As seasoned nurses we have experienced many nursing shortages, yet we also witnessed that they resolved. However, the current shortage has not ended, and in fact, has intensified. In the early 2000s nurses were complaining about poor working conditions, job dissatisfaction, and feeling under-valued. The Magnet designation was developed to highlight those hospitals with a better work environment for nurses. Not downplaying its attention to the nurse's work environment, the reality was that the shortage remained. Prior to the COVID-19 pandemic, as nurses we understood and appreciated the feelings of emotional exhaustion and burnout. Its effects were noted among nurses pre-COVID. Nurses were leaving the hospital workforce with job vacancies in some hospital positions up to 30% between 2019 and 2020.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google Scholar The reasons varied from lack of support from the organization, the supervisor, feeling overworked, under paid, burnout, or a combination. However, once COVID-19 began, burnout among nurses and other health care personnel increased dramatically, ranging from moderate to high burnout rates.2Zareei M Tabanaejad Z Oskouie F et al.Job burnout among nurses during COVID-19 pandemic: a systematic review.J Educ Health Promot. 2022; 11 (Available online Job burnout among nurses during COVID-19 pandemic: a systematic review (nih.gov)): 107PubMed Google ScholarAs the COVID pandemic continued, hospitals stopped conducting elective surgeries and canceled admissions to hospitals that were non-emergent. Ambulatory facilities closed. The health care world as we knew it dramatically changed. While some nurses lost their jobs, those nurses on the units acutely felt the stress of caring for the COVID- infected patients prior to any available vaccine.3Musto J. Front-line health care worker shortage due to COVID-19 vaccine mandates, burnout. Fox News. 2021. October 19, 2021. Available at: https://www.foxnews.com/health/frontline-health-care-workers-shortage-covid-vaccine-mandates-burnout. Accessed August 23, 2022.Google Scholar They encountered with a very different anxiety with COVID-19, the fear of the unknown. In addition, nurses were often separated from their families for long periods of time. They frequently had low resources of personal protective equipment, and many lost faith in their organizations.2Zareei M Tabanaejad Z Oskouie F et al.Job burnout among nurses during COVID-19 pandemic: a systematic review.J Educ Health Promot. 2022; 11 (Available online Job burnout among nurses during COVID-19 pandemic: a systematic review (nih.gov)): 107PubMed Google ScholarAs the COVID-19 pandemic eased some, from September 2020 to December 2020, hospital nurse staffing demand increased by 245%, or 50,000 nurses.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google Scholar Many nurses were sick with COVID themselves and could not return, while many nurses did not want to come back. Some nurses left the hospital setting for other nursing positions, or simply the profession of nursing all together for personal reasons. For example, they did not want to get the mandated COVID-19 vaccine.3Musto J. Front-line health care worker shortage due to COVID-19 vaccine mandates, burnout. Fox News. 2021. October 19, 2021. Available at: https://www.foxnews.com/health/frontline-health-care-workers-shortage-covid-vaccine-mandates-burnout. Accessed August 23, 2022.Google Scholar These personal decisions created dilemmas for patient care in several hospitals, like one hospital needing to pause deliveries, and a loss of 400 nurses at another hospital.3Musto J. Front-line health care worker shortage due to COVID-19 vaccine mandates, burnout. Fox News. 2021. October 19, 2021. Available at: https://www.foxnews.com/health/frontline-health-care-workers-shortage-covid-vaccine-mandates-burnout. Accessed August 23, 2022.Google Scholar Patients continued to enter the hospitals for care, including those not with a COVID diagnosis, and those with COVID-mutations like the Omicron or Delta variants. The staffing shortage worsened.Hospitals have cared for over 3.2 million COVID-19 patients up to August 2021, with an estimated $54 billion in net income losses in that same period.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google Scholar One-third of the hospitals were projected to be in the red by the end of 2021.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google Scholar Job vacancies extended past nurses, for example, up to 30% for respiratory therapists, who are a critical part of any COVID-19 team. It is also noted that staff turnover was extremely high in departments like nursing, emergency, and intensive care units. In fact, in these units, due to COVID-19 pressures, staff turnover has increased from 18% to 30%.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google Scholar Overall, it is expected that there will be a shortage of close to 3.2 million workers in the health care industry by 2026.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google ScholarNursing staffing shortages have already impacted patient care across the country. In Ohio, surgical, inpatient, and emergency services have ended in two Cleveland area hospitals.4Ellison A. Hospitals cutting services over staffing shortages. Becker's Hospital Review. Available at: https://www.beckershospitalreview.com/care-coordination/hospitals-cutting-services-over-staffing-shortages-0719.html. Accessed July 19, 2022.Google Scholar In Williamston NC, a nursing staffing shortage has caused the temporary closure of their ICU.4Ellison A. Hospitals cutting services over staffing shortages. Becker's Hospital Review. Available at: https://www.beckershospitalreview.com/care-coordination/hospitals-cutting-services-over-staffing-shortages-0719.html. Accessed July 19, 2022.Google Scholar A critical access hospital in Kemmerer WY can no longer provide labor and delivery services, as well as emergency surgical services because of their inability to recruit surgical nurses.4Ellison A. Hospitals cutting services over staffing shortages. Becker's Hospital Review. Available at: https://www.beckershospitalreview.com/care-coordination/hospitals-cutting-services-over-staffing-shortages-0719.html. Accessed July 19, 2022.Google Scholar Another WY hospital also closed its labor and delivery unit too after spending $100,000 per week on travel nurses in attempt to keep the unit open.4Ellison A. Hospitals cutting services over staffing shortages. Becker's Hospital Review. Available at: https://www.beckershospitalreview.com/care-coordination/hospitals-cutting-services-over-staffing-shortages-0719.html. Accessed July 19, 2022.Google Scholar Access to health care will continue to be a problem, especially in rural areas where there is already a disparity in care.Health care administrators should consider new ways of thinking about how to retain nurses, as well as deliver care. The Health Resources and Services Administrations in their 2018 National Sample Survey of Registered Nurses found that the average age of the RN was 50 years old. The median age of a RN, which is likely a better indicator, is 52 years old.5National Council of State Boards of Nursing. 2020. Available online: National Nursing Workforce Study | NCSBNGoogle Scholar With many nurses around 50 years old, efforts to retain this large group of nurses should be primary. Yet, the perception of many is that the time and energy focuses on the recruitment of the younger, new graduates. The real questions should be: What do these “older” group of nurses need to keep them engaged and employed with the health care facility? Is there something different administrators and managers can be doing for them?Few studies have focused exclusively on the older nurses and retention. One factor associated with early retirement with older nurses were family situations, such as the need to care for sick relatives, the need to assist with grandkids, or their spouse retiring.6Uthaman T, Chau Lert T, Ang SY. Older nurses: a literature review on challenges, factors in early retirement and workforce retention. In: Proceedings in Singapore Healthcare. 2016;25:50–55.Google Scholar Considerations should be made to offer shorter, staggered shifts and other unique benefits, such as an on-site elder care. Many may be caregivers for their elderly parents and would find value in this benefit. Flexible scheduling is also very attractive to those who are considering early retirement and are searching for a way to work differently. Older nurses who retired early reported having negative feelings towards the too many technological changes.6Uthaman T, Chau Lert T, Ang SY. Older nurses: a literature review on challenges, factors in early retirement and workforce retention. In: Proceedings in Singapore Healthcare. 2016;25:50–55.Google Scholar Could this be countered by adding in more training related to technology specifically designed for older learners? This may decrease the stresses associated with the rapid changes seen in technology in today's health care facilities.As nurses age physically, they can have challenges with lifting and transferring patients.6Uthaman T, Chau Lert T, Ang SY. Older nurses: a literature review on challenges, factors in early retirement and workforce retention. In: Proceedings in Singapore Healthcare. 2016;25:50–55.Google Scholar Having equipment and units ergonomically designed is beneficial for older nurses. Their vision changes or their hearing lessens which may result in tasks taking a little longer.6Uthaman T, Chau Lert T, Ang SY. Older nurses: a literature review on challenges, factors in early retirement and workforce retention. In: Proceedings in Singapore Healthcare. 2016;25:50–55.Google Scholar Many older nurses are female, which entails the biological phase of menopause. Menopause for many can cause severe symptoms, both physically and emotionally. Health care facilities can have resources available for nurses who are struggling with menopausal symptoms, which can continue for years. Knowing that the facility you work for understands and supports you during life changes shows care and appreciation for the nurse.Older nurses who do not have access to continual educational activities were more likely to leave. These nurses want to be valued for their years of experience and knowledge.6Uthaman T, Chau Lert T, Ang SY. Older nurses: a literature review on challenges, factors in early retirement and workforce retention. In: Proceedings in Singapore Healthcare. 2016;25:50–55.Google Scholar With the shortage of college instructors these older nurses could be excellent mentors for nursing students by sharing their expertise.The nurse staffing shortage is extreme. Older nurses are retiring at an alarming rate, with many calling themselves early retirees. The COVID pandemic added fuel to an already burning fire of emotional exhaustion and job dissatisfaction. Health care administrators need to consider innovative means to retain the older nurses, while attracting and retaining the younger nurses. The shortage is complex; thus, the solutions will be as well. Health care access and quality is in danger. It happens with every hospital that shutters a unit, especially those in rural and underserved areas. When you need quality care, who will be there for you? What do you need from your employer? Speak up now. As seasoned nurses we have experienced many nursing shortages, yet we also witnessed that they resolved. However, the current shortage has not ended, and in fact, has intensified. In the early 2000s nurses were complaining about poor working conditions, job dissatisfaction, and feeling under-valued. The Magnet designation was developed to highlight those hospitals with a better work environment for nurses. Not downplaying its attention to the nurse's work environment, the reality was that the shortage remained. Prior to the COVID-19 pandemic, as nurses we understood and appreciated the feelings of emotional exhaustion and burnout. Its effects were noted among nurses pre-COVID. Nurses were leaving the hospital workforce with job vacancies in some hospital positions up to 30% between 2019 and 2020.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google Scholar The reasons varied from lack of support from the organization, the supervisor, feeling overworked, under paid, burnout, or a combination. However, once COVID-19 began, burnout among nurses and other health care personnel increased dramatically, ranging from moderate to high burnout rates.2Zareei M Tabanaejad Z Oskouie F et al.Job burnout among nurses during COVID-19 pandemic: a systematic review.J Educ Health Promot. 2022; 11 (Available online Job burnout among nurses during COVID-19 pandemic: a systematic review (nih.gov)): 107PubMed Google Scholar As the COVID pandemic continued, hospitals stopped conducting elective surgeries and canceled admissions to hospitals that were non-emergent. Ambulatory facilities closed. The health care world as we knew it dramatically changed. While some nurses lost their jobs, those nurses on the units acutely felt the stress of caring for the COVID- infected patients prior to any available vaccine.3Musto J. Front-line health care worker shortage due to COVID-19 vaccine mandates, burnout. Fox News. 2021. October 19, 2021. Available at: https://www.foxnews.com/health/frontline-health-care-workers-shortage-covid-vaccine-mandates-burnout. Accessed August 23, 2022.Google Scholar They encountered with a very different anxiety with COVID-19, the fear of the unknown. In addition, nurses were often separated from their families for long periods of time. They frequently had low resources of personal protective equipment, and many lost faith in their organizations.2Zareei M Tabanaejad Z Oskouie F et al.Job burnout among nurses during COVID-19 pandemic: a systematic review.J Educ Health Promot. 2022; 11 (Available online Job burnout among nurses during COVID-19 pandemic: a systematic review (nih.gov)): 107PubMed Google Scholar As the COVID-19 pandemic eased some, from September 2020 to December 2020, hospital nurse staffing demand increased by 245%, or 50,000 nurses.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google Scholar Many nurses were sick with COVID themselves and could not return, while many nurses did not want to come back. Some nurses left the hospital setting for other nursing positions, or simply the profession of nursing all together for personal reasons. For example, they did not want to get the mandated COVID-19 vaccine.3Musto J. Front-line health care worker shortage due to COVID-19 vaccine mandates, burnout. Fox News. 2021. October 19, 2021. Available at: https://www.foxnews.com/health/frontline-health-care-workers-shortage-covid-vaccine-mandates-burnout. Accessed August 23, 2022.Google Scholar These personal decisions created dilemmas for patient care in several hospitals, like one hospital needing to pause deliveries, and a loss of 400 nurses at another hospital.3Musto J. Front-line health care worker shortage due to COVID-19 vaccine mandates, burnout. Fox News. 2021. October 19, 2021. Available at: https://www.foxnews.com/health/frontline-health-care-workers-shortage-covid-vaccine-mandates-burnout. Accessed August 23, 2022.Google Scholar Patients continued to enter the hospitals for care, including those not with a COVID diagnosis, and those with COVID-mutations like the Omicron or Delta variants. The staffing shortage worsened. Hospitals have cared for over 3.2 million COVID-19 patients up to August 2021, with an estimated $54 billion in net income losses in that same period.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google Scholar One-third of the hospitals were projected to be in the red by the end of 2021.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google Scholar Job vacancies extended past nurses, for example, up to 30% for respiratory therapists, who are a critical part of any COVID-19 team. It is also noted that staff turnover was extremely high in departments like nursing, emergency, and intensive care units. In fact, in these units, due to COVID-19 pressures, staff turnover has increased from 18% to 30%.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google Scholar Overall, it is expected that there will be a shortage of close to 3.2 million workers in the health care industry by 2026.1American Hospital AssociationData Brief: Health Care Workforce Challence Threaten Hosptials’ ability to care for Patients. American Hospital Association, Chicago IL2021Google Scholar Nursing staffing shortages have already impacted patient care across the country. In Ohio, surgical, inpatient, and emergency services have ended in two Cleveland area hospitals.4Ellison A. Hospitals cutting services over staffing shortages. Becker's Hospital Review. Available at: https://www.beckershospitalreview.com/care-coordination/hospitals-cutting-services-over-staffing-shortages-0719.html. Accessed July 19, 2022.Google Scholar In Williamston NC, a nursing staffing shortage has caused the temporary closure of their ICU.4Ellison A. Hospitals cutting services over staffing shortages. Becker's Hospital Review. Available at: https://www.beckershospitalreview.com/care-coordination/hospitals-cutting-services-over-staffing-shortages-0719.html. Accessed July 19, 2022.Google Scholar A critical access hospital in Kemmerer WY can no longer provide labor and delivery services, as well as emergency surgical services because of their inability to recruit surgical nurses.4Ellison A. Hospitals cutting services over staffing shortages. Becker's Hospital Review. Available at: https://www.beckershospitalreview.com/care-coordination/hospitals-cutting-services-over-staffing-shortages-0719.html. Accessed July 19, 2022.Google Scholar Another WY hospital also closed its labor and delivery unit too after spending $100,000 per week on travel nurses in attempt to keep the unit open.4Ellison A. Hospitals cutting services over staffing shortages. Becker's Hospital Review. Available at: https://www.beckershospitalreview.com/care-coordination/hospitals-cutting-services-over-staffing-shortages-0719.html. Accessed July 19, 2022.Google Scholar Access to health care will continue to be a problem, especially in rural areas where there is already a disparity in care. Health care administrators should consider new ways of thinking about how to retain nurses, as well as deliver care. The Health Resources and Services Administrations in their 2018 National Sample Survey of Registered Nurses found that the average age of the RN was 50 years old. The median age of a RN, which is likely a better indicator, is 52 years old.5National Council of State Boards of Nursing. 2020. Available online: National Nursing Workforce Study | NCSBNGoogle Scholar With many nurses around 50 years old, efforts to retain this large group of nurses should be primary. Yet, the perception of many is that the time and energy focuses on the recruitment of the younger, new graduates. The real questions should be: What do these “older” group of nurses need to keep them engaged and employed with the health care facility? Is there something different administrators and managers can be doing for them? Few studies have focused exclusively on the older nurses and retention. One factor associated with early retirement with older nurses were family situations, such as the need to care for sick relatives, the need to assist with grandkids, or their spouse retiring.6Uthaman T, Chau Lert T, Ang SY. Older nurses: a literature review on challenges, factors in early retirement and workforce retention. In: Proceedings in Singapore Healthcare. 2016;25:50–55.Google Scholar Considerations should be made to offer shorter, staggered shifts and other unique benefits, such as an on-site elder care. Many may be caregivers for their elderly parents and would find value in this benefit. Flexible scheduling is also very attractive to those who are considering early retirement and are searching for a way to work differently. Older nurses who retired early reported having negative feelings towards the too many technological changes.6Uthaman T, Chau Lert T, Ang SY. Older nurses: a literature review on challenges, factors in early retirement and workforce retention. In: Proceedings in Singapore Healthcare. 2016;25:50–55.Google Scholar Could this be countered by adding in more training related to technology specifically designed for older learners? This may decrease the stresses associated with the rapid changes seen in technology in today's health care facilities. As nurses age physically, they can have challenges with lifting and transferring patients.6Uthaman T, Chau Lert T, Ang SY. Older nurses: a literature review on challenges, factors in early retirement and workforce retention. In: Proceedings in Singapore Healthcare. 2016;25:50–55.Google Scholar Having equipment and units ergonomically designed is beneficial for older nurses. Their vision changes or their hearing lessens which may result in tasks taking a little longer.6Uthaman T, Chau Lert T, Ang SY. Older nurses: a literature review on challenges, factors in early retirement and workforce retention. In: Proceedings in Singapore Healthcare. 2016;25:50–55.Google Scholar Many older nurses are female, which entails the biological phase of menopause. Menopause for many can cause severe symptoms, both physically and emotionally. Health care facilities can have resources available for nurses who are struggling with menopausal symptoms, which can continue for years. Knowing that the facility you work for understands and supports you during life changes shows care and appreciation for the nurse. Older nurses who do not have access to continual educational activities were more likely to leave. These nurses want to be valued for their years of experience and knowledge.6Uthaman T, Chau Lert T, Ang SY. Older nurses: a literature review on challenges, factors in early retirement and workforce retention. In: Proceedings in Singapore Healthcare. 2016;25:50–55.Google Scholar With the shortage of college instructors these older nurses could be excellent mentors for nursing students by sharing their expertise. The nurse staffing shortage is extreme. Older nurses are retiring at an alarming rate, with many calling themselves early retirees. The COVID pandemic added fuel to an already burning fire of emotional exhaustion and job dissatisfaction. Health care administrators need to consider innovative means to retain the older nurses, while attracting and retaining the younger nurses. The shortage is complex; thus, the solutions will be as well. Health care access and quality is in danger. It happens with every hospital that shutters a unit, especially those in rural and underserved areas. When you need quality care, who will be there for you? What do you need from your employer? Speak up now.
Introduction: The risk of major atherosclerotic CV events increases with age, as do comorbidities, polypharmacy, and greater vulnerability to adverse drug reactions/events, posing challenges in the treatment of dyslipidemia. Three Phase III placebo-controlled trials evaluated the efficacy and safety of inclisiran according to age. Objective: To assess the efficacy and safety of inclisiran in patients across age categories. Methods: Patients were categorized according to age: <65 years (not old), ≥65 and <75 years (old), or ≥75 years (very old). The co-primary endpoints were percentage change in LDL-C from baseline to Day 510 and time-adjusted percentage change from baseline after Day 90 up to Day 540. Efficacy and safety parameters were assessed over 18 months. Results: Of a total 3660 patients, 1737 [47.5%] were not old, 1431 [39.1%] were old, and 492 [13.4%] were very old. At baseline, the prevalence of comorbidities increased with age (not old, old, very old): stage 3 CKD (8.4%, 19.9%, 31.2%), hypertension (72.9%, 85.2%, 88.1%) and diabetes mellitus (32.2%, 40.0%, 38.0%), respectively. The placebo-corrected percentage change in LDL-C with inclisiran was similar across all ages: from baseline to Day 510 [–51.3% (not old), –49.9% (old), –51.0% (very old); P <0.0001 for all] and time-adjusted from baseline to Day 90 up to Day 540 [–49.6% (not old), –51.5% (old), –50.8% (very old); P <0.0001 for all]. Overall AE and SAE rates increased with age and were similar between both treatment arms in all groups, except for injection-site reactions that were higher with inclisiran vs placebo across all ages, and were more frequent in not old patients. CK levels >5x ULN were more frequently elevated in the not old category (Table). Conclusion: Inclisiran lowered LDL-C similarly across all ages with an acceptable safety profile. Inclisiran added to maximally tolerated statin therapy could be a safe option for older patients with ASCVD who need more intensive lipid-lowering treatment.
Significant strides in advancing healthcare safety have been made. The improvements can be attributed, in part, to the proliferation of simulation-based medical education (SBME). The applications and benefits of simulation-based education have been demonstrated in: (a) teaching and emphasizing teamwork behaviors, particularly in high-risk fields like obstetrics; (b) simplifying, standardizing and practicing effective communication strategies; (c) implementing evidence based guidelines and recommendations; and (d) recognizing and practicing all these skills in interprofessional teams for high risk situations. Unique opportunities for simulation-based interprofessional education exist within obstetrics. A novel program for supporting simulation-based interprofessional education for Labor and Delivery staff by a professional liability insurer (PLI) will be described and lessons learned will be shared. A review of the utility of interprofessional simulation to introduce, improve and implement obstetric emergency checklists will also be presented.
