How healthcare reform affects nurses

Many organizations are looking to the nurse workforce to help close the primary care gap and meet the rising demand for healthcare services. But maybe we should consult nurses before relying on them to solve the problem of a growing shortage of physicians and the growing demand for care.

While physician assistants are embracing industry calls to fill holes in the healthcare system, not all registered nurses have confidence in their ability to meet the demands of healthcare reform. In fact, some nurses doubt whether their workforce is big enough to meet the demands, according to a new survey from AMN Healthcare. Older nurses are particularly not confident in the nurse supply.

In addition to the negative outlook, the survey shows a large number of older nurses may leave the profession. With an influx of 20 million new patients entering the healthcare system, should hospitals be worried?

I reached out to the survey author, Marcia Faller, Ph.D., a registered nurse herself, who said it presents a challenge for healthcare organizations that will face a critical shortage in terms of nursing positions and know-how.

"Not only is it just volumes of nurses that intend to leave and will likely not return because they're retiring, but it's also almost a 'brain drain' because those nurses hold a vast amount of experience and knowledge," Faller told me.

So what did this nurse recommend hospitals do to attract and retain their nursing workforce?

Focus on the workplace environment. To create an environment in which nurses feel they can provide high-quality care, make sure the hospital has adequate staffing and promotes a culture of safety, Faller said. Those are the most important factors to achieving solid nurse retention, she explained.

A good work environment does more than only get nurses to stay. It also leads to better patient outcomes and lower mortality rates, according to a study in the May issue of Medical Care. Moreover, a good nurse work environment means fewer readmissions, according to another Medical Care study in January. The researchers found a good work environment for nurses reinforces their autonomy, offers sufficient resources, establishes support and gives nurses a greater role in decisions, FierceHealthcare previously reported.

The AMN Healthcare survey also shows younger nurses are more open to changes in healthcare. As healthcare delivery and payment reforms kick in, how can hospitals address generational differences and get older nurses on board with new ways of providing care?

When it comes to using electronic medical records (EMR), hospitals are using creative way to address the challenge, and making some of the younger, more tech savvy nurses test the EMRs before training the older, more resistant nurses.

"I find myself in that latter category so I know that if I've got somebody else that's a subject matter expert and a super-user, then I can rely of them as a resource that's going to help my learning curve be better," Faller said.

While a lot of older nurses may be looking toward the exit, a renewed focus on safety and staffing could help hospitals hang on to their nursing workforce--for happier nurses and healthier patients. - Alicia (@FierceHealth)

Read more on