Issues in Educating Our Healthcare Workforce
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1 Issues in Educating Our Healthcare Workforce Deborah Anderson Principal, PivotPoint & Patricia M. Schoon, MPH, PHN, RN Distance Clinical Instructor, College of Nursing University of Wisconsin Oshkosh Upon completion a participant will: 1. Identify the preferred characteristics for individuals entering health professions. 2. Describe the methods of training future health professionals. 3. List the characteristics of a healthy medical work place. 1
2 Provide context and build awareness that workplace behavior is a significant problem Discuss selecting and educating healthcare workers Define a healthy workplace and methods of improving workplace behavior Role Expectations and Performance Personal Life Experiences First Professional Degree First Year of Professional Employment 2
3 Academic Students report experiencing and/or observing interpersonal abuse Students of color report being alienated Students, faculty, staff and administrators all report experiencing or witnessing interpersonal abuse Clinical Students report experiencing and/or observing interpersonal abuse between and among staff, students, preceptors, clinical faculty Workplace Primary reason new nursing graduates leave acute care is interpersonal abuse in the workplace N = 534 RR = 35% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Student Faculty Administration Staff I choose not to answ er this question 60.00% 50.00% 40.00% Question: Who has experienced or observed interpersonal abuse? Nursing PT/PTA OS/OT/OTA Did not answer 30.00% Radiography Schoon & Dols, 2007 Survey of Health Professions Departments at a Private Midwestern University, unpublished 20.00% 10.00% 0.00% 1 Other Health Programs Other Minneapolis Programs AA Non-Health & LAS 2 Uncounted % 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Students Faculty/professors Donâ t know No one People at my clinical or... Staff (in Admission, Re... Directors or departmen... Everyone Deans, President and... N = 514 Other Schoon & Dols, 2007 unpublished data 3
4 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Students Faculty/professors Don't know Staff (in Admission,... Everyone No one Other People at my clinical.. Directors or departme.. Deans, President an... Schoon & Dols, 2007 unpublished Constant complaining Blaming Favoritism Cursing and sw earing Demeaning of another person Allow ing unresolved disagreements Not communicating, using silence Being un-supportive, uncaring, Any actions that destroy self-esteem Behaving depressed, negative, Yelling or using a loud voice Mean Schoon & Dols, 2007 unpublished data Complaining Belittling Ignoring Lack of communication Not listening/walking away Talking behind someone s back Laziness Gossip Blaming Anderson 2012 unpublished data 4
5 Medical students experience a variety of abuses 80.6% of senior respondents reported abuse by their senior year Silver & (1990) Medical students report experiencing verbal abuse, sexual and racial discrimination, harassment, and physical abuse Rees et al (2011) Little has changed since % to 97% experienced or witnessed abuse Clark & Springer 2007, Cox 1991, Thomas & Burk 2009 Nursing students experience or witness abuse across academic settings Abusive behaviors include: incivility, verbal abuse, rude behavior, and physical violence Curtis et al. 2006, Lashey & Meneses 2001, Long 2000 Perceived frequency of abuse 16,000 respondents 95% of surveyed staff experienced or witnessed abusive behaviors 62-96% experienced or witnessed abuse in the last year 3-25% experienced or witnessed abuse daily Anderson 2004 unpublished data 5
6 Anderson 1999 unpublished data Anderson 2004 unpublished data New York Times May 8,
7 90% of health care workers report experiencing or observing harmful behaviors at work Olson, % of nurses report being bullied or harassed or experiencing incivility from nurses and physicians Hutton 2008; Wilson, Diedrich, Phelps, & Choi 2011, Spencer % of new grads change employment locations within the first two years Bowles & Candela 2005; Beecroft, Dorey, & Wenten (2008) Individuals experienced digestive problems, insomnia, long-term sickness, and more psychological distress than individuals who did not experience abusive workplace behaviors. Anderson 2004, Schoon & Dols 2007, Spencer Health issues identified in medical students include depressive symptoms, escapist drinking, cynicism about the profession, and low self-confidence Rees & Monrouxe 2011 Headaches, migraines Anxiety. Stress N = 79 Sleep disorders No medical problems 56 (74%) Anger, hostility Medical Problems 15 (20%) Fatigue Stomach problems, ulcers Irritable bowel disease Depression Aggressive behavior ( suicide, murder) Eating disorders, obesity Alcohol and drug abuse physical discomfort Back pain Hypertension Sick days Anderson 2014 unpublished data Not sure 6 (8%) 7
8 85,000 respondents 25-45% report medical problems related to abuse at work Sleeping problems (80%) Headaches (56%) Fatigue (44%) Depression (33%) Anxiety attacks (30%) GI problems (28%) Neck, shoulder, arm pain (27%) Alcohol/substance abuse (16%) Physical injuries (9%) Anderson unpublished data Top 9 Medical Problems N = 65 Range = 11 = % 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Headaches Sleeping problems Depression N = 521 Fatigue Stomach aches Schoon & Dols, 2007 unpublished data Anxiety attacks Mental health concerns Get sick easily or often Eating disorders/obesity/... N = 65 Range % 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% Other Back pain Alcohol or drug abuse 12.5 % Yes Sore aching jaw High blood pressure 85.6% No No Yes Not sure Ulcers Suicidal thoughts Heart disease Sexual problems 23 Abusive environments are associated with negative patient outcomes, decreased patient satisfaction, increased adverse events, and increased mortality Institute of Medicine (IOM) 2004, Spencer 2013, The Joint Commission 2008 Increased costs to organizations Staff turnover, dissatisfaction, loss productivity, absenteeism, and negative patient outcomes. 8
9 Incivility & bullying victimization Hostile workplace Shame Anger Revictimization Self-blame Self-attack Felblinger, 2008 Change and Complexity Lack of Support Reduction in Funding and Staffing Interpersonal Abuse and Incivility Safe Environment Personal respect Open, honest communication Trust and responsibility Adequate resources and training Constructive direction and feedback Recognition Meaningful work Personal growth Fun and Enjoyment Park Nicollet Institute 9
10 Self-respect, self-esteem Self-control, discipline Respect for others Tolerance, understanding Teamwork, cooperation Caring, empathy Fairness, justice Peaceful conflict resolution Social responsibility, caring for others Generosity, altruism Park Nicollet Institute Starts with the education Create a culture of respect; improve listening skills, team work, collaboration, and sensitivity to cultural diversity Requires organizational commitment Students model faculty There is a demand for improving healthcare culture What to look for Inquisitive Seeks strong role models Learns tacit rules Punctual/prompt Responsible Insightful What to look out for Instant expert Seeks power and influence Poor boundaries Chronic tardiness Blames and blameless Unable to see or use feedback 10
11 What to look for Seeks & uses feedback Truthful Humble Courageous Commitment to improving human condition What to look out for Obfuscating Arrogant Critical under stress Avoids truths Commitment to career Admission criteria to nursing schools Varies depending upon organization GPA, admission testing, essay, interviews Essential abilities include cognitive, sensory, communication, psychomotor, and behavioral/emotional/spiritual health abilities. Principles Caring, collaboration, and teamwork are cornerstones Empower students, faculty, staff Promote respectful relationships Address problematic behaviors before they escalate Realistic workload Clear and honest communication Healthy teamwork is an expectation. Actions Assess relationships and environment Role model and champion respectful behavior Establish healthy academic culture Work toward zero tolerance Acknowledge and address unhealthy behaviors and situations Address concerns and stressors Establish and disseminate standards for cooperation and communication 33 11
12 Student Academic Culture Clinical Culture Patient Healthcare Workforce Healthcare Administration Five Stage Process to Organization Change (18-24 month process) 1. Team building Governance concurrence Leader identification find a champion Representative workgroup selection 2. Assessment Organizational survey all levels 3. Implementation Informational sessions, posters, defining healthy and harmful behaviors, training in conflict resolution 4. Evaluation 5. Infusion/Sustainability 12
13 Principles Caring, collaboration, and teamwork as cornerstones Empower staff and victims Promote respectful staff relationships Target potentially problematic behaviors before they escalate Realistic workload grounded in respect and cooperation Clear and honest communication Management Actions Assess workplace relationships and environment Role model and champion respectful behavior Establish healthy unit culture Create zero tolerance Acknowledge unhealthy behaviors and situations Address staff concerns and workplace stressors Establish and publish standards for staff cooperation and communication Ongoing Journey Change does not occur overnight Time Energy Commitment THINGS CAN IMPROVE! Anderson, D. (2014). Unpublished data. Beecroft, P., Dorey., & Wenten, M. (2008). Turnover intention in new graduate nurses: A multivariate analysis. Journal of Advanced Nursing, 62(1), Bowles, C., & Candela, L. (2005). First job experience in recent RN graduates: Improving the work environment. The Journal of Nursing Administration, 35(3), Clark, C., & Springer, P. (2007). Incivility in nursing education: A descriptive study of definitions and prevalence. Journal of Nursing Education, 46(1), Cox, H. (1991). Verbal abuse nation-wide, Part II: Impact and modification. Nursing Management, 22. Felblinger, D. (2008). Incivlity and bullying in the work place and nurses shame responses. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37(2), Hutton, S. (2006). State of the science. Workplace incivility. The Journal of Nursing Administration, 36(1), Institutes of Medicine. (2004). Keeping patients safe: Transforming the work environment of nurses. Retrieved from Nurses.aspx Lashley, F., & Meneses, M. (2001). Student civility in nursing programs: A national survey. Journal of Professional Nursing, 17(2), Luperell, S. (2004) Faculty encounters with uncivil nursing students: An overview. Journal of Professional Nursing, 17(2), Rees C., Monrouxe L. (2011). Journal of The Association of American Medical Colleges [Acad Med] 2011 Nov; Vol. 86 (11), pp Silver, H., & Glicken, A. (1990). Medical student abuse: Incidence, severity, and significance. JAMA. Vol 263, pp Schoon, P. & Dols, C (2007). Survey of abusive behaviors in a midwestern university. Unpublished. Spencer, C. (2013). Healthy work environments: Personal Civility in healthcare. Academy of Medical-Surgical Nurses, 22(1). Retrieved from The Joint Commission. (2008). Sentinel event alert: Behaviors that undermine a culture of safety. Issue 40. Retrieved from Thomas, S., & Burk, R. (2009) Junior nursing students experiences of vertical violence during clinical rotation. Nursing Outlook, 57(4), Wilson, B., Diedrich, A., Phelps, C, & Choi, M. (2011). 13
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