The vaccine is working, hospitals are ready to discharge, but I need staff. How to create a facility where quality nurses want to work.

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By: Thomas E. Hanzel, Pharm.D., MBA

Even though the serenity prayer teaches us that we need the courage to change the things we can, we can all quickly find things to complain about this past year. In today’s world, you have to work a little harder to put a smile on your own face. I can easily list more things to worry about than things that make me hopeful; therefore, I am on a mission to find things that will make me laugh. Silly jokes, funny videos, or even dare I say, a meme.   

Pandemics, economic issues, and political debates can turn any one of us into a hot emotional mess rather quickly. As we surge past the pandemic with incredible success due to vaccines and determined professionals across our industry, we can be proud of watching positive COVID cases plummet. We can also maintain a level of hope that nursing center’s census will once again thrive. But – and you knew a but was coming – the nursing shortage is not a laughing matter. In fact, it is predicted to be so severe that in and of itself will someday be an epidemic of its own. 

CURRENT STATE 

We have all heard for years that a nursing shortage crisis is coming, but it seems as if COVID has sped it up. A recently released survey conducted by AHCA / NCAL states  “nearly three-fourths of nursing homes and more than half of assisted living communities say their facility’s overall workforce situation has gotten worse compared to 2020.” Also, “94% of nursing homes and 81% of assisted living communities have faced a shortage of staff members.”

I recently spoke with a senior officer at a well-known national pharmacy chain and he explained they are seeing evidence the vaccine is working, positive COVID cases are down and hospitals want to discharge, but many of his nursing centers still cannot admit residents due to lack of staff.  He said, “they cannot hire nursing staff fast enough to adequately care for new admissions, so they are declining admissions.” You are reading that right.  Turning down admissions.   

It is not just a staffing issue with nurses though. We all know that the frontline Certified Nursing Aides (CNA’s) are the essential backbone of nursing centers and the staffing shortage impact is being felt with this group as well. The same AHCA / NCAL study said, “In 2020, more than half of facilities said staff in essential positions, such as CNAs or direct caregivers and dietary staff, have quit.” Also, according to this McKnight’s Long-Term Care News article, the “US is facing a certified nurse aide shortage of about 200,000.”  

FUTURE STATE

This isn’t just a temporary “blame it on COVID” crisis. The US Bureau of Labor Statistics reviewed the employment projection data for registered nurses, and stated there will be about 175,900 openings for registered nurses projected each year over the next decade. But, and there is that word again, only 221,900 new additional nurses will be available. If my abacus is still working right, that is a shortage of over 1.5 million nurses by 2030!  Maybe those estimates are high, but even if they are half right, this shortage should be considered a national crisis headed for our country.  

WHAT IS CAUSING THE SHORTAGE

There are many causes of the current and future nursing shortage crisis. We can start by attributing this to the baby boomer generation. The impact from this generation is actually three-fold. 

First, as widely known, the aging population in America will vastly increase. According to RHI hub, between 2020 and 2030 alone, the number of older adults is projected to increase by almost 18 million. This means by 2030, 1 in 5 Americans is projected to be 65 years old and over.  

Secondly, this same aging population will retire hundreds of thousands of nurses. The American Nurses Association expects more than 500,000 nurses will retire as early as 2022. That doesn’t even take into account the impact COVID had on nurses leaving the industry. According to an article by Greg Volmer in reviewing a nationwide survey, he said, “Of the 1,300 nurses surveyed, three out five are likely to leave their position or specialty as a result of their experience with the COVID-19 pandemic. Further data analysis shows that 67 percent of respondents will either leave their current facility or quit the industry altogether.”  Hopefully now many nurses are mentally recovering from the initial pandemic shock and have avoided burning out, but there will still be a percentage that won’t.       

Lastly, as nurses retire, there is a deficiency in nurse educators. As it takes a nurse to train a nurse, understaffed nursing schools are turning away qualified applicants. The American Association of Colleges of Nursing (AACN) reported that in just 2019 alone, nursing schools in the U.S. turned away more than 80,000 qualified nursing applicants.  

OK, SO WHAT CAN I DO FOR MY NURSES?

Forging ahead and fixing national issues always starts at home, and for long-term care providers, they need to concentrate on what they can control. Most notably, they need to work hard at creating an environment to help nurses and all staff reduce stress, avoid burnout, and makes their lives easier.  

Improving pay, schedules, and atmosphere are all very important, but most of a nurse’s daily responsibilities are assuring medications are passed accurately and efficiently. Therefore, removing or reducing the stresses of med pass should be a top priority for all long-term care management. The best way to do this is by switching to adherence packaging for the residents’ medications.  

Adherence packaging has been proven to significantly decrease med pass time, reduce med pass errors, and overall, make the nurse’s life easier. It is not hard to put financial and emotional value on improved medication adherence while decreasing stress on your nurses. Fortunately, both can be accomplished simultaneously through adherence packaging.  

Adherence packaging will unchain the nurse from the med cart and give them an opportunity to spend valuable quality time with each resident. In addition, the nurse has less physical demand on their bodies with adherence packs because there are less packs to open, the packs are easier to open, and the med carts are lighter to push. All resulting in less burden on their hands, arms, legs, and back.

Lastly, adherence packaging is usually sent out by your pharmacy in a cycle format, allowing the nurse to avoid the time-consuming process of removing labels and manually reordering. Once again, reducing their daily tasks and make the job less stressful.   

The serenity prayer reminds us to accept what we cannot change, to have courage to change the things we can, but to have the wisdom to know the difference. You now have the wisdom in knowing how you can make life easier on your hard-to-find critical nursing staff with adherence medication packaging. The only question left is, do you have the courage to make the change?   

Thomas E. Hanzel, Pharm.D., MBA, is an industry thought leader and the national VP of long-term care and nutraceuticals at Parata, an automation company that provides pharmacy technology solutions that support business growth, better health outcomes, and lower medical costs.

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