Understaffed schools, stressful environment and pandemic pose challenges for nursing

Source/Disclosures

Disclosures: Belmonte, Livaudais and Thomas-Hawkins report no relevant financial information.


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Tina Livaudais, RN, BSN, MBA, has a great story to tell about his involvement in kidney care.

She began her career as a patient care technician for DaVita Kidney Care in 1995. In September 2021, she was named chief nurse for the company, which treats over 200,000 patients.

“I always share details about my personal DaVita journey with current and potential nurses,” said Livaudais, who lives in New Orleans. Nephrology News and Issues. “I want each of them to know that they can achieve the same level of professional fulfillment,” she said.

Tina Livaudais

Nursing staff

At the head of a nursing force of more than 18,000 people, Livaudais has major concerns about finding new nursing recruits.

  • According to an analysis published in Health Affairs. The nursing workforce fell by 1.8% between 2019 and 2021, marking the biggest drop in 4 decades, according to the study.
  • The US Bureau of Labor Statistics predicts that more than 275,000 additional nurses will be needed from 2020 to 2030 to provide patient care in the United States.
  • In 2020, the median age of RNs was 52, with more than a fifth indicating their intention to retire from the nursing profession in the next 5 years, according to the National Council of State Boards of Nursing 2020 and the National Forum of State Nursing Workforce Centers national survey of the nursing workforce in the United States. The pandemic has accelerated this trend, the survey showed.
  • Young people interested in nursing are struggling to find a school that will accept them due to a significant shortage of nurse educators. According to a recent report by the American Association of Colleges for Nursing (AACN), US schools of nursing declined 80,407 qualified applications to baccalaureate and graduate nursing programs in 2019 due to insufficient numbers. faculty, clinical sites, classroom space, clinical preceptors and budget constraints.

Shortage before COVID-19

Kear and Walz wrote that the nursing shortage began long before stress and high patient mortality due to the COVID-19 pandemic had nephrology nurses wondering if it was time to quit the job. occupation.

Kathleen Belmonte, MS, RN-CS, MBA, chief nursing officer of Fresenius Medical Care North America, agreed.

Kathleen Belmonte

“…Before COVID-19, there were already serious questions about whether the profession was going to be able to attract enough nurses to care for populations, and that also includes the [end-stage renal disease] ESRD population, the [chronic kidney disease] CKD population, moving into the future,” Belmonte said in a podcast earlier this year. “… [W]hen we talk to our nurses and ask them how they feel and how it went, they tell us that they feel stressed, that they are exhausted, that they are exhausted. And of course, when we hear our nurses tell us that they’re burnt out, we worry that a consequence of that might be nurses choosing to leave the field, to leave the profession.

Livaudais added, “The broader healthcare community has been grappling with a critical shortage of clinicians for nearly a decade, which has been exacerbated by COVID-19. Prior to 2020, the primary concern was to replace retiring talent. However, the pandemic has taken a meager workforce and stretched it further than ever. Inevitably, many nurses experienced burnout, and some left the field altogether.

According to sources, there is no quick fix to the shortage.

“Solutions are simply difficult” Charlotte Thomas-Hawkins, PhD, RN, FAAN, associate dean of nursing and associate professor and director of the Center for Healthcare Quality in the Division of Nursing at Rutgers University School of Nursing, said Nephrology News and Issues. “Research I’ve done in nephrology…showed that dialysis units that have low RN staffing, as measured by patient-RN ratios, were predictive of negative nurse outcomes like burnout. and the intention to leave,” Thomas-Hawkins said. “Nephrology nurses’ intention to leave their jobs is higher when they work in a unit that has consistently low nursing staff.

“This is not a new finding,” Thomas-Hawkins said. “We know that’s true in hospitals and other settings.”

Thomas-Hawkins said it’s clear that outcomes are better in dialysis units when nurse staffing is better.

“That was the problem with the COVID-19 pandemic,” Thomas-Hawkins said. “It exacerbated already existing problems with low RN staffing and a stressful work environment.”

young nurses

Researchers acknowledge that the stress created by the COVID-19 pandemic has given nurses doubts about staying on the job. But most of those who leave the nursing profession are, surprisingly, not those who have reached retirement age. In the journal Health Affairs, titled “A worrying decline in the number of young nurses,” David I. Auerbach, MS, PhD, and colleagues found that young nurses – not an older generation retiring – were driving the exodus from the profession.

“Just before the pandemic, the total workforce decreased by 1.8 [%] until 2021, which consisted of a 4[%] reduction in the number of RNs under 35, to 0.5[%] reduction in the number of RNs from 35 to 49 years old [years]and a 1[%] reduction in the number of RNs over 50 [years],” they wrote.

This will hurt the growth of the profession, as nurses generally remain in the workforce for the long term.

“A sustained reduction in the number of younger RNs would have worrisome consequences for the future workforce. Since RNs generally continue to work in nursing throughout their careers, a reduction in the number of younger RNs in the workforce would have an impact that would be felt across a generation, unlike a reduction. modest long-term AI supply due to early retirement of baby boomers. RNs working in their 60s and 60s,” they wrote.

Favorable news

There is good news for dialysis providers looking for nurses. According to data released April 5 by the AACN, student enrollment in undergraduate nursing programs increased by 3.3% in 2021.

As part of its efforts to increase interest in nephrology, Belmonte is working with the FMCNA on a program that enrolls nurses who graduate from colleges and universities nationwide through a 12 to 15 month residency.

“Growing our own nursing talent gives us the opportunity to not only fill nursing vacancies, but also to develop novice nurses into future leaders within the organization,” Belmonte said. Nephrology News and Issues. “Residents are holistically supported with a nurse mentor and support from their cohort and program leaders. We also continue to evolve and expand the scope of this program to include work opportunities in home therapies.

“It’s a fantastic way to expose new graduates to nephrology nursing.”

Thomas-Hawkins also sees the rise in interest in nursing as an opportunity to expose nurses to other options. “I think there are a lot of opportunities in the area of ​​chronic kidney disease for advanced practice nursing,” she said. Nephrology News and Issues. “New payment models for kidney care and the interest in value-based care” may help us redefine the role of nursing.

Asked about the future of kidney care nursing, Livaudais said dialysis providers have recognized the value of keeping nurses healthy and valued.

“… [W]We are increasing salaries, expanding training opportunities, which is essential when educational opportunities are somewhat limited, building greater support for nurses’ well-being and new technological innovations to help boost efforts to recruitment,” said Livaudais.

“While the shortage will not be solved overnight, we are getting closer to identifying what nurses really need and deserve.

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