With permission from the author, I would like to share the following article printed in the February 2022 issue of The Colorado Nurse, speaking to the state of nursing today:
Investing in a Nursing Workforce
Colleen Casper, DNP, RN, MS Director of Practice and Government Affairs Colorado Nurses Association
“Never let a good crisis go to waste.” Winston Churchill
Florence Nightingale was a pioneer in public health nursing and dramatically improved the health care planning and delivery of services to the British soldiers in the Crimean war. Nightingale led widespread changes by tracking data specific to incidences and frequency of the horrific conditions that were leading to the death of British soldiers in the military hospitals. Practices that Nightingale studied and implemented continue to be relied upon today, in both hospital care delivery and the education and preparation of public health providers.
Nightingale’s work highlights the importance of data to drive health care systems improvement. Current data is significantly lacking in terms of hospital specific conditions that are contributing to the “great resignation” of front line nurses and other essential healthcare providers, including pharmacists, respiratory therapists, physicians, certified nurse assistants, environmental health services and food and nutritional services staff. Investing in and assuring an essential health care workforce is going to require significant operational and cultural changes in today’s clinical care environments, from public health, to primary care, acute care, emergency care, and long term care, be it in long term living facilities or at home.
Attempting to describe a path forward, it is our premise that we need to create a more significant and shared awareness of the real factors contributing to workforce resignations. I will focus on the nursing workforce with the understanding that most health care providers share similar characteristics. Those characteristics include:
• Nursing is a relationship and knowledge based profession that requires time to develop competencies and to provide adequate care;
• Nursing practice standards are developed nationally (ANA National Scope & Standards of Care) and are governed at the state level by the Colorado Nurse Practice Act;
• Inability to provide safe care, whether due to worker safety through things such as personal protective equipment, adequate sick time, and sufficient workforce, puts patients at significantly greater risk of complications;
• RN and LPN licensees and Certified Nurses Assistants are all subject to disciplinary actions by the Colorado State Board of Nursing based on complaints against licensee related to inability to provide adequate care;
• Moral distress occurs when individual providers are unable to provide the care in accordance with known standards due to factors beyond their control;
• Prolonged moral distress leads to burnout, helplessness, and resignation; and,
• Colorado frontline nurses have repeatedly been silenced by their employers and subject to threats and retaliation.
This is what “investment” does not look like!
Moving forward, there are options.
1. The Colorado Department of Public Health and Environment (CDPHE) licenses each and every care facility (employer) in the State of Colorado, including hospitals, a long term care, surgical centers, urgent care centers, home care and hospice care facilities, and probably more. That license is a contract with the State and its people, Coloradans, that assures minimum standards of care are met for all patients, residents, and consumers. CDPHE must more closely monitor the performance of facilities and track essential data points as a means of understanding trends in the incidences and frequency of bad outcomes related to patients and workforce. CDPHE must hold employers accountable and not solely the licensed professionals who are working in sub-optimal work environments.
2. The Colorado Department of Health Care Finance and Policy can take a stronger stance in public reporting of percentages of employer profits that support the nursing workforce. What actual and percentages of costs are afforded “administrative budgets” as compared to direct, front line clinical care? Do these costs reflect the time required for professionals to deliver adequate care?
3. Human resource policies and practices must be adapted to reflect the diverse needs of the front line workers. There is evidence to suggest that twelve-hour shifts are less than safe, let alone greater than three twelve-hour shifts per week. Traveler (temporary contracted) nurses are currently signing contracts for upwards of $330.00 per hour if they agree to work 20 hours of overtime per week, equally more than $15,000.00 per week per nurse. Employers want the federal and state governments to “backfill” this expense. What if we invested $10,000.00 per week to retain experienced staff and assure sane, safe workloads with career pathway development to remain at the bedside?
Without aggressive, responsible, and accountable leadership that includes real investment in workforce and work environments, Colorado nurses will not have a choice but to legislate nurse staffing – on behalf of patients. What’s your choice?
Colleen Casper
Hope you enjoyed this post! Feel free to comment. Thanks for visiting the COENA GAC Blog. Deborah Skeen, MSN, RN, CEN, CPEN. COENA 2022 Government Affairs Chairperson
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