The American Association of Critical-Care Nurses, (AACN), the American College of Chest Physicians, (ACCP), and one of the nation's leading authorities on the growing shortage of nurses in the U.S., Peter Buerhaus PhD, of Vanderbilt University in Nashville will join forces to address the challenges of the nursing shortage and their impact on critical care. These three organizations representing various disciplines within the healthcare and critical care industries announced yesterday in a press conference that they will work together towards identifying solutions to this crisis.
While much has been written on the shortage of nurses in the U.S., today's announcement is unique in that three organizations representing distinct health disciplines (physicians, nurses and academia) have come together to disseminate a joint statement to American healthcare policymakers on the issue.
AACN specifically warned that the impact of the nursing shortage has potentially serious implications for the field of critical care medicine. By definition, the sickest patients in a hospital, the critically ill are placed in Intensive/ Critical Care and Coronary Care units. These are the patients who require the highest nurse-to-patient staff ratios -- in some cases as high as two nurses for one patient, and the most intensive, round-the-clock intervention and bedside care. Further, because of the complexity and severity of many of the patients' conditions, the critically-ill are most likely to need the attention and skills of the most highly trained nursing personnel available on staff.
The impact of nurse/patient staffing ratios on patient outcomes has recently been supported by a study just released that was co-authored by Peter Buerhaus, Professor of Nursing and Sr. Associate Dean for Research at Vanderbilt University. In the study, which was funded by the Department of Health and Human Services and sponsored by four of its agencies, it was found that the presence of registered nurses had a significant impact on the reduction of serious medical complications including pneumonia, shock, upper gastrointestinal bleeding, urinary tract infections and even hospital length- of-stay. Further, it was found that higher staffing levels for all types of nurses was associated with a 2%-25% range of decrease in adverse outcomes.
One major issue impacting the severity of today's nursing shortage is the ever-changing U.S. demographics. With a significantly older U.S. population, the demand for services performed by critical care professionals is greater while the supply of nurses decreases. The average age of a Registered Nurse in America today is currently about 45 years of age, and increasing every year that nursing school enrollments fall behind the number required to replace those nurses who retire or leave the field.
AACN President Denise Thornby said, ``The current shortage of nurses in America is more than just an issue of professional recruitment and retention. Nurses face a myriad of workplace issues today which range from mandatory overtime, non-competitive salaries, stressful and sometimes even dangerous working conditions -- compounded by the emergence of many new career opportunities which offer more lucrative salaries and more desirable schedules.'' Thornby said. ``It's a challenge to attract and keep the best and brightest in this noble profession today, because there are so many other options for our smartest students and most skilled clinicians, but we must, because when it comes to critical care, our very own futures may well depend on it.''
What is missing in the equation, according to Robert G. Johnson, MD, FCCP, President of the American College of Chest Physicians, is the need for greater accountability and support of nurses on the part of the other elements of the healthcare delivery system. ``From our colleges and nursing schools to the hospital itself, we need to address a true cultural change in the way we value the contributions of nurses in America,'' Johnson said. ``As a cardiovascular surgeon, I have seen firsthand how essential highly trained healthcare professionals are to the overall delivery of patient care in the critical care setting.''
Further, Dr. Johnson noted the fact that the nursing shortage is likely to be exacerbated by a projected shortfall of critical care physicians which was cited in a study co-sponsored by the ACCP. The shortfall of physicians in the critical care field is expected to be largely due to the sheer number of baby boomers who will become the ICU and CCU patients of the future, and the longer lead time needed to train highly specialized clinicians.
In addition to partnerships with medical associations such as ACCP, AACN has recently partnered with a number of the nation's other professional nursing organizations to resolve and reverse the nursing shortage by addressing both public policy and workplace issues. Among the workplace initiatives the AACN has officially supported are restrictions on mandatory overtime, ``whistleblower'' protections, the development of new standards to determine staffing levels by patient acuity, and a stronger role for nurses in professional decision-making, policy-setting and clinical advisory roles.
According to Peter Buerhaus, ``Assistance will be needed from hospitals, physicians, policymakers, the public, and media if the problems confronting nurses are to ascend onto the national social policy agenda where, hopefully, additional resources can be obtained to ensure a strong and well-prepared professional RN workforce.''
The American Association of Critical-Care Nurses (AACN) is the largest specialty nursing association in the world with approximately 65,000 members. Its international headquarters is located in Aliso Viejo, California. Founded in 1969, the Association now has more than 250 chapters worldwide and is working toward a healthcare system driven by the needs of patients and families, where critical care nurses make their optimal contribution. More information about AACN is available at www.aacn.org or by calling 800-899-AACN.
The American College of Chest Physicians (ACCP) is a not-for-profit organization made up of more than 15,000 physicians, allied health professionals and individuals with PhD degrees around the world. The ACCP meets its mission and vision by providing physicians, researchers and healthcare practitioners with such resources as continuing medical education opportunities; CHEST -- The Cardiopulmonary and Critical Care Journal; clinical practice guidelines and representation in government and public affairs; and the CHEST Foundation. The ACCP is headquartered in Northbrook, Illinois. For more information, visit www.chestnet.org or call 800-343-2227.
Peter I. Buerhaus, PhD, RN, FAAN, is a Valere Potter Professor of Nursing and Senior Associate Dean for Research at Vanderbilt University School of Nursing, and is the author of over 20 publications on the nursing shortage. A former medical center administrator and highly-published researcher, Dr. Buerhaus is a former Robert Wood Johnson Foundationfellow in healthcare finance at Johns Hopkins University. He served for eight years as the director of the Harvard Nursing Research Institute and was also assistant professor of health policy and management at Harvard School of Public Health.