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NEWSIn the

12 AJN ▼ March 2022 ▼ Vol. 122, No. 3 ajnonline.com

Nursing Shortage or Exodus?

A new report claims that hospital practices are undermining nursing.

A recent report by National Nurses United (NNU) claims that methods used by the hospital industry to maxi- mize revenue are driving nurses from the bedside.

Among examples cited by the report—Protecting Our Front Line: Ending the Shortage of Good Nursing Jobs and the Industry- Created Unsafe Staffing Crisis—is the pursuit by health care organiza- tions of high customer satisfaction scores at the expense of authentic nurse–patient relationships. Few patients realize that nurses—often to their dismay—are told to im- prove these scores through repeated use of specific words such as “ex- cellent” and “thank you” to con- dition patients to rate the hospital as “excellent” on surveys. In turn, the positive surveys are used by health systems to maximize in- centive payments by the Cen-

ters for Medicare and Medicaid Services.

The NNU report also questions the oft-cited shortage of nurses in the United States, concluding that it may not be due to a dearth of nurses so much as a lack of good nursing jobs. As of November 2021, there were 4.4 million li- censed RNs in the United States, but only 3.2 million employed as RNs and 1.8 million work- ing in hospitals, according to the report, which faults poor work- ing conditions such as understaff- ing for driving nurses away from acute care.

Also cited are systemic fail- ures by health care organizations to invest in measures to protect nurses from health and safety haz- ards such as workplace violence, infection, and musculoskeletal injury. RNs have also reported ex- periencing moral distress, physi- cal exhaustion, and such mental health issues as stress, anxiety, depression, and posttraumatic stress disorder, which the NNU report attributes to overwork and inadequate resources to support safe, high-quality nursing care.

The report recommends several federal remedies, including pas- sage by Congress of the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, which would establish min- imum RN-to-patient ratios, and the Workplace Violence Preven- tion for Health Care and So- cial Service Workers Act, which would mandate workplace safety protections. Both bills have been referred to Senate committees for study. In addition, the NNU re- port urges Congress to fund nursing programs at public com-

munity colleges so students from underserved minority commu- nities can attend tuition-free, thereby augmenting and diversi- fying the nursing workforce.

Some states have already moved to implement the recom- mended measures. As early as 2004, California implemented specific nurse-to-patient ratios. Massachusetts did so in 2014, but only in ICUs. New York passed a law last year requiring hospitals to include nurses on staffing committees; it also launched a program that will cover tuition for 1,000 nursing students at state and city univer- sities. And Kentucky governor Andy Beshear in December is- sued an executive order allowing nursing schools with sufficient resources to open new campuses and those at full capacity to refer qualified applicants to other schools with vacancies.

Also in December, the NNU participated in a virtual brief- ing of Congress to present its re- port and offer testimony from several nurses—among them Kelly Anaas, RN, from Minne- apolis, who told the lawmakers that nurses were running out of stamina. “Does everyone remem- ber when the pandemic arrived on our doorstep and we imple- mented all these mitigation efforts to make sure that we, as a soci- ety, did not get to the point where we are rationing care?” she asked. “Well, the truth is that we’ve been rationing care in this country for a long time. Short staffing leads to the rationing of care. Just because we are not pulling names out of a hat to see who gets a ventilator and who doesn’t, doesn’t mean

National Nurses United held a candlelight vigil in Washington, DC, in January to honor the nurses who lost their lives to COVID-19 and to demand the hospital industry invest in safe staffing. Photo by Rick Reinhard / Courtesy of National Nurses United.

[email protected] AJN ▼ March 2022 ▼ Vol. 122, No. 3 13

Health care workers are at greater risk than the general population for COVID-19 infection, and nurses providing direct care to patients have the highest risk of all, ac- cording to several studies. For that reason, the results of a recent study in the New England Jour- nal of Medicine should be reas- suring for nurses on the front lines who are fully immunized.

According to the study, the Moderna (mRNA-1273) and Pfizer–BioNTech (BNT162b2) vaccines are highly effective at protecting health care workers in real-world settings, not just in the controlled conditions of a clinical trial. The study included 4,931 health care workers at 33 acute and long-term care sites across the United States. Effectiveness against symptomatic infection after two doses was 96% for the Moderna vaccine and 90% for Pfizer–BioNTech. After adjusting for possible confounders, such as age, race, and ethnic group; un-

derlying conditions or risk factors for severe disease; and commu- nity or workplace behaviors, ef- fectiveness was 90% after two doses for both vaccines and 80% after one dose. Effectiveness was the same regardless of the health care worker’s level of patient con- tact. Yet, according to a study of over 3 million hospital-based health care workers in the Ameri- can Journal of Infection Control, as of September 2021, only 70% of health care workers were fully vaccinated—defined at the time of the study as two doses.

The percentage has likely in- creased since that time, as vaccine mandates that went into effect later in 2021 propelled many health care workers to get vacci- nated. And, in January, the U.S. Supreme Court upheld the federal vaccination mandate for health care workers who treat Medicare and Medicaid patients, making it harder for people to refuse and still keep their jobs. The study by Pil- ishvili and colleagues adds to the

evidence that vaccination protects against COVID-19 illness, rein- forcing the need for continued ef- forts to improve vaccination rates among nurses and other health care workers.—Karen Roush, PhD, RN, FNP-BC, news director

Pilishvili T, et al. N Engl J Med 2021;385(25): e90; Reses HE, et al. Am J Infect Control 2021;49(12):1554-7.

MRNA Vaccines Are Effective at Preventing COVID-19 in U.S. Health Care Personnel

But vaccination rates, including among nurses, still lag.

News Director: Karen Roush, PhD, RN, FNP-BC E-mail: [email protected]

Nurse Elyse Isopo receives the Pfizer vaccine booster at Long Island Jewish Medical Center in New Hyde Park, New York. Photo by Lev Radin / Sipa USA / AP Images.

we haven’t been making awful de- cisions about the level and quality of care people receive.”

To read the NNU report, go to www.nationalnursesunited. org/sites/default/files/nnu/

documents/1121_StaffingCrisis_ ProtectingOurFrontLine_ Report_FINAL.pdf.—Dalia Sofer

NewsCAP ƒ Americans are finding it increasingly difficult to pay for health care. According to the West Health– Gallup 2021 Healthcare in America Report, the percentage of Americans who report not having access to affordable health care increased from 18% in February 2021 to 30% in October 2021, based on a survey sam- ple of 6,600 adults. The percentage of people who reported forgoing health care because of cost tripled from 10% to 30% from March to October. This surge was not confined to lower-income households; among those earning more than $120,000 a year, the percentage of people who said they were forgoing care jumped from 3% to 20%. The authors cite increased use of health care services and greater out-of-pocket ex- penses due to decreasing government assistance for COVID-19–related care as major contributing factors.