Crown Heights/ Prospect Heights Community Assessment

Health Promotion Poster

Stress in the workplace is often common and unavoidable no matter the title or position. Many people of the working class experience high levels of stress depending on their occupation and many do not know how to effectively cope with it. This often results in “burnout” and excessive absenteeism. Danielle Lamb and Nicola Cogan wrote the article I read entitled “Coping with work-related stressors and building resilience in mental health workers”. Lamb and Cogan take a phenomenological research approach in answering the question, “how do mental health workers cope with work-based stressors and how do they develop resilience?” The two examine two groups, NHS mental health workers and Samaritan’s volunteers and compare the working experience of both parties.
Resilience is defined as a “dynamic process encompassing positive adaptation within the context of significant adversity. Previous research has identified that those individuals classed as ‘resilient’ have some shared characteristics, for example being female, socially responsible, good communicators, capable of self reflection, flexible and determined and having supportive social and family relationships” (Lamb,2016, p. 475) . It is important for mental healthcare workers to gain a sense of resilience because of the high emotional demands of the job. In this study, Lamb and Cogan conclude that the primary stressor of working in mental health services is not the content of the job but it can become so when it is combined with other stressors such as excessive workloads and lack of supervision. They also note that having adequate time to prepare for contact with service users to complete administrative task and to keep up to date with developments in the field is vital in maintaining the high- quality services they seek to offer. I agree and relate to this statement. As a nurse working in the healthcare field it can be very demanding. At times before I walk into work I have to tell myself to leave my feelings at the door because as a healthcare worker you often take on the burdens of your patient or client. This can have a negative impact on your level of stress and ability to perform duties appropriately. I feel like all high stress level jobs should offer stress management training as well as other resources that employees can utilize when experiencing job related stress. The information I gained from this article ties back into the classroom discussion we had on job strain and job stressors. It also raises the question as to why a program that can teach employees how to effectively cope with stress and develop resilience has not been implemented in high stress environments yet. Research shows and supports the fact that high stress environments lead to high absenteeism, poor work ethic and high turnover rates. In my opinion, such a program will benefit employers and employees alike in the near future.

References

Lamb, D., & Cogan, N. (2015). Coping with work-related stressors and building resilience in mental health workers: A comparative focus group study using interpretative phenomenological analysis. Journal of Occupational and Organizational Psychology, 89(3), 474-492. doi:10.1111/joop.12136

It is no secret; the United States has faced many nursing shortages throughout history however, the current nurse shortage Americans face today is unlike those of the past. Due to the many changes in the American economy, politics and education, the nursing profession has encountered an epidemic that seems to have no current resolution. Researchers have thoroughly examined the causative factors that contribute to the nursing shortage and the strategies used it however none have been successful and here’s why.

The nursing shortage we are about to face has many different causative factors that combine to create “the perfect storm.” ANA Health Care Economist Peter McMenamin on the Nursing Shortage Outlook indicated that there are six causative factors that contribute to the nursing shortage; they include the economic recovery, the baby boomers, the Affordable Care Act, employer changes, market changes and care coordination. Changes in the delivery of the healthcare, the increase in retiring healthcare professionals and economic recession continues to leave a strain on the nursing profession by eliminating staff nurse positions, freezing hiring, and creating a large amount of registered nursing positions without a pool of employees to fill these positions. Along with these causative factors, the United States Bureau of Labor Statistics (2018) states that the projected employment growth will be 15 percent from 2016 to 2026, which is much faster than the average for all occupations. This projected growth along with the current nurse shortages we face across the country raises issues of concern for the succession and progression of the nursing profession.

Economically speaking, the recession of 2007 had a direct effect on the nursing shortage we are faced with today; the recession of 2007 led to a profuse amount of budget cuts, layoffs and hiring freezes in hospitals nationwide. With nurses being the largest professional group in healthcare, these cost-effective changes have strongly impacted the nursing profession. Economic downsizing has triggered several negative outcomes within the profession which includes poor retention rates, job dissatisfaction, and nurse burnout. Huston (2018) states, “one of the most significant yet least addressed factors leading to the current RN shortage is workplace dissatisfaction, resulting in high turnover levels and nurses leaving the profession.” Low autonomy, heavy workloads, and the inability to ensure patient safety has caused high turnover rates, leaving hospitals and skilled nursing facilities extremely understaffed. American Nurse Today (2012) reports that 30% of new graduate nurses (NGN) will leave their jobs within the first year and 58 % will leave during their second year. These high turn over rates leave hospital and nursing facilities with the task of figuring out how they can retain new nurses to help fill the gaps left from the retiring generation.

Due to the gradual increase in the aging population and number of patients who will require treatment for chronic diseases such as chronic obstructive pulmonary disease, diabetes and coronary artery disease, the projected increase in registered nursing positions will contribute to the current issue we face with nursing shortages.  AMN Healthcare 2017 survey suggest a “long- predicted wave of retirements among baby-boomer nurses”; this information amplifies the crisis of nurse shortage and as healthcare professionals continue to experience the negative impacts of this shortage, the expectancy of improvement continues to decline. AMN Healthcare indicates that

“nursing shortages are already being felt throughout the country, and they are expected to intensify as the retirement wave becomes a more significant factor. The retirement wave is combined with other macro trends, such as the rising demand for healthcare services from our aging general population, to create a perfect storm of steadily worsening clinical workforce shortages.”

The AMN accurately describes the current nursing shortage as the combination of events as “the perfect storm”. Due to the combination of events that have directly influenced the current nursing shortages, an epidemic has been created that could not have existed independently by one single cause.

Reforms in health care acts such as the Affordable Care Act (ACA) have also directly impacted the demand for RNs. The increase in insured clients has caused an increase in emergency visits; clients who were once reluctant to seek medical advice due to financial status no longer worry about hefty hospital bills which is why nurses and doctors currently encounter heavier caseloads. The ACA also has a direct impact on the places RN’s work and the skills they require to be successful in settings other than the hospital. With healthcare moving more toward the community setting, an array of positions continue to be created to keep clients at home and out of the hospital. According to Spetz (2014)

“Registered nurse employment is expected grow most rapidly in outpatient settings – particularly physician offices – and home health care. In these settings, RNs will be expected to serve as care coordinators, case managers, patient educators, and chronic care specialists.”

This shift in healthcare has created an array of positions outside of the clinical area without adequate supply of qualified nurses to fill positions. In addition to the increase in demand for RN outside of the clinical field, many of these positions such as telephonic assessment nurse requires advance skill and experience which new grads do not possess.

From an educational standpoint, reasons why there is a nursing shortage in the United States include low funding which resulted in the closure of many nursing programs, vacancies in teaching positions which resulted in a lack of faculty to educate nursing students.

“Budget constraints, an aging faculty, and increasing job competition from clinical practice sites have contributed to the nursing faculty shortage across the country which has resulted in limiting student capacity at a time when the need for professional registered nurses continues to grow (American Association of Colleges of Nursing [AACN], 2017).”

Snavely (2016) reports that nursing schools reported a substantial amount of shortages in faculty, restricting nursing programs from enrolling an optimum number of new students.  According to the AACN, U.S. nursing schools turned away nearly 80,000 qualified applicants to baccalaureate and graduate programs in 2012 “due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints”.  Some nursing schools have even gone as far as to close nursing programs due to funding.  Despite the steady increase in enrollment in school, the increases are not enough to replace the nurses who will be lost to retirement in the coming decade. Increases in federal money for nursing education over the last decade. Vacancy in teaching positions and financial encouragement for nursing students to complete their studies and assume teaching positions.

Experts have attempted to fix the nursing shortage in many ways. Huston (2018) identifies one of the problems in nursing recruitment to be the focus on recruiting young nurses instead of bringing unemployed and part time nurses back into full time positions. However, what experts failed to realize is that the recession of 2007 forced many unemployed and part time RN’s to return to full time positions. In a sense, experts were depending on a resource that had already been tapped out.  The shortage has also been alleviated in part by the importation of RN’s from foreign markets. This has served as a temporary fix as the shortage continue to rise at a steady rate while foreign nurse return to their country after the expiration of visas.

In my opinion, the nursing shortage is an issue that must be addressed from a multiple focal approach. There are many political, economical and social issues that contribute to the nursing shortage and in order to fully resolve this issue nursing leaders and experts must approach each issue individually in order to come up with a solution that is conducive to the improvement of nursing shortages.

References:

American Association of Colleges of Nursing (2017). Nursing faculty shortage fact sheet. Retrieved from http://www. aacn.nche.edu/media-relations/fact-sheets/nursing-facultyshortage.

Huston, C. J. (2016). Professional issues in nursing: Challenges and opportunities. Philadelphia: Lippincott Williams & Wilkins.

Spetz, Joanne (2014, January/February). How Will Health Reform Affect Demand for RNs? Retrieved from https://www.questia.com/read/1P3-3251006261/how-will-health-reform-affect-demand-for-rns

The film “Wit”, based on the Margaret Edson play follows Ms. Vivian Bearing as she begins her journey towards death and dying. “ Death, be not proud, though some have called thee. Mighty and dreadful, for thou art not so; “ (Donne and Dickerson, n.d.) seems to be the recurrent theme throughout movie as the main character (Vivian Bearing) describes her voyage toward eternal life.

As an English scholar, Bearing spent most of her life studying and teaching the work of John Donne who personifies death by characterizing it as “not proud” and “ not dreadful or mighty”. Ironically after studying death for all her life ,the movie begins with Bearing being newly diagnosed with advanced ovarian cancer. Now faced with her own possible death, she begins to reflect on her life and past work. During her intense medical treatment and undergoing aggressive chemotherapy, Vivian encounters a compassionate staff nurse, Susie played by Audra McDonald who seems to be the only person who treats her as person rather than a scientific experiment.

Nurse Susie embodies the true definition of a professional nurse. The professional nurse practices holistic care, which is defined by the American Journal of Nursing as “nursing practice that has healing the whole person as its goal. A holistic nurse is a licensed nurse who takes a “mind-body-spirit-emotion-environment” approach to the practice of traditional nursing.” (AJN,2013). Susie’s holistic approach allows her to provide care that is comforting to Bearing during the uncomfortable transition from life to death.

In the movie, there is one particular scene that conveys the image of a holistic nursing care. The scene involves Susie as she takes the time out to discuss the course of treatment and advanced directives to the patient. During this scene, she explains complex medical terminology in layman terms; this simple gesture shows the audience that Susie has taken into consideration that even though her patient is highly educated, she understands that emotional stress can become a barrier that can interfere with personal comprehension. Unlike the physicians taking care of the patient, Susie sees Dr. Bearing as an individual facing an emotionally stressful life event.

The nursing profession is reflective of Jean Watson’s theory of human caring, which focuses on providing holistic care. Susie’s role in the movie “Wit” is in direct alignment the carita (virtue) process which states that nurses, “ engage in transpersonal teaching and learning within context of caring relationship; staying within other’s frame of reference—shift toward coaching model for expanded health/wellness (Watson,2010). This carita focuses on understanding the client’s perspective of their illness and providing adequate information in order for the individual to make informed decisions about their course of treatment. Explaining advanced directives can be an emotional conversation; professional healthcare experience has taught me the importance of assessing patients in a holistic way. Having a clear understanding of the client’s emotional, spiritual, mental and physical status allows the nurse to create a strong, trusting interpersonal relationship. Said relationships allow the nurse to undertake the role of patient advocate which Susie portrays at the end of the movie when she demands that the doctors respect her patient’s wishes to be DNR ( Do not resituate ).

References :
Donne, J. and Dickson, D. (n.d.). John Donne’s poetry.
Holistic nursing: Focusing on the whole person. (2017, November 06). Retrieved October
23,2018, from https://www.americannursetoday.com/holistic-nursing-focusing-on-the-
whole-person/
Watson, J. (2010). New Dimensions of Human Caring Theory. Caring in Nursing Classics.
doi:10.1891/9780826171122.0010

According to Healthcare Information and Management Systems Society (HIMSS), “Nursing informatics (NI) is defined as the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice. NI supports nurses, consumers, patients, the interprofessional healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve desired outcomes. This support is accomplished through the use of information structures, information processes, and information technology.

Along with the advancement of technology, the delivery of nursing education has evolved as well; social media has become an outlet for patient and nursing education. Social sites such as YouTube, Facebook and Instagram are currently being used as educational platforms, allowing the exchange of educational information and knowledge worldwide. Schmitt (2012) states “Social media is a platform that can assist nursing faculty to help students gain greater understanding of communication, professionalism, healthcare policy, and ethics.” YouTube and Instagram users such as Novice is the New Nurse, Nurse Mike from Simple Nursing and Nurse Mo use these platforms to discuss a wide range of topics that are relatable to the experiences that nurses encounter daily. These topics include clinical skills such as how to start an IV, how to remove a Foley and pharmacology.

Advantages of using social media as an educational resource include, alternative methods of teaching and engaging students, opportunities for enhanced distant education, and increased accessibility for educational resources. Although there are many advantages from the use of social media for educational purposes, consumers must also be aware of disadvantages such as unreliability. Credibility plays an important role in nursing practice; therefore, it is essential that the information received is sound for safe patient care.

In conclusion, about 80% of Americans use social media daily. With the use of social media as an educational platform, information is readily available with the click of a button anywhere at any time. Professors of nursing schools are beginning to utilize YouTube videos and other social media host to engage students while helping them grasp intricate concepts and clinical skills. While completing my associate degree, social media played an immense role in my clinical and educational learning. Users such as Nurse Mike from Simple Nursing and Novice is the New Nurse provided words of encouragement during my journey while explaining in simple terms the concepts that were once difficult for me to grasp. Nursing school has taught me that I am not a traditional class learner, I learn from seeing and listening to content repetitively. Therefore, I believe the use of social media is important to nursing education. Social media provides an alternative method of learning for the students who need additional educational resources in combination with traditional classroom learning.

REFERENCES:

Schmitt, T. L. (2012). Social Media Use in Nursing Education. The Online Journal of Issues in Nursing, 17(3). Retrieved October 13, 2018, from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No3-Sept-2012/Social-Media-in-Nursing-Education.html

What is Nursing Informatics? (2017, February 23). Retrieved from       https://www.himss.org/what-nursing-informatics