Category Archives: Health Care Workers

For better patient care, prevent nurse burnout

Source: Futurity, January 30, 2018

“Compassion practices” can have a positive effect on nurses’ work and well-being, a new study suggests.

The phrase refers to relatively conventional organizational practices that reward and recognize caregiving work and include job-related resources to cope with stress and provide pastoral care. “We know there is a burnout epidemic among nurses.”

Nursing is among the top 10 fastest-growing occupations in the United States, but the number of nurses exiting the profession currently outpaces the number of those entering. And the turnover rate is getting even higher.

The Robert Woods Johnson Foundation recently reported that nearly 20 percent of nurses leave the profession during their first year and one in three is gone within two years…..

Related:
Compassion Practices, Nurse Well-Being, and Ambulatory Patient Experience Ratings
Source: Laura E. McClelland, Allison S. Gabriel, Matthew J. DePuccio, Medical Care, Vol. 56 no. 1, January 2018
(subscription required)

From the abstract:
Background:
Compassion practices both recognize and reward compassion in the workplace as well as provide compassionate support to health care employees. However, these practices represent an underexplored organizational tool that may aid clinician well-being and positively impact patient ambulatory care experiences.

Objective:
To examine the relationship between compassion practices and nursing staff well-being and clinic-level patients’ experience ratings in the ambulatory clinic setting.

Research Design:
Surveys were collected from ambulatory nurses in January and February of 2015 in 30 ambulatory clinics affiliated with an academic medical center. Patient experience ratings were collected April to June of 2015.

Subjects:
One hundred seventy-seven ambulatory nurses (Registered Nurses, LPNs, medical assistants), as well as 3525 adult patients from the ambulatory clinics.

Measures:
Ambulatory nurses assessed compassion practices, emotional exhaustion, and psychological vitality. Patient experience ratings were patient perceptions of courtesy and caring shown by nurses and patients’ ratings of the outpatient services.

Results:
Compassion practices are significantly and negatively associated with nurse emotional exhaustion and positively associated with nurse psychological vitality. At the clinic-level, compassion practices are significantly and positively associated with patient perceptions of caring shown by nurses and overall patient ratings of the outpatient clinic. Supplemental analyses provide preliminary evidence that nurse well-being mediates the relationship between compassion practices and patient ratings of their care experience.

Conclusions:
Our findings illustrate that compassion practices are positively associated with nurse well-being and patient perceptions of the care experience in outpatient clinics.

Examining Exposure Assessment in Shift Work Research: A Study on Depression Among Nurses

Source: Amy L Hall Renée-Louise Franche Mieke Koehoorn, Annals of Work Exposures and Health, Advance Access, January 11, 2018

From the abstract:
Introduction:
Coarse exposure assessment and assignment is a common issue facing epidemiological studies of shift work. Such measures ignore a number of exposure characteristics that may impact on health, increasing the likelihood of biased effect estimates and masked exposure–response relationships. To demonstrate the impacts of exposure assessment precision in shift work research, this study investigated relationships between work schedule and depression in a large survey of Canadian nurses.

Methods:
The Canadian 2005 National Survey of the Work and Health of Nurses provided the analytic sample (n = 11450). Relationships between work schedule and depression were assessed using logistic regression models with high, moderate, and low-precision exposure groupings. The high-precision grouping described shift timing and rotation frequency, the moderate-precision grouping described shift timing, and the low-precision grouping described the presence/absence of shift work. Final model estimates were adjusted for the potential confounding effects of demographic and work variables, and bootstrap weights were used to generate sampling variances that accounted for the survey sample design.

Results:
The high-precision exposure grouping model showed the strongest relationships between work schedule and depression, with increased odds ratios [ORs] for rapidly rotating (OR = 1.51, 95% confidence interval [CI] = 0.91–2.51) and undefined rotating (OR = 1.67, 95% CI = 0.92–3.02) shift workers, and a decreased OR for depression in slow rotating (OR = 0.79, 95% CI = 0.57–1.08) shift workers. For the low- and moderate-precision exposure grouping models, weak relationships were observed for all work schedule categories (OR range 0.95 to 0.99).

Conclusions:
Findings from this study support the need to consider and collect the data required for precise and conceptually driven exposure assessment and assignment in future studies of shift work and health. Further research into the effects of shift rotation frequency on depression is also recommended.

Health Care Just Became the U.S.’s Largest Employer

Source: Derek Thompson, The Atlantic, January 9, 2018

In the American labor market, services are the new steel. …. Due to the inexorable aging of the country—and equally unstoppable growth in medical spending—it was long obvious that health-care jobs would slowly take up more and more of the economy. But in the last quarter, for the first time in history, health care has surpassed manufacturing and retail, the most significant job engines of the 20th century, to become the largest source of jobs in the U.S. ….

Violence against emergency medical services personnel: A systematic review of the literature

Source: Brian J. Maguire, Peter O’Meara, Barbara. O’Neill, and Richard Brightwell, American Journal of Industrial Medicine, Early View, November 27, 2017
(subscription required)

From the abstract:
Background
Violence against emergency medical services (EMS) personnel is a growing concern. The aim of this systematic review is to synthesize the current literature on violence against EMS personnel.

Methods
We examined literature from 2000 to 2016. Eligibility criteria included English-language, peer-reviewed studies of EMS personnel that described violence or assaults. Sixteen searches identified 2655 studies; 25 studies from nine countries met the inclusion criteria.

Results
The evidence from this review demonstrates that violence is a common risk for EMS personnel. We identified three critical topic areas: changes in risk over time, economic impact of violence and, outcomes of risk-reduction interventions. There is a lack of peer reviewed research of interventions, with the result that current intervention programs have no reliable evidence base.

Conclusions
EMS leaders and personnel should work together with researchers to design, implement, evaluate and publish intervention studies designed to mitigate risks of violence to EMS personnel.

Workplace violence injury in 106 US hospitals participating in the Occupational Health Safety Network (OHSN), 2012-2015

Source: Matthew R. Groenewold, Raymond F.R. Sarmiento, Kelly Vanoli, William Raudabaugh, Susan Nowlin and Ahmed Gomaa, American Journal of Industrial Medicine, OnlineFirst, November 20, 2017
(subscription required)

From the abstract:
Background
Workplace violence is a substantial occupational hazard for healthcare workers in the United States.

Methods
We analyzed workplace violence injury surveillance data submitted by hospitals participating in the Occupational Health Safety Network (OHSN) from 2012 to 2015.

Results
Data were frequently missing for several important variables. Nursing assistants (14.89, 95%CI 10.12-21.91) and nurses (8.05, 95%CI 6.14-10.55) had the highest crude workplace violence injury rates per 1000 full-time equivalent (FTE) workers. Nursing assistants’ (IRR 2.82, 95%CI 2.36-3.36) and nurses’ (IRR 1.70, 95%CI 1.45-1.99) adjusted workplace violence injury rates were significantly higher than those of non-patient care personnel. On average, the overall rate of workplace violence injury among OHSN-participating hospitals increased by 23% annually during the study period.

Conclusion
Improved data collection is needed for OHSN to realize its full potential. Workplace violence is a serious, increasingly common problem in OHSN-participating hospitals. Nursing assistants and nurses have the highest injury risk.

Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid

Source: Brie Hawley, Megan Casey, Mohammed Abbas Virji, Kristin J Cummings, Alyson Johnson, Jean Cox-Ganser, Annals of Work Exposures and Health, Early View, Published: 25 October 2017
(subscription required)

From the abstract:
Cleaning and disinfecting products consisting of a mixture of hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are widely used as sporicidal agents in health care, childcare, agricultural, food service, and food production industries. HP and PAA are strong oxidants and their mixture is a recognized asthmagen. However, few exposure assessment studies to date have measured HP, PAA, and AA in a health care setting. In 2015, we performed a health and exposure assessment at a hospital where a new sporicidal product, consisting of HP, PAA, and AA was introduced 16 months prior. We collected 49 full-shift time-weighted average (TWA) air samples and analyzed samples for HP, AA, and PAA content. Study participants were observed while they performed cleaning duties, and duration and frequency of cleaning product use was recorded. Acute upper airway, eye, and lower airway symptoms were recorded in a post-shift survey (n = 50). A subset of 35 cleaning staff also completed an extended questionnaire that assessed symptoms reported by workers as regularly occurring or as having occurred in the previous 12 months. Air samples for HP (range: 5.5 to 511.4 ppb) and AA (range: 6.7 to 530.3 ppb) were all below established US occupational exposure limits (OEL). To date, no full-shift TWA OEL for PAA has been established in the United States, however an OEL of 0.2 ppm has been suggested by several research groups. Air samples for PAA ranged from 1.1 to 48.0 ppb and were well below the suggested OEL of 0.2 ppm. Hospital cleaning staff using a sporicidal product containing HP, PAA, and AA reported work-shift eye (44%), upper airway (58%), and lower airway (34%) symptoms. Acute nasal and eye irritation were significantly positively associated with increased exposure to the mixture of the two oxidants: HP and PAA, as well as the total mixture (TM)of HP, PAA, and AA. Shortness of breath when hurrying on level ground or walking up a slight hill was significantly associated with increased exposure to the oxidant mixture (P = 0.017), as well as the TM (P = 0.026). Our results suggest that exposure to a product containing HP, PAA, and AA contributed to eye and respiratory symptoms reported by hospital cleaning staff at low levels of measured exposure.

‘Whatever it takes’: Hospitals get creative in hiring nurses amid a national shortage

Source: Max Blau, STAT, September 13, 2017

It’s hard to find a nurse who’ll move to West Virginia.

That’s what Doug Mitchell realized after becoming the chief nursing officer of WVU Medicine in late 2015. Early on, he had to hire 200 nurses to staff the nonprofit health system’s new $200 million expansion of its Heart and Vascular Institute. Traditional incentives — signing bonuses, overtime pay, flex scheduling — were all on offer. But they weren’t cutting it. ….

….Hospital administrators, long accustomed to the world of hiring incentives, are making more enticing offers to nurses than ever before. Five-figure signing bonuses have replaced four-figure ones. One Texas health system dangles the prospect of free nursing degrees to train existing staff or volunteers as nurses, while a Missouri health system offers an enticing loan forgiveness program. A Kentucky hospital even gave new nurses who came aboard a chance to win a 2017 Ford Mustang convertible…..

How 1,000 Nurses in Northern Michigan Went Union

Source: James Walker, Labor Notes, September 20, 2017

Nurses in rural northern Michigan made history August 9-10 when we won labor’s biggest organizing victory since “right to work” took effect in the state in 2013. By a vote of 489–439, more than 1,000 RNs at Traverse City’s Munson Medical Center, the area’s largest employer, will be represented by the Michigan Nurses Association.

Munson nurses tried to organize years earlier, unsuccessfully. “I was involved in the effort to organize 15 years ago,” said critical care pool RN Dagmar Cunningham. “Since then benefits have decreased and the workload due to sicker patients has increased. Something had to change.”

This time around, we succeeded. How did we do it?. ….

Organizational Restructuring in US Healthcare Systems: Implications for Jobs, Wages, and Inequality

Source: Eileen Appelbaum and Rosemary Batt, Center for Economic and Policy Research (CEPR), September 2017

From the summary:
The healthcare sector is one of the most important sources of jobs in the economy. Healthcare spending reached $3.2 trillion in 2015 or 17.8 percent of GDP and accounted for 12.8 percent of private sector jobs. It was the only industry that consistently added jobs during the Great Recession. In 2016, the private sector healthcare industry, which is the focus of this report, added 381,000 private sector jobs, the most of any industry. It is a particularly important source of employment for workers without a college degree, most of whom, as we document in this report, earn low wages.

This report describes how organizational restructuring is affecting the job opportunities and wages of healthcare workers. We focus on changing employment and wages in hospitals and outpatient clinics, where the most profound restructuring is occurring. Over the last decade or more, hospitals have restructured the organization of care delivery in response to major technological advances, regulatory changes, and financial pressures. This restructuring has occurred at two levels: the consolidation of hospitals and providers into larger healthcare systems on the one hand; and the decentralization of services and the movement of jobs to outpatient facilities on the other. Outpatient care facilities include a wide range of services — from primary care centers to specialized units such as urgent care centers, ambulatory surgery centers, free-standing emergency rooms, dialysis facilities, trauma and burn units, and other specialty clinics. These organizational changes began before the 2010 passage of the Patient Protection and Affordable Care Act (ACA), but have accelerated considerably since then, and are likely to continue even as the ACA is revamped in the future.

This shift to outpatient care centers offers benefits to patients — convenience as well as opportunities for preventative care — and most healthcare providers and unions have supported the move to more community-based care. But in this report, we show that workers are bearing the costs of this organizational restructuring.

Related:
Supplement
Press release

Growth in Health Hiring and Hospital Spending Decline

Source: Altarum Institute Center for Sustainable Health Spending, Press Release, September 8, 2017

Hiring in the health sector moderated in August after rising over the last few months, while July spending growth slowed, according to analysis of health economic indicators released today by Altarum’s Center for Sustainable Health Spending. Driving low overall spending growth is historically low hospital spending, which, at a revised .8% June growth rate, is the lowest year-over-year monthly growth rate recorded in more than 25 years. After 2 months of unexpectedly robust growth (41,000 in July and 36,000 in June), the health sector only added 20,000 jobs in August, consistent with the slower level of growth seen in the first 5 months of the year. … Hospital hiring is continuing to grow at about two-thirds the 2015 and 2016 pace (6,000 versus 10,000-11,000 new jobs per month). With indications of declining hospital utilization and reports of potential job losses at individual hospitals, further declines in hospital job growth are expected in coming months. …

Related:
Health Sector Trend Report
Source: Altarum Institute Center for Sustainable Health Spending