Occ-health pros can play part in reducing shortage

Despite great pressures, most nurses like their jobs

While the nursing shortage has grabbed the attention of the entire health care profession, the issue is especially relevant for occ-health nurses and, in particular, for those who manage occupational health programs and facilities. Not only do they have to worry about staffing shortages and the potential impact on patient safety, as do all nurse managers, but they also face the additional challenge of dealing with the occupational health and safety issues impacting the entire nursing staff — which is, after all, composed of employees of the facility.

Because of the widespread impact of the nursing shortage, a new survey conducted jointly by the American Hospital Association’s (AHA) American Organization of Nurse Executives (AONE) and NurseWeek magazine has generated significant attention. It not only reveals the extent of the shortage, but it also offers some clues as to how this disturbing trend may be reversed.

The survey, conducted among a national sample of 7,600 registered nurses, produced some findings that were not surprising. For example, 88% of respondents reported a nursing shortage in their community, and seven of 10 hospital nurses said they had seen a negative impact on the quality of patient care in the past year as the result of a greater number of patients per nurse and higher turnover among experienced nurses.

In the face of these trends, however, 77% of the RNs said they were satisfied with being a nurse, and 60% said they would recommend nursing as a career choice.

"We got both the good and the bad," says Carol Bradley, MSN, RN, regional vice president/editor of NurseWeek’s California edition. "People who think about what they do as a nurse are still happy with their career choice — they do not regret choosing to be a caregiver."

Bradley says her team purposely recruited nurse-researchers with a very high priority of being as objective as possible, and framed the questions in as unbiased a fashion as possible. "Nevertheless, the respondents were willing to tell the researchers what bothers them the most about the workplace, and they what want to see fixed," she asserts.

Some of those issues can be found in another intriguing survey response. Many RNs who plan to leave their present jobs said they would consider staying, and still others who have left nursing altogether say they would consider returning if certain conditions were met. Among those conditions were better compensation, an improved work environment, better hours, and more respect from management.

The logical choice

Because of their unique position in the healthcare industry, occupational health nurses are the logical choice to lead the charge to eliminate the nursing shortage and to work to improve the aforementioned working conditions, asserts Ann Cox, CAE, executive director of the Atlanta-based American Association of Occupational Health Nurses (AAOHN). "We are both part of the problem and part of the solution," she explains.

AAOHN is fighting a three-front war against the nursing shortage, says Cox. The three areas of focus are:

• Offering training to help occupational health nurses be a more effective voice in the decision-making processes in their work environments. "If you can’t speak the language, you can’t be effective," she explains.

• Refining key messages for internal and external dissemination. These messages will be centered around the concept that AAOHN is committed to the health and safety of its members and is creating programs to reduce injury and illness.

• Working on a comprehensive database repository of evidence-based information that demonstrates the bottom line contributions — i.e., those resulting in cost decreases — made by occupational health nurses. "We have over some time collected a body of individual research," she explains. "We will be developing benchmarking approaches for comparative analysis. One of the products we are working on is a template around the balanced scorecard approach used in other businesses — applying it to issues such as productivity, return to work programs, and so on."

The organization is not only targeting those currently in the nursing profession, but those considering nursing as well. "We regularly participate in education sessions at the National Association of Student Nurses annual conferences," says Cox. "At the local level, our members serve as faculty."

Finally, AAOHN is targeting policy makers. "They need to consider occupational health and safety issues when they are addressing the nursing shortage and seeking to find solutions," Cox explains. "We have an aging work force, and the data support the assertion that the key contributing factor to the nursing shortage is the work environment."

A good foundation

Judging by the survey results, AAOHN has a solid foundation upon which to build. With all of the factors mitigating against job satisfaction, the percentage of respondents saying they were content with their profession is encouraging.

Those with long years of experience in the profession think they know why job satisfaction remains relatively high. "Nursing was always an elevated profession in the eyes of the public," says Annette B. Haag, RN, BA, COHN, president of Annette B. Haag & Associates of Simi Valley, CA, "and that’s still true — it’s one of the must trusted groups of professionals."

Haag, who recently got her MBA, was encouraged to hear management guru Tom Peters say that women make excellent managers because of their caring attitude. "I love the profession because you get to see in peoples’ faces the gratitude they have for what you do for them," she adds. "We are so needed."

Diane Riggert, RN, COHN-S, manager of occupational health services, Children’s Hospital and Regional Medical Center, Seattle, agrees. "I think nurses enjoy that patient-nurse relationship a great deal," she says. "It’s very satisfying, when that’s your area of strength and skill, to be able work in that area — to be able to make a difference — and to have a body of scientific knowledge you can apply. It’s also enjoyable to be part of a community of nurses."

Of course, being deprived of that ability to help can contribute to job dissatisfaction and all the attendant stress-related woes. "When nurses can’t have that one-to-one contact, and have to do other different things, the job become less satisfying to them," says Riggert.

While noting the strides that women have made in the job market in recent years, Haag says health care lags in this area. "We now see more equality in general, and women have greater recognition in business, but not in medicine. We’re still not properly recognized for what we contribute."

Reversing the trends

Most observers agree that if present job conditions persist, the nursing shortage will only get worse — despite relatively high job satisfaction and despite the best efforts of groups like the AAOHN. So, how can they be reversed? In terms of getting greater respect from management, Haag asserts there is much that nurses can do on their own to reverse current trends. "The real key is learning to understand the business of healthcare," she says. "We are currently not in a position of setting policy."

Government agencies such as OSHA have long emphasized the importance of the worker, she observes, and that should apply equally in the hospital setting. "But we don’t learn enough skills in nursing school curricula on how to effect policy. Going back to school really helped me, and I encourage nurses to go and take business courses so you can talk that language," she advises.

This, in turn, can help solve the salary issue. Through exposure to business courses, nurses will learn negotiating skills as well as financial and policy management. "People should be paid according to position," Haag says. "Write down your job description and review the organizational structure. If you are responsible for an entire department and have strong credentials, why should you make less than another department head with less credentials?"

Some nurses feel they don’t deserve as much money because they are not bringing in revenue, but that’s erroneous reasoning, says Haag. "They need to look at cost avoidance — case management, return-to-work programs, and so forth," she says.

Nurses are getting additional help in this area from organized labor, notes Riggert. "The unions are giving nurses quite a bit of support and I see them really working things out quite well," she says. "I think nurses are fairly well compensated here, but it varies a lot in different parts of the country. Yes, salary is a huge factor in job satisfaction."

Bradley says attitudes within the hospital world have begun to change. "Just look at what’s going on; there’s been a tremendous amount of focus on what hospitals need to do about their workplace," she says. For example, the AHA recently published its work force commission report, In Our Hands. "That’s just one of many examples of where hospitals are finally realizing there is much they have to do about the workplace," Bradley declares.

Other issues at work

Issues impacting job satisfaction and the well-being of nurses extend beyond those specifically outlined in the survey responses, says Riggert. For example, an improved work environment must also mean a safer work environment. "From the occupational health nurse’s point of view, our goal is to really focus on helping to prevent injuries, using the epidemiological approach to figure out what really is happening, and to use an injury prevention approach — primary, secondary, and tertiary," she says. "Our biggest challenge is back injuries," Riggert continues. "Now, we have the data on costs of back injuries. This is compelling information for administrators because these high costs affect the bottom line of hospitals. Preventing back injuries is an opportunity for cost savings."

Part of the problem, she says, is that agencies have not clearly focused on the issue. "JCAHO [Joint Commission on Accreditation of Healthcare Organizations, based in Oakbrook Terrace, IL] only focuses on patient safety and not on staff safety, and that’s something that has to change," she insists. "Hospitals are only safe for patients when they are a safe place to work. As the nursing population ages and suffers natural degenerative changes, they are put at greater risk for back injury if nothing is done to make patient lifting and transport easier. Even NIOSH is trying to focus on the [workplace] risks to health care workers, and I know they’re looking at what can be done in this area."

So what’s the solution? "This requires an attitude change on the part of nurses as well as management — in the future we will have to look at both of these areas," Riggert advises. "For example, when nurses need to move a difficult patient, they must develop the mindset that they will wait for help, or that they will use the lifting devices. That takes buy-in, and we need to be involved in making that happen."

But nurses need management support as well, she declares, to make sure there are other people available to help nurses lift patients. "We need lift teams, assistance in restraining difficult patients," Riggert says. "The whole idea has not been well received because of cost, but perhaps you don’t have to hire more people, rather look to people already on staff to help — for example, lifting assistance or a code lift team on any shift. Also, management may want to consider having built-in lift devices in the ceilings. That would make their job more attractive. It says to nurses that we really are thinking about you — by practicing primary prevention."

One issue that should not be a major concern, says Riggert, is long working hours. "I had been concerned about all of the 12-hour shifts and whether they were contributing to back injuries among nurses," she concedes. "But my research couldn’t link long shifts to injury. Besides, nurses love the 12-hour shifts because they give them more time to be with their families. I don’t think they’d want to go back to eight-hour shifts if they could."

In search of other solutions

There are a number of other strategies, say the experts, that can serve to ameliorate the nursing shortage. "We need to tap the CNAs [certified nurse assistants]," Haag suggests. "We should approach them and say, Let’s find programs where we can elevate you to RN.’ I wonder what strategies could really be developed."

"Looking at it strictly from an occupational health point of view, having highly trained safety officers who really know how to put the principals of injury prevention in place in a hospital will be very important," Riggert offers. "For years, hospitals — compared to manufacturing — have been slower to address the safety of workers. Now we know more of the risks posed by this work environment and addressing this is critical to retaining highly valued nurses."

"The solutions are going to have to be local," adds Bradley. "They must be a combination of responding to issues in the workplace and building the pipeline [of new nurses]."

That pipeline has been poor for three decades, Bradley notes. "We now have a lot of subsidies beginning to flow from hospitals directly into schools of nursing in California. They are identifying which schools have enrollment improvement capacity, then writing direct checks to fund faculty positions. We added 600 students last year, which on a percentage basis is quite impressive."

AAOHN is seeking to enhance its own efforts by partnering with other organizations. "We are collaborating with the American Nurses Association, which has developed a comprehensive strategic plan to address the shortage," says Cox. "All of us within professional organizations will carry activities for our own groups to help make a difference from the bottom up." In addition, Cox says, AAOHN is aiding Johnson & Johnson with its own initiative to combat the nursing shortage. "We are listed on their web site as an informational resource for those interested in nursing," she explains. "We provide information on the numerous types of positions they can consider."

One of the key motivators Bradley had going into the study, she reasserts, was to try to provide a balanced view of what was happening. "Unfortunately, because the nursing shortage is so hot a topic, a lot of what has been covered has been a negative portrayal," she observes. "The affirmation I got out of this is that we know it’s not all bad. There’s a great deal of opportunity to improve the hospital employment environment."

Cox asserts that occupational health nurse are the logical choice to lead the charge. "We can bring both business and health care expertise together to help address the management and occupational health issues related to healthcare professionals," she concludes.

[For more information, contact:

• Carol Bradley, MSN RN, Regional VP and Editor, NurseWeek, NurseWeek Publishing, 1156-C Aster Ave., Sunnyvale, CA 94086. Telephone: (800) 859-2091. Fax: (408) 249-3756.

• Annette B. Haag, RN, BA, COHN, President, Annette B. Haag & Associates, P.O. Box 2098, Simi Valley, CA 93062. Telephone: (805) 581-3234.

• Diane Riggert, RN, COHN-S, Manager of Occupational Health Services, Children’s Hospital and Regional Medical Center, 4800 Sand Point Way N.E., P.O. Box 5371, Seattle, WA 98105. Telephone: (206) 526-2555.

• Ann Cox, CAE, Executive Director, American Association of Occupational Health Nurses, Inc., 2920 Brandywine Road, Suite 100, Atlanta, GA 30341. Telephone: (770) 455-7757. Fax: (770) 455-7271. Web: www.aaohn.org.]