to work with adult populations "in an unprecedented fashion," while others have been temporarily furloughed or permanently laid off due to a stronger demand for critical care nurses and a lower demand for primary care nurses.
"While physical disease impacts on children have generally not been as dire as some historic precedents like polio, they are by no means spared," Peck said in a press release.
"Pandemic conditions have fundamentally altered the norms of pediatric care delivery and, as a profession, we share collective concerns: severe COVID in children with pre-existing conditions, life-threatening multi-system inflammatory syndrome, disturbing disparities in severity of illness and death, particularly for children of color who account for 75% of pediatric COVID-19 deaths, and free-falling immunization rates with recovery not yet in sight," she said.
As with most nurses, the strongest impact of COVID-19 has been on APRNs' mental health. The research indicates that 34% of respondents are feeling moderate to extreme concern for professional burnout; 25% feel anxious or nervous; and 15% are experiencing depression or hopelessness. Overall, 20% of participants reported feeling moderate to extreme concern for their mental health.
"As a profession, many pediatric nursing professionals are working far more hours for far less compensation, isolated from professional networks. They are learning new technologies and implementing new policies in little time with even less support. Pediatric clinics are severely disrupted," Peck said.
"Children’s hospitals received less than 1% of all federal relief monies provided to U.S. hospitals, leaving children without access to care," she said. "All of this contributes to destabilized pediatric infrastructure, which disproportionately impacts marginalized children."
About 32,000 healthcare employees had threatened to strike beginning today over understaffing and wages.
Kaiser Permanente healthcare workers are on the job today after the company averted what could have been a crippling strike.
The healthcare giant reached a tentative agreement with the Alliance of Health Care Unions over the weekend on a four-year contract, covering nearly 50,000 Kaiser Permanente healthcare employees in 22 local unions, according to a press release.
Some 32,000 employees in California, Oregon, and six other states had threatened to walk off the job beginning today in protest of understaffing and wages.
The agreement includes new staffing language and annual wage increases and maintains benefits while providing career development and advancement opportunities for Alliance union-represented employees.
Details of the tentative agreement include:
Wage increases: Guaranteed across-the-board wage increases each year through 2025 in every region for all Alliance-represented employees
Health benefits: No reductions or takeaways to family medical and dental coverage with the same co-pays for prescriptions and office visits
Retirement benefits: The agreement maintains retirement income benefits and employer-subsidized retiree medical
Bonus opportunities: Introduction of the Alliance Bonus Plan, which provides annual payouts for achieving new mutually agreed to objectives to address affordability
New safe staffing and workload language: Will ensure every Kaiser Permanente patient receives safe care
Opportunities for career growth: Alliance-represented employees will continue to have career development and advancement opportunities
The tentative agreement was approved by members of the economic subcommittee of the Alliance of Health Care Unions and will now go to union members for ratification. Voting on the tentative agreement will occur over the next several weeks.
"The Alliance of Health Care Unions fought to preserve a Kaiser Permanente where patients can count on excellent patient care and service," said Hal Ruddick, executive director, Alliance of Health Care Unions. "This has guided our work for 24 years."
"This agreement will mean patients will continue to receive the best care, and alliance members will have the best jobs," he said. "This contract protects our patients, provides safe staffing, and guarantees fair wages and benefits for every alliance member."
The agreement positions Kaiser Permanente to continue providing quality, affordable healthcare to the communities it serves, said Christian Meisner, Kaiser Permanente's senior vice president and chief human resources officer.
"These were challenging negotiations, but this tentative agreement demonstrates the strength of our Labor Management Partnership and the unique success it can achieve when we work together," he said.
The alliance and Kaiser Permanente have agreed to form a national Affordability and Competitiveness Task Force with specific targets to find innovative ways to address issues of affordability while continuing to work together to protect high-quality patient care.
