More young people are entering the profession thanks to a efforts to make nursing a more appealing career option. According to a new study published in Health Affairs, there’s been an 62% increase in the amount of people aged 23-26 who started careers in the field between 2002-2009.

Now, the number of registered nurses is expected to keep pace with population growth through 2030. Previously, the number of nurses was expected to decline over the next 20 years.

The problem isn’t totally resolved though. Several independent reports suggest that key specialties, most notably geriatrics, may not have adequate numbers of well-trained nurses to meet patient needs.

To keep the workforce growing, experts recommended finding ways to make nursing a more mobile career. Right now, more than 52% of nurses work within 40 miles of where they went to high school. In the long-term, that could create regional pockets where there aren’t enough nurses to fill the required positions. To meet long-term needs of those areas, the researchers recommended:

• Expanding the number of educational programs in under-served areas, such as off-campus “registered nurse to bachelor’s degree in nursing” programs or increased use of distance learning
• Targeting educational support such as scholarships and loan forgiveness programs to local students, to encourage them to not only be nurses but also to serve their local area
• Urging state and university leaders to review admission policies for nursing programs and the financial aid they offer, and
• Funding programs and policies such as the National Health Services Corps that offer financial incentives to attract nurses to under-served areas.

A study published in PLoS Medicine found that employees, especially women, who work even just a few overnight shifts a month may be at a greater risk for Type 2 diabetes.

Several health factors are negatively affected by rotating shift work, including obesity, high blood pressure, depression, heart disease and decreased metabolism. The body often has trouble adjusting when normal sleep patterns are disturbed, which can contribute to those conditions. Also, nurses working rotating shifts may not always get proper exercise and nutrition.

Since obesity is linked to Type 2 diabetes, it’s no wonder shift work is correlated with the disease.

Women who had rotating work schedules for 20 years had a 60% greater chance of developing the disorder than those who never worked night shifts. Women on shift work for 10-19 years had a 40% greater chance, and those who spent three to nine years on shift work had a 20% greater chance.

The study only included nurses whose schedules rotated between night and day shifts.

In addition to that study, the Institute of Medicine recently released a report stating there is evidence of a possible link between shift work and breast cancer.

Hospital management can help prevent those issues by offering wellness programs to encourage nurses who work rotating shifts to get the proper diet, rest and excercise.

The numbers indicate increasingly high — and growing — levels of dissatisfaction on the job among the nation’s nurses. Notably, while nurses rated their career satisfaction at 74, satisfaction with the role nurses play is down to 58% .

Other survey results indicate health care organizations should be ready to face higher staff turnover: 32% of nurses plan to leave nursing completely or reduce their clinical work significantly in the next one to three years.

The report, appearing in the current edition of the New England Journal of Medicine, found that mismanaging staffing levels of nurses — on a shift-by-shift basis — negatively impacted patients’ mortality rates.

According to the researchers, when a hospital had nursing shifts that were understaffed by a significant amount (falling 8 or more hours under target levels), patients’ risk of  mortality went up 2%. The average patient in the study encountered three such shifts per stay, raising the individual’s risk 6%.

Under-staffing isn’t the only issue: In units with high patient turnover from transfers, admissions, etc. (and the co-responding increase in work for nursing staff) the mortality risk also increased. Each high-turnover shift a patient experienced in which turnover had a 4% higher risk of mortality. On average, patients in the study experienced one high-turnover shift.

Of course, over-staffing comes with it’s own issues, and isn’t a feasible solution to the problem. The researchers recommend making an ongoing effort to fine-tune staffing levels for each shift to adjust for changes in workload as the number of patients fluctuates and nurses workloads shift.

Have hospitals gone too far to protect “sensitive” information when even a simple procedure and a photo on Facebook are all it takes to get a number of  employees reprimanded for bad behavior? 

Cathy Miller, a nurse at Genesys Regional Medical Center in Grand Blanc, Michigan, wasn’t sure at first why she was given a written reprimand for “unprofessional” behavior and warned that as the investigation continued, she could lose her job..

Turns out, management had discovered photos of Miller and several other Genesys employees on Facebook. But unlike other incidents involving employees on social networks, these photos didn’t show any patients, discuss hospital events or demonstrate employees misusing equipment or acting inappropriately on the clock.

In this case, Miller  had gotten a splinter and a fellow nurse took the fragment out in an unused operating room while the two were on their break. The other nurse posted those photos, and several other “break time” shots on Facebook. The hospital wouldn’t comment on the matter, but according to Miller, the photos didn’t depict patients, didn’t indicate they were taken at Genesys and were all taken while the staffers were on break.

Management ordered the photos to be taken down and reprimanded Miller — a 12-year veteran of the hospital — as well as several other employees involved.

Miller received the lightest punishment — a written reprimand for violating health and safety regs, undesirable conduct and misuse of hospital equipment. (The other nurse wore hospital-owned headlights when removing the splinter.) Other employees received stiffer penalties — up to one month with no pay.

Miller filed a grievance through her union and had the reprimand removed, as did two other employees. Another two workers are still in the arbitration process.

No one denies that hospital staff posting inappropriate information — whether corporate data or individual patient information — is a no-no on any social networking site. But where should the line be drawn? Do health care workers have less ability to post the kinds of daily workplace trivia that workers in other industries take for granted? Share your thoughts in the comments.

That’s according to a newly released report by the Institute of Medicine.

Nurses, as the largest segment of workers in the health care field — and the group that spends the most time actively involved in patient care — will bear a lot of the impact of the changes that develop because of (and in the wake of) health reform legislation.

To meet the changing needs of the health care system, the report recommended that nurses should:

• be given opportunities to gain more leadership skills, and practice to the full extent of their education and training.
• attain higher levels of education and training, and have access to improved educational programs that help their seamless academic progression, and
• be full partners, with physicians and other health care professionals, in health care.

A new study by the Emergency Nurses Association (ENA) reveals startling levels of violence against emergency department nurses.

A nine-month survey of emergency department nurses found that each week 8% to 13% experience some form of physical violence at work. More than half the nurses surveyed said they had experienced verbal or physical abuse at work in the past week.

Among those who experienced physical violence, 15% said they were injured — and in half of those cases, no action was taken against the abuser.

As disturbing as the level of violence is, hospitals’ reactions do little to help. Three-fourths of the nurses who reported violent incidents said they received no response from the hospital. When hospitals did respond, it was most often to give the aggressor a warning.

Who’s at risk — and when

According to the survey, the abusive person was typically either a patient or a patient’s relative in 97% of physical abuse cases, and 91% of incidents of verbal abuse. The most common location for an aggressive act was in a patient room (80% of incidents). About 23% of the abuse took place in common areas, such as elevators, stairwells and hallways; 15% of incidents took place at the nurse’s station. (Some incidents carried into one or more locations.)

Nurses are at most risk when triaging patients (38% of incidents), restraining or subduing patients (34%) or performing an invasive procedure (31%). Male nurses were more likely to be assaulted than female nurses –15% of men reported incidents compared to 10% of women.

Call to action

The ENA has asked the Occupational Safety & Health Administration (OSHA) to change its current guidelines on violence prevention into mandatory standards (downloadable PDF) that hospitals and other health facilities would be required to follow.

The current guidelines recommend hospitals do the following:

• establish a zero-tolerance policy toward both physical violence and verbal abuse
• encourage reporting of all incidents
• ensure employees who report incidents don’t face reprisals, and
• have an ongoing relationship with a liaison in law enforcement to handle incidents as they arise.

The ENA also said hospitals should debrief employees who report incidents to tell them whether the police had been contacted and if the perpetrator was warned, arrested, sent for a psych consult or fled the scene. As for prevention, the ENA encouraged more hospitals to use panic buttons, silent alarms, enclosed nurses’ stations and improved lighting to create an overall safer facility for everyone.

You’d think this would go without saying: Nurses’ duties don’t include providing certain intimate “services” to patients. A nurses union in the Netherlands has launched a national campaign to get that very basic point across.

The campaign, using the tag “I draw the line here” was started following a complaint from one of its members. The nurse filed a complaint after she was dismissed by a 42-year-old disabled man she worked for.

He asked the nurse to provide “sexual services” as part of his care. She refused, and was subsequently fired. The man claimed she was unfit to provide necessary care.

The nurse who filed the complaint claimed she had witnessed other nurses in the man’s employ providing the requested service.

The union, NU’91, wants patients and health care organizations to acknowledge that that kind of “assistance” is outside the scope of a nurse’s responsibilities. The union also reported the incident to the police.

Have you ever had to handle an outrageous patient request? Share your perspective in the comments.

A nurse who reported a doctor’s unorthodox-at-best techniques now finds herself facing criminal charges of misusing official information.

Last June, Anne Mitchell and Vickilyn Galle, two nurses at Winkler County Memorial Hospital in Texas, sent an anonymous letter to the Texas Medical Board detailing their concerns about Dr. Rolando Arafiles’ treatment of patients.

Mitchell and Galle each have more than 20 years of nursing experience and their duties included quality improvement issues. Mitchell also served as the hospital’s compliance officer.

The letter they sent to the board included relevant file numbers, but no patient names. They cited six specific problematic cases, among them: Arafiles had performed an unsuccessful skin graft in the ER without surgical privileges. In another case, Arafiles sutured a rubber tip to a patient’s crushed finger — a technique that the Dept. of State Health Services later deemed inappropriate care. The nurses also claimed that Arafiles had e-mailed patients, encouraging them to purchase an herbal supplement he sold on the side.

The nurses stated in the letter that they weren’t signing it because hospital administrators had already been alerted to the problems, had not acted, and the nurses feared retribution if their actions were discovered.

Harassment or Whistle-blowing?

Their fears appear to have been well-founded.

After Arafiles heard about the report from the medical board, he told the county sheriff — a personal friend who credits the doctor with saving his life after a heart attack — that he felt the report amounted to harassment.

In response, the sheriff got a search warrant, seized computers at the hospital, and eventually discovered that Mitchell and Galle were responsible. They were fired in June 2009.

Shortly afterward, the county prosecutor brought charges against the women for “misusing official information.” Eventually, charges against Galle were dropped, but Mitchell’s trial started this week. A third nurse who had reported Arafiles in her own letter to the medical board after resigning from the hospital was not charged.

Mitchell and Galle have countersued in federal court, alleging vindictive prosecution and a denial of First Amendment rights by the hospital, sheriff, prosecutor and Arafiles.

Public opinion seems to be with the nurses. The Texas Medical Board’s executive director warned prosecutors this trial could scare other clinicians from reporting malpractice. Several nurses’ associations have raised money for Mitchell’s legal fees. And most legal experts believe Mitchell’s actions fall under the state whistle-blower protection laws.

We’ll keep you posted on this case as it develops.

According to a new survey, 11% slots for doctors are vacant — and fully 95% of hospital CEOs said there was a shortage of physicians.And 46% of them said the shortage was hurting patients’ access to care.

The study was a joint project of AMN Healthcare Services and the Council on Physician and Nurse Supply.

The shortage is affecting virtually every clinical position. Even nursing, which has seen its shortage shrink recently, is expected to return to high rates of vacancies as soon as the economy bounces back. (In the past year, many nurses have extended their hours, or come back from working in other fields. They aren’t expected to continue to do that.)

Part of the problem for health care providers is that most simply don’t have as much  money to spend on recruitment efforts as they used to. But 54% of surveyed CEOs said they plan to increase spending again soon.