A multitude of strains add up to one big headache. Feeling the pressure?

A multitude of strains--most beyond the control of health care executives--are converging to create major headaches for hospitals and systems. Skyrocketing insurance premiums, surging drug spending, Medicaid cuts, a staffing crisis and huge hikes in liability insurance rates contribute to the unprecedented confluence of pressures. And there's more.

The nursing shortage. Implications for military nurses

Trends relative to nursing vacancies are expected to exist into the next decade. Unlike the cyclical shortages of the past, this shortage may not resolve itself. The authors present five major factors in nursing that have led to the shortage and that contribute to its continuation. Because military nurses provide much manpower in the healthcare industry, shortages in their ranks will affect the entire healthcare system. The five factors were applied to the military nursing force to demonstrate that the military also feels the pinch of the current nursing shortage.

Flexible working hours and well-being in Finland

Flexibility of working hours became more prevalent in the 1990s in Finland. According to a representative survey on Finnish wage and salary earners (n = 1790) at the beginning of 2000, a great majority of male (76%) and female (65%) employees regularly worked overtime and/or had irregular working hours every month. These employees were flexible in meeting the needs of their companies/employers. Individual flexibility of working hours was far less common, only one third of male and female employees were able to regulate their working hours. A better balance between company-controlled and individual flexibility would, however, improve the well-being of employees. Employees working overtime without being allowed to regulate their working hours felt more symptoms of distress and had more conflicts in combining workplace and family roles than those who could individually determine their working hours flexibly. An investment in individually determined flexibility, for example by means of participatory planning, would improve the well-being of employees, and thus also improve the productivity of the organization.

Work schedules in health care in France: very few changes between 1991 and 1998, according to national data

It is important to know whether working time schemes offer, following the adoption of the 1990 ILO Night Work Convention, a better use of the actual knowledge in moderating the adverse effects of shiftwork for both sexes. The last two national studies on a representative sample, about working conditions in France (1991, 1998), show an increase of night work among female nursing staff. Long hours of work are becoming more common for nurses. The percentage of women health care workers not working the same number of days every week increased, with work weeks of 7 days or more. Few positive aspects exist such as a reduction in the proportion of those having to work 17 Sundays or more and a reduction of shifts beginning before 7 a.m. for female nurses. New negotiations, starting in 2001, should be an opportunity for improvements.

Flexible work hours, health and well-being in the European Union: preliminary data from a SALTSA project

Demand for flexible work hours (FWH) is increasing in Europe aimed at increasing the number of production hours on one hand, and, on the other, reducing individual working hours and/or increasing autonomy and control on them. In view of the lack of knowledge of the effects of FWH on health and safety, we started a pilot project, funded by the Joint Programme for Working Life Research in Europe (SALTSA), aimed at: a) comparing the most relevant national legislation and how the EU Directive 93/104 "concerning certain aspects of working time" has been implemented in the member States; b) reporting prevalence and trend of FWH in Europe according to the three EU Surveys on Working Conditions carried out in the last decade; c) collecting practical examples of innovative FWH; d) evaluating their impact on health and safety in relation to work sectors, job demands, social life, aging and gender. Consequent actions are going to include information and consultancy for pertinent authorities and social parties involved, as well as training programmes for Union officials and similar groups concerning the organisation of FWH according to ergonomic principles.

The French 35-hour workweek: a wide-ranging social change

The reduction of the legal working week to 35 hours in France has generated wide-ranging social change. We examine the resulting changes in working-time patterns as well as their repercussions on the use of the time gained and on the quality of life and health. To compensate the reduction in the length of the working week, companies have modified the working-time patterns, by extending operation time (shiftwork, atypical schedules) and by matching the on-site workforce to production requirements (flexible working hours). They have sought to make more efficient use of working time: job intensification or job compression. The effects on the off-the-job life and health are linked to the shiftwork and atypical schedules designed to increase the company's operating time, and adjustments to the company's need for flexibilization impose working time/free time patterns that are at odds with biological rhythms and social life patterns. Changes to working-time patterns have unexpected consequences for work organization: heightened difficulties for the individual and the crew. These changes may generate a range of health problems related to overwork and stress. The way some companies have adapted may call into question the usefulness of work done by employees, thus damaging their social identity and mental well-being.

Licensed nursing staff reductions and substitutions in Pennsylvania hospitals, 1991-1997

Nurses report a decline in RN/patient and skill mix in the 1990s while quantitative studies fail to confirm this. This study examines aggregate hospital nursing staff in Pennsylvania from 1991-1997, focusing on changes in licensed nursing staff. It finds that licensed nursing staff declined while nursing assistants increased in this period. With adjustment for patient acuity, there was a slight decrease in RN/adjusted patient days of care (APDC), a 23% decrease in LPN/APDC, and a 4% decrease in licensed nurse/APDC. The RN/nurse ratio increased slightly, and licensed nurse/nurse fell slightly. Since RNs often operate in environments which make use of teams of licensed staff, nurses' perceptions of a decline in the RN/patient ratio is a result of the decline in licensed staff/APDC, and of an increase in patient acuity.

Workforce planning. Of one mind

The NHS is heavily reliant on locum doctors, many of whom trained overseas. It is important they are appropriately trained so they can be integrated into the workforce. A pilot nine-session course for consultant locum psychiatrists was well received by participants. Medical directors have expressed willingness to pay for locums to attend such courses.

A developing crisis. Staffing overshadows all other challenges facing radiology departments

The shortage of radiologists and technologists poses a huge problem for hospitals as the demand for imaging services grows. It behooves hospital executives, therefore, to find creative ways to partner with their radiology groups--before somebody else does. This is the first installment in H&HN's quarterly Clinical Management series, which examines how hospitals are responding to dramatic shifts in specific clinical areas.

On the brink of change? Implications of the review of undergraduate education in New Zealand for mental health nursing

A New Zealand Nursing Council review of undergraduate education provides an ideal opportunity to make much needed changes to the system of preparation for mental health nurses. This article critiques comprehensive nursing education through an examination of its history in New Zealand, recent mental health reports and a projected estimate of workforce needs. Historical analysis reveals a process of marginalization and invisibilization of psychiatric/mental health nursing within comprehensive programmes with a consequent reduction of skills and a weakening of the profession. The author concludes that psychiatric/mental health nursing is a distinct scope of practice which requires specialty undergraduate preparation.

Pressure ulcers, outcomes, and the nursing shortage

The incidence of pressure ulcers is dependent on a number of variables. This article argues that the current and upcoming nursing shortage will adversely influence the pressure ulcer-related goals of public policy initiatives that strive to reduce the humanistic and cost burden of certain chronic conditions. The current state of the nursing shortage is described herein, along with examples of legislation proposed to control for this crisis and a consideration of the just distribution of goods and services (e.g., pressure ulcer care). Also provided is the voice of a nurse profoundly affected by the situation--a consideration of real and perceived threats to care.

The state of the health care workforce

The shortage of health care workers has emerged as one of the field's biggest long-term challenges. The number of nurses, technicians, pharmacists and even housekeeping staff is on the way down, and worker dissatisfaction is on the way up. The health care workforce is slowly vanishing, and those workers who remain are unhappy. In this special fold-out section, Hospitals & Health Networks looks at this complex problem by analyzing how serious it really is and how bad it's going to get, taking a look at workers' frustration, and offering tips and resources to start to fix it.