U.S. healthcare system pinched by nursing shortage

WASHINGTON (Reuters) - The U.S. healthcare system is pinched by a persistent nursing shortage that threatens the quality of patient care even as tens of thousands of people are turned away from nursing schools, according to experts.

The shortage has drawn the attention of President Barack Obama. During a White House meeting on Thursday to promote his promised healthcare system overhaul, Obama expressed alarm over the notion that the United States might have to import trained foreign nurses because so many U.S. nursing jobs are unfilled.

Democratic U.S. Representative Lois Capps, a former school nurse, said meaningful healthcare overhaul cannot occur without fixing the nursing shortage. "Nurses deliver healthcare," Capps said in a telephone interview.

An estimated 116,000 registered nurse positions are unfilled at U.S. hospitals and nearly 100,000 jobs go vacant in nursing homes, experts said.

The shortage is expected to worsen in coming years as the 78 million people in the post-World War Two baby boom generation begin to hit retirement age. An aging population requires more care for chronic illnesses and at nursing homes.

"The nursing shortage is not driven by a lack of interest in nursing careers. The bottleneck is at the schools of nursing because there's not a large enough pool of faculty," Robert Rosseter of the American Association of Colleges of Nursing said in a telephone interview.

Nursing colleges have been unable to expand enrollment levels to meet the rising demand, and some U.S. lawmakers blame years of weak federal financial help for the schools.

Almost 50,000 qualified applicants to professional nursing programs were turned away in 2008, including nearly 6,000 people seeking to earn master's and doctoral degrees, the American Association of Colleges of Nursing said.


One reason for the faculty squeeze is that a nurse with a graduate degree needed to teach can earn more as a practicing nurse, about $82,000, than teaching, about $68,000.

Obama called nurses "the front lines of the healthcare system," adding: "They don't get paid very well. Their working conditions aren't as good as they should be."

The economic stimulus bill Obama signed last month included $500 million to address shortages of health workers. About $100 million of this could go to tackling the nursing shortage. There are about 2.5 million working U.S. registered nurses.

Separately, Senator Dick Durbin and Representative Nita Lowey, both Democrats, have introduced a measure to increase federal grants to help nursing colleges.

Peter Buerhaus, a nursing work force expert at Vanderbilt University in Tennessee, said the nursing shortage is a "quality and safety" issue. Hospital staffs may be stretched thin due to unfilled nursing jobs, raising the risk of medical errors, safety lapses and delays in care, he said.

A study by Buerhaus showed that 6,700 patient deaths and 4 million days of hospital care could be averted annually by increasing the number of nurses. "Nurses are the glue holding the system together," Buerhaus said.

Addressing the nursing shortage is important in the context of healthcare reform, Buerhaus added. Future shortages could drive up nurse wages, adding costs to the system, he said.

And if the health changes championed by Obama raise the number of Americans with access to medical care, more nurses will be needed to help accommodate them, Buerhaus said.

(Editing by Maggie Fox and Mohammad Zargham)

Air Force nurse charged in three patients' deaths

(CNN) -- An Air Force nurse has been charged with murdering three terminally ill patients by giving them fatal overdoses, the Air Force said Tuesday.

Capt. Michael Fontana is continuing to work at Wildford Hall Medical Center.

Capt. Michael Fontana, a nurse at Wilford Hall Medical Center at Lackland Air Force Base in San Antonio, Texas, also was charged Monday with conduct unbecoming an officer for changing a medical document.

"The charges are the result of an Air Force investigation that occurred after irregularities were discovered in Capt. Fontana's administration of medications which may have resulted in the death of an end-of-life patient," hospital spokesman David Smith told reporters.

The nurse was charged with three counts of violating Article 118 of the Uniform Code of Military Justice. "It is considered murder," Smith said.

After an Article 32 hearing, akin to a civilian grand jury proceeding, the commander will decide whether the case goes to court-martial.

The three deaths occurred in July, Smith said. He cited the privacy act in refusing to divulge the suspect's age and hometown. 

He said he did not know the motive but was confident no other patients were victimized. 

"We know that there are no other patients involved in this case," he said.

Fontana, an intensive-care unit nurse who has been working at the hospital since 2006, the year he joined the Air Force, has been released on his own recognizance and is continuing to work at the hospital, though he is no longer involved in patient care, Smith said.

"As far as we can tell, he has been an exemplary nurse," Smith said.

Fontana also served as a nurse at the Air Force Theater Hospital in Balad, Iraq, Smith said. His work there was investigated, "and there was nothing found," he said.

A call to a San Antonio phone number listed as belonging to Michael Fontana got a message that said, "Thank you for calling. Due to the ongoing investigation, I have no comment for you right now, but I do appreciate your call and will talk to you soon."

Relatives of the dead patients have requested privacy, the Air Force said.
Wilford Hall Medical Center is the Air Force's largest medical facility.

Vocollect's device has health-care workers talking

Businesses that launched new products in late 2007 could start their own survivor's club today, with monthly meetings convened around a mid-sized dining table.

In that elite club, one seat should be reserved for Vocollect Healthcare Systems in Wilkins, which Â-- counter to the economic times -- saw its sales more than triple last year.

The company's product is a voice-assisted care device that, to an outsider, looks a lot like the headsets worn by the counter help at fast-food restaurants.

But Vocollect's device, called AccuNurse, is more -- a voice-activated portable system that provides nursing home aides with information on their residents as they work while also capturing data to ensure the nursing home gets proper reimbursement.

When it debuted, AccuNurse was sold in two states. Now it is available in 23.

"There's enormous opportunity for us, so we have pretty high expectations for this company," said James Quasey, president of the firm.

He makes the case that AccuNurse has a number of benefits: It helps ensure nursing home residents get proper care at the proper time; it streamlines the work day for aides, who no longer have to keep handwritten records or sit through shift-change meetings; and it makes sure the nursing home captures the full reimbursement.

"It is a system that pays for itself within months," Mr. Quasey said.

In 2005, Roger Byford, chairman and CEO of Vocollect Healthcare's parent company, visited the small Virginia company that developed the system. "It was very clear to me that it was a great application for the technology," he said.

So he bought AccuNurse and brought it back to Pittsburgh, where Vocollect technicians spent 18 months building a second generation model that is more powerful, smaller, more ergonomically designed and less expensive.

They put special emphasis on top-drawer voice recognition software, knowing that garbled messages lead to intolerable delays and mistakes. And they made sure potential customers would see the financial benefit.

Among its local customers are UPMC's skilled nursing facilities, which, in an article in Nursing Homes magazine last year, reported increased reimbursement due to improved documentation and dramatic declines in staff turnover. Within three months, the system had paid for itself, according to the article.

Last month, St. John Specialty Care Center in Mars took some of its units fully online. Executive Director Tom Prickett said, "We're very pleased with it." Judy Hon, assistant director of nursing, said staff members feel empowered, knowing when they walk into a resident's room they actually have a handle on everything that resident needs.

Because workers can page each other through the headset, rather than an intercom, noise levels in the facility have gone down, too.

Vocollect officials keep pricing and revenue figures private, but they are clearly optimistic about the company's future. While potential 10 percent to 20 percent annual growth would make most companies swoon, "that would be short of our expectation, that's for sure," Mr. Quasey said.

With 45 employees, Vocollect Healthcare is only one-tenth the size of its parent, Vocollect Inc., which sells voice-activation systems for use in warehouse distribution. With many of its customers in the retail sector, the economic downturn has hit Vocollect Inc., forcing the company to lay off 65 workers in November.

"We expect both businesses to grow," said Mr. Byford, but in five years he hopes the parent is only two to three times bigger than Vocollect Healthcare, a wholly-owned subsidiary.

There are 17,000 nursing homes in the United States, he noted. The company also is already exploring the possibilities of adapting the application to hospital settings.

"It's not just that we're growing in a slow economy," Mr. Quasey said. "It's that we're helping people."

Steve Twedt can be reached at stwedt@post-gazette.com or 412-263-1963.
First published on March 17, 2009 at 12:00 am

Online nurses prove skeptics wrong

Pratt Community College has done what few colleges or universities even attempt, what skeptics doubt can be done well, and has achieved a high level of success.

Last November 94 percent of students enrolled in PCC’s online nursing program passed their national examination to become registered nurses on the first try. Four classes have graduated since the online course was initiated in 2006, with an overall first-time pass rate of 85 percent, above state and national averages, and identical to the rate for students in the traditional on-ground program.

“There are plenty of skeptics who think that quality student learning cannot be delivered via online instruction. The number of skeptics grows even larger when the program is one as demanding as nursing,” Vice President of Instruction Jim Stratford said. “The way to counter the skeptics is to demonstrate a high level of student learning outcomes.” 

The instruction, both theory and hands-on, is the same, whether students are in a classroom or in their homes at whatever hour they can fit into their schedules, according to Gail Withers, dean of nursing and allied health. Online students come to campus for skill labs and participate in the same number of clinical hours at four sites across the state.

Nearly 100 percent of them are non-traditional, Withers said. They have families, jobs, are older than most campus students, and may have been out of school for a number of years. Most are female, though every class includes a few males. Classes are also becoming more internationally diverse. Many students are not close enough to a campus to attend college in the traditional way. 

PCC has become a pioneer in largely uncharted territory for a fairly mundane reason.

The college serves the largest geographic area of the state, but with the smallest population.
Funding is tied to credit hours, so the college had to look outside its service area to increase enrollment, Withers said.

On a more altruistic note, nursing programs are being challenged to increase capacity to fill 2,000 to 4,000 additional nursing positions in Kansas. Nursing is at the top of the job outlook projections, Withers said. An additional 800,000 registered nurses will be needed nationwide by 2020.

Three years ago the PCC nursing program had an approved capacity of 60 students; with expansion at the Pratt campus, the establishment of a PCC nursing program in Winfield and the development of online courses, the number has grown to 220.

Students start in allied health, earning certification as a nurse aide, medication aide, home health or restorative aide. Those classes are also available online and many high school students take them for concurrent credit. Success rates are good for those classes as well, Withers said. More than 90 percent pass certification exams the first time. 

Certification is a prerequisite to the nursing program. After the first year, students are eligible for licensure as practical nurses; completion of the second year allows an LPN to take the registered nurse exam.

Because “life happens,” students can stop at any point with marketable skills, work for a while and come back for more education, Withers noted.

Future expansion of the program includes certification in health occupations, available next fall. The 16-credit hour course allows an LPN or RN to move into some management positions without a bachelor’s degree. Also available in the fall is a program to allow a paramedic to transition to registered nursing.

The program has outgrown Chandler Hall on the northeast corner of the campus, and a 3,000 square foot addition is being constructed to include offices, a simulation hospital, two classrooms and additional storage.

At one time, 90 percent of registered nurses at Pratt Regional Medical Center were PCC graduates, Withers said, and three graduates are now on the PCC nursing faculty.

Compassionate Care -- Nurse Receives DAISY Honor for Excellent Service

from Commercial Appeal, The .. 

By Lori Simpson 

Porsha Divittorio, a nurse in the emergency department at Baptist Memorial Hospital-Memphis, recently earned the DAISY Award for Extraordinary Nurses, given in appreciation of the work nurses do. 

Divittorio was nominated by Kirsten Baxter, a technician in materials management at Baptist Memphis. Baxter suffered a hand injury and was impressed by the level of personal concern and compassion Divittorio showed while caring for her. Each month, Baptist Memphis' nursing administrators accept nominations and select a nurse to receive the DAISY Award. At a presentation in front of the nurse's colleagues, physicians, patients and visitors, the honoree receives a certificate and a sculpture called "A Healer's Touch," hand-carved by artists of the Shona Tribe in Africa. 

"Porsha is a fine example of what a nurse should be," said Dana Dye, chief nursing officer at Baptist Memphis. "She works to heal her patients' physical conditions while remembering to care for their emotional needs, as well." 

For more information on Baptist Memphis, please call 226-5000 or visit memphis.baptistonline.org. 

Lori Simpson is a public relations intern for the Corporate Communications department at Baptist. 

Originally published by Lori Simpson Special to My Life .

he Eighth Leading Cause of Death in the U.S. is…

The eighth leading cause of death in the U.S. is medication error. This statistic may surprise you. Other frightening statistics include the following:

* 7,000 deaths occur each year that are directly attributable to medication errors.
* Errors occur around 1 in 5 times that medication is administered.
* The FDA estimates 1 death per day due to medication errors.

The three most common errors are giving an improper dose, giving the wrong drug, and giving the drug by the wrong route (for example, intravenous instead of oral).

Everyone involved in health care is aware of errors and know that they occur more often than they should. The question then becomes: 

If it is known that errors are happening, what can be done to prevent them?

Nursing personnel are the front-line staff most often responsible for administering medications to patients. Any factor that decreases the effective functioning of nursing staff will impact how safely nurses can perform their duties.

The nursing shortage impacts nursing care in a negative way. A shortage of nursing staff translates to fewer nurses to care for the same amount of patients. The shortage of nurses also means that nurses are working overtime more often, and coming in to work on their days off more often. Nurses often work in excess of 12 hours a day. All of these factors add up to fatigue and stress, a double whammy when it comes to human error.

Hospitals are now turning to technology to attempt to decrease hospital medication errors. Computer-generated prescriptions cut down on errors that occur in transcribing doctor’s orders. In some centers, nurses are being provided with hand-held computers that contain drug information on dosing, routes, and adverse effects. Medications are being provided in single-dose packaging, and drugs that have names similar to other drugs are packaged differently and include clearer labeling. Dangerous medications are signed for by two staff members instead of one (for example, insulin, narcotics, and anticoagulants). Abbreviations that are dangerous or misleading have been abolished in some cases.

Patients are now becoming more educated about their medications, their conditions, and their treatment, but too many still blithely accept medications and treatments without asking questions of health care personnel. All too often, patients are not aware of the names, correct doses, and prescribing reasons behind the medications they are on. Questioning medical personnel about their medications and why they are being given these medications is one way that patients can help safeguard themselves.

The nursing shortage is not likely to end any time in the near future. Decreasing the risk of medication errors is the job of all medical personnel who care for patients. Doctors can do their part by writing (or printing) orders legibly and clearly stating their orders with no ambiguity. Nursing staff who administer medications need to take advantage of all technology available that may help them do their jobs more safely. Finally, patients need to be their own best advocates by being fully aware of their treatment plan and medications. If a patient is unable to understand, a family member or friend can take on this role.

To err is human but, by working together, hospital personnel can help reduce the staggering statistics of medication error.

A Nurse’s Distress Over a Dying Patient

Oncology nurse Theresa Brown is a regular contributor to Well. Today she writes about a family’s reluctance to accept the inevitable death of a loved one.

The patient being transferred to me had metastatic cancer. I was told she had a large tumor in her hip, buttock and abdomen, but that description did not prepare me for what I saw when the patient got to my floor. 

Her “large tumor” was so grotesque it is difficult to describe. She had visible growths resembling giant warts extending in a solid mass from her backside, around one hip, and covering one side of her belly from her navel to her groin. There were blackened, necrotic (dead) areas scattered throughout and other sections festered, oozed and bled. The smell was horrific.

Four of us moved her from the stretcher to the bed and, in the process, realized she was lying in layers of sheets soaked with her own secretions and bodily fluids. It was impossible to clean her up without causing her significant pain since her skin was so fragile. She was only in her early 40s, but she didn’t know where she was or what was happening. Although she had been prescribed oral pain medications, rolling and cleaning her still was physically agonizing for her.

The patient was “D.N.R./D.N.I.” — that means “do not resuscitate, do not intubate” in the case of heart failure. But she was still getting treatment because the relative who held her power of attorney said the patient could have antibiotics and blood products. An earlier scan of her chest and abdomen had shown widespread metastatic disease in her lungs and tumor growth in her groin that pressed on a main artery. She had intractable anemia that transfusions relieved but would not cure.

From my point of view she was dying, and after three of us got her rolled and changed and cleaned up, I left the room so angry I was shaking. Suffering can be part of healing, and nurses bear witness to constant suffering in the hospital, but this patient’s suffering seemed pointless and cruel. 

Nurses are supposed to be the patient’s advocate, and this situation compelled me to speak up. I called the doctor and expressed my deep misgivings with the plan of care. I thought the patient should be “C.M.O.,” or “comfort measures only,” meaning we would stop doing tests on her, stop giving her antibiotics, and start giving her enough intravenous narcotics that she wouldn’t have to live in pain. The doctor heard me out and then explained that, just the week before, the patient had been mentally intact and had insisted on continuing treatment.

Family members showed up soon after I had this conversation. I’m still a pretty new nurse, but something about this patient motivated me to bring up the issue of comfort measures with the family.

“So there’s no hope for her?” they asked, with tears in their eyes.

“We just want her to get better,” said one of her sisters.

I explained her condition to them, and then the doctor came and we all talked together. These were caring family members trying to do the right thing for someone they loved. The phrase that came up repeatedly was, “She’s not ready.” The family wanted the patient to be at peace with the decision to withdraw treatment. They, and the doctor, hoped that an infection had caused her mental status changes, and that once the infection cleared the patient would address future treatment questions herself.

I found myself telling them, “You know, sometimes people can’t be peaceful with that decision, ever, not even at the very end, and it’s heartbreaking for the families.”

Later, after the family left, the doctor and I talked again. From her point of view, and I’ve heard other medical people express this idea, physicians have an ethical obligation to address problems that can possibly be reversed, even when the patient is near death. If the patient had an infection, it could be treated with antibiotics. The patient’s anemia was also potentially treatable if the cause could be discovered.

Everyone involved had the best, even noble, motives, but nobility may be misplaced in a situation like this. The question on my mind was misery.

With her incontinence and already vulnerable skin, the patient was at risk for recurrent infections that would further debilitate her and increase her physical discomfort. As her disease grew in her lungs, her respiratory status would become more and more compromised until she was gasping for air. This patient, who was visibly suffering, who had very little real hope of living for too much longer, also was receiving very expensive health care.

The doctor was honest and empathic, the family sympathetic — there were no bad guys here. But this tableau offers a snapshot of some of the most pressing ethical issues plaguing American health care. Should patients receive expensive treatments with little hope of efficacy just because they ask for them? Should we fix problems that can be treated when those problems probably occurred because of an irreversible progression of a patient’s disease? What does it mean to be “ready” to die?

When Jan, her nurse, told me the patient finally was going home on hospice I got tears of relief in my eyes.

Americans have a hard time facing death, but we need to do better. “Do not go gentle into that good night,” Dylan Thomas wrote. The truth is, nobody needs to be told. Very few people meet death easily, and no one wants to die. But when someone’s body is wasting from disease and there is no hope, we need to bring more than good intentions to the table.