Category Archives: Health Care Workers

The Mental Health Workforce: A Primer

Source: Elayne J. Heisler, Congressional Research Service, CRS Report, R43255, April 20, 2018

Congress has held hearings and some Members have introduced legislation addressing the interrelated topics of the quality of mental health care, access to mental health care, and the cost of mental health care. The mental health workforce is a key component of each of these topics. The quality of mental health care depends partially on the skills of the people providing the care. Access to mental health care relies on, among other things, the number of appropriately skilled providers available to provide care. The cost of mental health care depends in part on the wages of the people providing care. Thus an understanding of the mental health workforce may be helpful in crafting policy and conducting oversight. This report aims to provide such an understanding as a foundation for further discussion of mental health policy.

No consensus exists on which provider types make up the mental health workforce. This report focuses on the five provider types identified by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) as mental health providers: clinical social workers, clinical psychologists, marriage and family therapists, psychiatrists, and advanced practice psychiatric nurses. The HRSA definition of the mental health workforce is limited to highly trained (e.g., graduate degree) professionals; however, this workforce may be defined more broadly elsewhere. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) definition of the mental health workforce includes mental health counselors and paraprofessionals (e.g., case managers).

An understanding of typical licensure requirements and scopes of practice may help policymakers determine how to focus policy initiatives aimed at increasing the quality of the mental health workforce. Most of the regulation of the mental health workforce occurs at the state level because states are responsible for licensing providers and defining their scope of practice. Although state licensure requirements vary widely across provider types, the scopes of practice converge into provider types that generally can prescribe medication (psychiatrists and advanced practice psychiatric nurses) and provider types that generally cannot prescribe medication (clinical psychologists, clinical social workers, and marriage and family therapists). The mental health provider types can all provide psychosocial interventions (e.g., talk therapy). Administration and interpretation of psychological tests is generally the province of clinical psychologists. …..

Shot on the Way to Work: Is Travel Time Work Time?

Source: Fatima Hussein, Daily Labor Report, April 18, 2018
(subscription required)  

• Worker killed on the way to on-call employment draws questions of travel time to work 
• Consequences of case could affect wage and hour claims in Ohio

After an on-call Ohio hospital worker was fatally shot on his way to work, his widow was awarded a worker’s compensation claim in her late husband’s name. ….

Workplace violence in healthcare

Source: Journal of Healthcare Protection Management, Vol. 34 no. 1, 2018
(subscription required)

Articles include:

Team Wilson: how a single workplace violence incident changed healthcare security
Robert Rusting
A potential breakthrough in the need for hospital management to recognize the consequences of violence to nurses and other staff members and to take action to upgrade security result from CEO reactions to a horrendous incident in a Massachusetts hospital. The involvement of a nurses’ organization [the Massachusetts Nurses Association] in providing hospital management with the means to deal with the growing violence against staff is also detailed.

Aspects of combating terrorist activities in healthcare
Anthony Luizzo, Ben Scaglione
The keys to maintaining a terrorism-free workplace lies in the security administrator’s mastering of knowing how to capture terrorist threats before they wreak havoc on the institution and its surroundings, according to the authors, who provide in this article a wealth of sources to the administrator for obtaining such a mastery.

OSHA: focusing on healthcare’s continuing increase in workplace violence
Kevin Tuohey
Injuries to nurses, nursing assistants and other healthcare workers continue to be far more prevalent than in other industries and continue to grow in numbers. In this article, the author reviews new efforts to prevent and reduce workplace violence by OSHA and other agencies. He also describes in detail the activities of IAHSS in this area and makes recommendations about maximizing the expertise of healthcare security and safely.

Hospital settlement: OSHA spells out requirements for implementing a WPV program
In a settlement …. with Bergen Regional Medical Center (BRMC) researched in May 2017 and verified in September 2017, OSHA and one of the nation’s largest public hospitals have resolved litigation by reaching an agreement that requires the center to enhance its efforts to prevent violence in the workplace.

Systematic review: What works to address obesity in nurses?

Source: M Kelly, J Wills, Occupational Medicine, Advance Articles, March 22, 2018
(subscription required)

From the abstract:
Background: There is evidence that the prevalence of overweight and obesity among nurses is increasing. As well as the impact on health, the costs associated with obesity include workplace injury, lost productivity and sickness absence. Finding ways to address obesity in nurses may be a challenge because of the barriers they face in leading a healthy lifestyle.

Aims:
To identify the available evidence for interventions to address obesity in nurses. Methods Databases searched included CINAHL, SCOPUS (which encompasses the Cochrane Database of Systematic Reviews), PsycINFO, MEDLINE and British Nursing Index. Ancillary searching of the grey literature was conducted for case studies of weight management interventions in National Health Service (NHS) settings. Inclusion criteria were studies involving nurses that reported on interventions addressing health behaviours that contribute to obesity and included at least one obesity-related outcome measure.

Results:
Eleven primary studies were found concerning lifestyle interventions for nurses. There was no strong evidence for any particular intervention to address obesity, although integrating interventions into nurses’ daily working lives may be important. Case studies from the grey literature showcased a range of interventions, but very few studies reported outcomes.

Conclusions:
The review demonstrates that there is insufficient good-quality evidence about successful interventions to address obesity in nurses. Evidence does indicate that interventions should be designed around the specific barriers nurses may face in leading a healthy lifestyle.

Changing schedules take a toll on medical interns

Source: Kara Gavin, Futurity, March 18, 2018

This year’s crop of graduating medical students just found out what hospital they’ve “matched” to for the residency training they’ll start this summer. A new study suggests the changing schedules they’ll have to endure as residents may take a heavy toll on sleep, physical activity, and mood. ….

Related:
Effects of Sleep, Physical Activity, and Shift Work on Daily Mood: a Prospective Mobile Monitoring Study of Medical Interns Authors Authors and affiliations
Source: David A. Kalmbach, Yu Fang, J. Todd Arnedt, Amy L. Cochran, Patricia J. Deldin, Adam I. Kaplin, Srijan Sen, Journal of General Internal Medicine, First Online: March 14, 2018

From the abstract:
Background:
Although short sleep, shift work, and physical inactivity are endemic to residency, a lack of objective, real-time information has limited our understanding of how these problems impact physician mental health. Objective To understand how the residency experience affects sleep, physical activity, and mood, and to understand the directional relationships among these variables.

Design:
A prospective longitudinal study. Subjects Thirty-three first-year residents (interns) provided data from 2 months pre-internship through the first 6 months of internship.

Main Measures:
Objective real-time assessment of daily sleep and physical activity was assessed through accelerometry-based wearable devices. Mood scaled from 1 to 10 was recorded daily using SMS technology. Average compliance rates prior to internship for mood, sleep, and physical activity were 77.4, 80.2, and 93.7%, and were 78.8, 53.0, and 79.9% during internship.

Key Results:
After beginning residency, interns lost an average of 2 h and 48 min of sleep per week (t = − 3.04, p < .01). Mood and physical activity decreased by 7.5% (t = − 3.67, p < .01) and 11.5% (t = − 3.15, p < .01), respectively. A bidirectional relationship emerged between sleep and mood during internship wherein short sleep augured worse mood the next day (b = .12, p < .001), which, in turn, presaged shorter sleep the next night (b = .06, p = .03). Importantly, the effect of short sleep on mood was twice as large as mood’s effect on sleep. Lastly, substantial shifts in sleep timing during internship (sleeping ≥ 3 h earlier or later than pre-internship patterns) led to shorter sleep (earlier: b = − .36, p < .01; later: b = − 1.75, p < .001) and poorer mood (earlier: b = − .41, p < .001; later: b = − .41, p < .001). Conclusions: Shift work, short sleep, and physical inactivity confer a challenging environment for physician mental health. Efforts to increase sleep opportunity through designing shift schedules to allow for adequate opportunity to resynchronize the circadian system and improving exercise compatibility of the work environment may improve mood in this depression-vulnerable population.

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.