RACHEL CRAWFORD, CHEYENNE KIRKWOOD, MORGAN

ADRINE, AND LUCIA PETRUS

 PROMOTING WORKFORCE ADVOCACY AND A
PROFESSIONAL PRACTICE ENVIRONMENT
• Nurses are experiencing more control and involvement
in the work environment than there has ever been
• Professional nurses face many obstacles in providing
high quality health care, such as limited resources
• A nurses duty to his or her patient as an advocate
often leaves them in conflict with those in higher
power such as a doctor or administrators
PROMOTING WORKFORCE ADVOCACY AND A
PROFESSIONAL PRACTICE ENVIRONMENT CONT’D
• The way that nurses handle these conflicts is known
as workforce advocacy
• Work force advocacy are tools and services used to
promote an optimal working environment and
personal and professional development
• Staffing, personal and social factors, physical
environment and organization factors are all part of
work force advocacy
PROMOTING WORKFORCE ADVOCACY AND A
PROFESSIONAL PRACTICE ENVIRONMENT CONT’D
• Examples of work force advocacy are promoting and protecting
the occupational safety and health of nurse, using the political
process to influence legislation in favor of protecting nurses and
patients, and establishing coalitions/support groups that enable
nurses to advocate for their profession
• For over a century The American Nursing Association (ANA) has
advocated for nurses and quality patient care through education
and research
 Decreased mortality rate and prevented premature mortality
 Increased hospital profitability
THE NURSING SHORTAGE
• The nursing profession has had a long history shortages,
although during the late 1990s and early 2000s the shortage
was a result of a lack of limitation on the rising cost of health
care
• There now seems to be a chronic shortage of professional
nurses, but in more recent years there has been a steady
increase in the number of younger professional nurses.
• Although the work force is stabilizing, there are still concern that
the growing need for nurses will not be met as the population
ages, more citizens are living with chronic illnesses, and
healthcare reform is giving more individual access to care
FUTURE RN EMPLOYMENT OPPORTUNITIES
• Professional nursing is the largest healthcare profession in the
U.S. and employment is expected to grow much faster than the
average occupation.
• Employment opportunities will result from the following:
 A need to replace those that leave or retire from the profession
 Advances in patient care that will lead to more access to health care
and a need to specialized treatment, also an emphasis on education of
preventative care
 Rapid growth in the elderly population
• Hospital employment will grow at a slow pace because of many
services moving to out patient facilities. Home health care and
long term care facilities will have an increase in employment
due to the aging population
HEALTH CARE AS A CHALLENGING WORK ENVIRONMENT
• Important factors in the nursing shortage are the work place environment and job
satisfaction
• A combination of three national surveys recognized areas that negatively impact
nursing satisfaction
 Opportunities to influence workplace organization and patient care
 Recognition of accomplishments
 Opportunity for personal and professional development
• Job satisfaction is on the decline; surveys showed that half of nurses would move
to a less demanding nursing position, if possible.
• Finding these challenges is inevitably forcing the health care system to redesign
the work place to attract and retain new nurses
NURSING SCHOOL ENROLLMENT AND RECRUITMENT
• Efforts to recruit new nurses has been mostly successful
• Nursing associations try to educate the public about the shortage
and the benefits of the career
• The Johnson & Johnson Campaign for Nursing’s Future gave $30
million as a national initiative to improve the image of nursing
and recruit/retain nurses
• Even with all of these incentives, nursing schools are unable to
accept many student because of the nursing education staff
shortage
EDUCATION PREPARATION
• In the past during shortages employers have hired nurses
regardless of their education background
• Currently nurses with baccalaureate degree or previous
experience in clinical specialties are in high demand
• Evidence-based recommendations made by the Institute of
Medicine, stated that nurses must achieve higher levels of
education to meet the demands of the ever changing
health care system and meet the varying needs of patients
FACULTY SHORTAGE
• A critical problem facing the nursing work force is the aging
nursing faculty
• This shortage contributes to the current nursing shortage in that
it limits the number of student admitted to nursing programs
• Thousand of qualified applicants we not accepted to
baccalaureate programs because of an insufficient number of
faculty members
• A contributing factor to the faculty shortage is salary benefits.
Nonacademic positions tend to have more salary benefits than
an academic position
NURSE RETENTION
• Nurse retention is defined as focusing on preventing nurse turnovers and
keeping nurses in an organization employment.
• Nurse retention was proven from past nursing shortage to be one of the most key
opportunities to successful nursing.
• Nurses want to work in an environment that supports decisions making and
nurse-physician relationships, improving patient advocacy.
• A national a survey was conducted by registered nurses asking them to rate the
quality of their relationships with others in the workplace.
 The RN’s stated the highest relationship was the relationship among
other RN’s
 The second highest relationship with the RN’s was their relationships with
their physicians
 The lowest relationship being the relationship among RN’s and their
administration
MAGNET HOSPITALS
 In 1980, the American Academy of Nurses and affiliated with the
American Nurses Association developed a landmark study known as the
“Magnet Hospitals: Attraction and Retention of Professional Nurses”
 Was one of the most successful nurse retention models focusing on
promoting standards for professional nursing practice and recognizing
quality, excellence, and service.
Purpose:
 To identify workplace factors, for instance management style, nursing
autonomy, quality of leadership, organizational structure, professional
practice, career development, and quality of patient care as influencing
nurse job satisfaction and low turnover rates in acute care settings.
MAGNET HOSPITALS CONTINUED
Results:
 Out of the 163 hospitals that participated, only 41 were deemed Magnet
hospitals.
 Another focused was developed by combining quantitative and
qualitative factors to make sure nursing services were measured. With
the qualitative factors being the conceptual framework for the appraisal
process.
Magnet Recognition Program Application Manual:
 Was developed in 2007 as a statistical analysis to combine the results
obtained from the Magnet Hospital Retention Program by placing them
into 30 groups to yield a model in order to measure outcomes and have
more streamlined documentation.
MAGNET HOSPITALS CONTINUED
Overall:
 The magnet Recognition Program reached a high level of
prestige within the nursing community due to its
relationship between quality patient care and nursing
excellence.
 According to research, “Magnet Status” is “now seen as the
single most effective mechanism for providing consumers
and nurses with comparative information, the gold
standard for quality nursing care.”
PATHWAY TO EXCELLENCE HOSPITALS
 Was developed by the TNA (Texas Nurses Association) in 2003 to improve
nurses workplace by positively affecting nurse retention.
Goal:
 To improve both the quality of patient care and professional satisfaction
of nurses working in small and rural hospitals in Texas
 Recognition is earned by acute-care and long-term care organizations
that create work environments where nurses can flourish.
 The award substantiates the professional satisfactions of nurses and
identifies the best places to work.
AGING WORKFORCE AND RETENTION
 A lot of education programs are created to help develop up
coming nurses, but strategies must also be developed to retain
the older and professional nurse
Statistics:
 In 2008 the median age of professional nurses was 46 years old.
 In 2008 RN’s younger the 30 years old only represented 10.6% of
total nurse population.
 Professional nurses 40 years old or older represented 67.8% of
the workforce, and 23.7% being older then 54 years old.
AGING WORKFORCE AND RETENTION CONTINUED
 A qualitative study was conducted showing that older nurse had a harder time dealing
with stress, frustration, constant change, physical and mental declines, and dealing
with intergenerational conflicts.
 But a positive outcome when it came to the quality and cherishing of patient care due
to past experiences.
Strategies:
 Work environment layouts. Ex. Physical layouts, technology improvements, and
teamwork opportunities
 Staffing enhancements. Ex. Consistent patient-to-nurse ratio
 Creating staffing plans with shorter shifts, which can lead to the expansion of older
nurses in the workplace
 Development of technology accessories that reduce the physical demands on nurses
which is exactly what the ANA’s Handle with Care campaign is about.
EMERGING WORKFORCE RECRUITMENT AND RETENTION
Studies:
 Several studies were conducted with a focusing on the work and management
expectations of today’s young worker who expects balance and perspective in the
workplace.
 One studied was on nurses born after 1980 also known as Generation Y, which
nurse recognition being a big factor. It also showed that nurses identified their
needs as stability, flexible, work schedules, and adequate supervision.
Overall:
 Young nurses are searching for opportunities to gain advanced training, education,
and certification. Also expect feedback to help refine skills and build confidence.
INTERNATIONAL NURSE RECRUITMENT
 Is conducted by importing nurses to ease nursing shortages. Which the Untied
State has conducted for several decades.
 Internationally educated nurses representing 5.1% of the nursing workforce
before 2004 and 8.1% since then.
The Commissions on Graduates of Foreign Nursing Schools
 Helped international nurses come to work in the United States.
 Included verification of foreign Nursing Schools knowledge-based practice
competency

 Due to economic recession and visa retrogression has lowered international

nurses to 50% in 2007.
NURSING SALARIES
 Is one of the main causes of nursing shortage specifically in the 1960’s, 1970’s, 1980’s, and
early 1990’s. These shortages were not resolved until wage increases brought back the
balance.
1980:
 Showed that professional nurses hourly wages increased approximately 3% each year.
1990:
 Showed that nursing salaries remained flat.
2002 and 2003:
 There was a sharp increase in wages due to a demand on nurses from 2001 to 2004.
2004 and 2005:
 Growth of RN wages stopped , and hospital employment decreased by 50,000, and vacancy
raised to 8.5%
2006:
 RN’s wages were increased slightly but resulted with vacancy decreasing down to 8.1%, and
116,000 positions stayed unfilled.
WORK ENVIRONMENT
Studies:
 Several studies were conducted focusing on how the work environment contributes to
the difficulty of recruiting and retaining RN’s.
 One main factor being due to workload and staffing patterns.
 Other factors being due to insufficient supply of qualified managers, increase
market demand, and inappropriate staffing.
Importance:
 To address the importance of issues related to the work environment and to make
successful retention strategies, so an increase of nurses would develop.
Principles and Elements of a Healthful Practice/Work Environment:
 The Nursing Organizations Alliance developed this to provide a framework to improve
the work environment for nurses. Were they stated “if the staffing levels and work
environments are not safe for the nurses, the will not be safe for the patient.”
APPROPRIATE STAFFING
• Inappropriate staffing is a contributing factor to
dissatisfaction within the workplace
• Aiken and Colleagues (2002)
• Landmark study – found that hospitals with fewer
nurses per patient, surgical patients were more likely
to experience higher death rates from failure to
rescue and death from complications
• Nurses in these institutions more likely to experience
emotional exhaustion and greater job dissatisfaction
FLOATING AND MANDATORY OVERTIME
• Practice of requiring nurses to work mandatory overtime spread
across the U.S. in 2000
• U.S. Dept. of Labor found increasing scheduled work time
increased time lost to absenteeism and increased injuries;
required 3 hours of work to produce an additional 2 hours of
productivity
• Nursing research found increased work hours raise the likelihood
of adverse events and errors in health care
• Excessive and recurrent use of overtime, when used as a staffing
strategy, has made it necessary for states creating a legislation in
order to limit its use
ADVOCATING FOR SAFE STAFFING
• Survey with 220,000 RNs from 13,000 nursing units in over 550
hospitals and a response rate of 70%, nurses reported that 54% of
nurses in adult medical units and emergency rooms don’t have
sufficient time with patients
• Federal legislation states a nurse can not work more than 12 hours in a
24-hour period and 80 hours in a consecutive 14-day period.
• Mandatory overtime and adequate staffing levels have become
legislative issue at the national and state levels of government
• 16 states placed restrictions on the use of mandatory overtime for
nurses
• Overtime increased during past year
• 43% of all RNs working extra hours due to the unit being short-staffed
or busy
ADVOCATING FOR SAFE STAFFING CONT.…
• 3 models of staffing are informing policymakers of current situation:
• Fixed minimum ratios
• Patient classification systems
• Pay-for-performance
• California 1st state to enact fixed minimum ratios legislation requiring hospitals to
meet minimal staffing standards, limiting the numbers of patients that RNs and LPNs
care for at one time (1999)
• One nurse can not care for more than 5 people in medical surgery; one nurse per 4
patients in specialist care and one nurse per 3 people in step-down units
• Nurse staffing plans require direct-care nurses have input in a plan ensuring safe
nurse-to-patient ratios based on patient need
• ANA endorses this approach through Principles for Nurse Staffing
• Provides recommendations on appropriate staffing & requires nurses to be integral
part of nurse staffing plan development and decision making process
ADVOCATING FOR SAFE STAFFING CONT.…
• 3 approaches to assure sufficient nurse staffing has been utilized at
state level
• 1st approach: require hospitals to have nurse-driven staffing committee
to create staffing plans reflecting needs of patient population and
match skills of the staff
• 2nd approach: legislators mandate nurse-to-patient ratios in legislation
or regulation
• 3rd approach: require facilities to disclose staffing levels to the public
and/or legislator plans
• Pay-for-performance model proposed in recent years
• Insurance companies and government health care programs provide
greater payments to hospitals meeting or exceeding quality standards
SHARED GOVERNANCE
• Benefits:
• Provide organizational framework for nurses in direct care to
become committed to nursing practice
• Render structure and an environment that empowers staff to
make care choices
• Results in more than job satisfaction for nurses; better patient
outcomes
• Key indicator of excellence in nursing practice
• This model has attracted the attention of nursing in response to
maintaining nursing job satisfaction, quality care and fiscal
viability
PATIENT ADVOCACY AND SAFETY
- As nurses it is up to us to advocate for our patients. We are the ones who are with
the patients the most and develop relationships with them.
- Goals of patient advocacy (Ellis and Hartley 2005, Bu and Jezewski 2007)
- Nurses need to advocate for end of life requests, medical errors, patient dignity,
culture sensitivity, dealing with health care providers, patient safety, insurance
issues, and HIPPA laws.
- Advocating for patients ensures a safe environment and creates a better
atmosphere for both the patients and the nurses.
- Advocacy is defined by the Merriam-Webster Collegiate Dictionary (2009),as the
act or process of supporting a cause or proposal. An advocate is defined as one
that pleads, defends, or supports a cause or interest of another.
WHY PATIENT ADVOCACY IS IMPORTANT
https://youtu.be/pPjGVul5UYE

What if ?? You are working as a nurse in an acute medical unit. One day, you find that
a doctor has prescribed an incorrect dose of a calcium supplement, and that your
colleague has administered this without checking the patient’s drug chart against
the electronic patient medication record system.
What steps would you take to advocate for the patient, and reflect on how your
colleagues might react to your actions?
WHAT WOULD DO?
PATIENT SAFETY
- What is patient safety? Patient safety was defined by the IOM as “the prevention of harm to
patients.”
- Between 44,000-98,000 patients die in U.S. hospitals each year from preventable medical
errors (Kohn,2000).
- Organizations such as the National Database of Nursing Quality Indicators, Transforming
Care at the Bedside, and the Quality of Safety Education for Nurses project were created to
encourage quality and safety programs implemented by nurses.
- National Center for Nursing Quality (NCNQ) was created to address patient safety and quality
nursing care and nurses’ working lives ( ANA, 2011).
- What else do the NCNQ do? Uses qualitative measurements, research, and collaborative
learning ensure nurses are providing quality of care.
- National Database for Nursing Quality Indicators ( NDNQI)
PATIENT SAFETY….
Transforming Care at the Bedside (TCAB)
4 major areas for improvement (Institute of Healthcare Improvement, 2016)
A. Safe and reliable care
B. Vitality and teamwork TCAB has scored multiple hospitals
around the country to help improve
C. Patient-centered care
nursing quality care.
D. Value added care processes
INTERACTION AMONG HEALTH PROFESSIONALS
What happens when there is rude interaction by health care professionals that
threaten patient safety?
“ Intimidating and disruptive behaviors can foster medical errors, contribute to poor
patient satisfaction and to preventable adverse outcomes, increase the cost of
care, and cause qualified clinicians, administrators and managers to seek new
positions in more professional enviroments. Safety and quality of patient care is
depedent on teamwork, communication, and a collarboartive work enviroment. To
ensure quality and to promote a culture of safety, healthcare organizations must
address the problem of behaviors that threaten the performance of the health
care team.” ( TJC, 2008, paragraph 1)
WHISTLE-BLOWER PROTECTION
Nurses want to know that if they speak up and advocate for their patients that they
have retaliation. So what is whistleblower protection laws?
- It is protection that prohibits healthcare organizations from retaliating against nurses when
the professional nurse in good faith discloses information or participates in agency
investigations.
- Protects nurses who speak out about unsafe situations
- Ensures they can’t be fired for speaking up or be subjected to disciplinary actions by their
employers.
- Makes sure the law or upper hand people can’t abuse their power and silence nurses when
they speak up about wrong doings they see or experience.
- Nurses should always check with their hospitals laws when it comes to this. Every state is a
little different.
WORKPLACE SAFETY
Hospitals and healthcare places are not always the safest places to work. Its
becoming harder for nurses to provide the best quality of care.
Categories of healthcare hazards in the workplace
1.Biologic Hazards- bacteria, viruses, fungi, or parasites that may be transmitted by
contact with infected patients or contaminated fluids or body secretions
2. Ergonomic Hazards- musculoskeletal injury to the back due to lifting, standing for long periods,
and repeated hand motions.
3. Chemical Hazards- Medications, solutions, gases, cytotoxic agents, latex, PVC plastics, and
mercury exposures.
4. Psychological Hazards- Stress, shiftwork, mandatory overtime, verbal abuse by patients
5. Physical Hazards- Radiation, lasers, noise, electricity, and violence.
EXPOSURE TO BLOODBORNE PATHOGENS AND
ERGONOMIC INJURIES
- Exposure to pathogens is an extreme risk for medical professionals. They risk
exposure to : Hepatitis B, Hepatitis C, and HIV- AIDS
- Occupational Safety and Health Administration role
- Needlestick Safety and Prevention Act (2000)
- Nursing is ranked 2nd for physical workload intensity. Nurse aides, attendants,
and orderlies reported the highest MSD’s making them be away from work.
- RN’s rank 5th in reporting MSD’s. 12% of nurses leave the job annually due to
back injuries, 52% complain of chronic back pain
- ANA’s Handle with Care campaign
- Reluctance of reporting injuries ( fear of repercussions, ”complainer”,
harrassment, denial of promotion, termination)
WORKPLACE INJURIES…
- Each organization is different with their workplace injury policies.
- ANA provides resources concerning safety rights and nurses’ health
- OSHA requires to keep a log of workplace injuries, prevents discrimination against
employees who report a work related injury, illness, or fatality.
WORKPLACE VIOLENCE AND ADVOCATING FOR
SAFER WORKPLACES
- Healthcare workers have the highest rates of nonfatal assault injuries in the workplace
( U.S. Department of Labor, 2012)
- Most prevalent who experience workplace violence are ED nurses
- Ex: Nurses reported more than 20 times in the past 3 years they experienced
workplace violence and with thin that 3 year period they experienced more than 200
times verbal abuse by patients. ( Gacki-Smith et al, 2009)
- Lateral violence is acts between colleagues, usually perpetrated by those of an higher
authority. Can cause stress, or even cause nurses to leave their jobs.
- Its up to nurses to advocate for safer workplaces. Zero tolerance is a must and keeping
detailed records of these incidents if they do happen are key in prevention. Create
plans for how to handle violence within the workplace and train employees the proper
way on what to do in cases of violence.
WORKPLACE SAFETY
- Having a proper staff to patient ratio is important with workplace safety.
- Need efficient training on how to handle situations
- Safeguards in place if things happen
- ANA and other organizations advocate for administrative controls, adequate
staffing, health policies, protection equipment procedures.
- Understanding most workplace injuries are preventable is key.
REFERENCES
1. American Nurses Association: Whistle blower protection, 2011.
Http://www.nursingworld.org/MainMenuCategories/Policy-
Advocacy/State/2006/whistle12768.html.Accessed January 2012
2. Cherry, B., & Jacob, S. (Ed.) (2014). Contemporary Nursing: Issues, Trends, and Management. Elsevier
Mosby.
3. Choi, P. P. (2015, February 23). Patient advocacy: The role of the nurse. Continuing Professional
Development, 29, 41,52-58. Retrieved November 8, 2016, from
http://journals.rcni.com/doi/pdfplus/10.7748/ns.29.41.52.e9772
4. Gacki- Smith J, Juarez AM, Boyett L, et al: Violence against Nurses working in the US emergency
departments, J Nurs Adm 39(7-8):340-349, 2009.
5. Jones, C., Gates, M. (2007) "The Costs and Benefits of Nurse Turnover: A Business Case for Nurse
Retention" OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 3, Manuscript 4.
6. Occupational Safety and Health Administration: Bloodborne pathogens and needlestick prevention, 2011.
www.osha.gov/SLTC/bloodbornepathogens/index.html. Accessed January 2012.