Issue link: https://beckershealthcare.uberflip.com/i/1508822
20 NURSING SPOTLIGHT Where are all the med-surg nurses? By Erica Carbajal S t. Louis-based BJC HealthCare hoped to see more nurses go into medical-surgical once the COVID-19 pandemic died down and competitive pay rates for travel assignments in critical care and emergency departments stabilized. at hasn't happened. More than 70 percent of the system's agency dollars are currently being spent on nurses to work in med-surg units, Tommye Austin, PhD, RN, senior vice president and chief nursing executive at the health system, told Becker's. When it comes to the national nursing shortage, many hospitals are feeling the effects hardest in med-surg, the areas that account for most of their beds. Before the pandemic, Cleveland Clinic Marymount Hospital in Garfield Heights, Ohio, would see more than 30 med-surg nurse hires in a single summer. "Now, however, every hospital across the country has openings that need to be filled," the hospital's CNO, Barbara Zinner, DNP, RN, said in an October blog post. Perceptions about med-surg as a specialty don't help. Oen, it's considered a "stepping stone rather than a fulfilling career path," Dr. Zinner said. And it's oen thought of as more strenuous than other specialties, given med-surg nursing requires a broad range of knowledge to care for patients who may each have very different conditions and needs. So what will it take to attract and retain more med-surg nurses? On-the-job support & flexibility For one, much more additional support so nurses can, as an American Nurses Association leader recently put it, "just be nurses" and practice at the top of their license, spending less time on tasks that aren't direct patient care. A study from 2018 concluded nurses spend about 10 percent of their time on non-nursing tasks that can be delegated — a figure that has likely risen with worsening staffing shortages over the past few years. On this front, BJC HealthCare is looking to roll out virtual nursing in med-surg areas systemwide in 2024, based on success it has seen piloting virtual nursing at four of its facilities. Virtual nurses support med-surg nurses by assisting with the admissions process, patient education and discharge, Dr. Austin said. "We've also seen the virtual nurse be used as a mentoring resource because of the number of new grads we have," as new nurses who may be intimated to ask their nurse preceptor questions can call experienced virtual nurses for support, she said. Cleveland Clinic Marymount Hospital has leaned more heavily on patient care nursing assistants to mitigate the nurse shortage in recent years, according to Dr. Zinner. e purpose of the hospital's PCNA support program is two-fold: to better support med-surg nurses and to build a pipeline of future nurses via professional development efforts for PCNAs. BJC Healthcare is also looking into adopting robots and how technology can be implemented to vital sign machines and other medical equipment so that repetitive tasks can eventually be the exception, not the rule, for nurses. "If I'm a registered nurse working in a med-surg unit, I should be able to expect that I don't have to double document vital signs. I don't have to double document IV drips and things of that nature," Dr. Austin said. "I think there are certain things organizations should put in place so that the work environment is a lot easier." BJC HealthCare has also "heard loud and clear" from nursing staff that they want more scheduling flexibility. e system rolled out a flexible scheduling app earlier in 2023 for nurses to pick up as many or as few additional hours as they like. States take on 'doctor' title debate By Mariah Taylor S everal states are taking on the debate of whether to prevent nonphysicians from using the doctor title, but nurse practitioners with doctorates are pushing back, The Washington Post reported Aug. 20. Many states are contending with the question of how much independence to allow advanced practitioners, including what they can call themselves. In 2022, Indiana and Georgia attempted to pass laws that would prevented nurses from using terms such as "doctor" even if they had a doctorate degree. A 2023 Florida bill — that was vetoed in June by Gov. Ron DeSantis — would have prevented nonphysicians from using titles such as "doctor," "physician," "medical resident" and "hospitalist." Recently, California ordered a nurse practitioner to pay nearly $20,000 for advertising herself as "Doctor Sarah," which led to a lawsuit from several nurses challenging the law. The longstanding debate has become more relevant as the physician shortage continues. In 1994, only five states allowed nurse practitioners full practice authority. Today, 27 states and the District of Columbia no longer required physicians to oversee nurse practitioners. According to the article, legislators are becoming tired of the decadeslong debate. "They told us: 'We're tired of hearing this. Can you all just stop bickering?' We're not bickering," Carmen Kavali, MD, a Georgia-based plastic surgeon, told the Post. "We're trying to protect patients here." The debate circles many of the same arguments: Physicians worry that nurse practitioners don't have the experience to properly treat patients which could lead to adverse outcomes, and nurse practitioners meanwhile point to "50 years of research" on providing similar outcomes to physicians. n