International Connections

Abstract

THE VERY SUCCESSFUL International Conference of PeriAnesthesia Nurses (ICPAN) was held October 2 to 5 in Toronto, Canada. What a treat to network and learn together with anaesthetic, recovery and perianesthesia nurses from around the world. We say so often now that the world is only getting smaller, and I saw evidence of that at the ICPAN meeting. I was able to meet some nurses with whom I had been chatting on a regular basis as part of the inaugural conference committee—and I was able to put faces with names. Some nurses I met were just excited to hear about an international conference where they could discuss their own practices and learn from others.I learned about end-of-life care in Ireland and how it affects perianesthesia nurses, and how we can better care for those patients and families. I learned about the crisis in Greece and how it is affecting nurses and other health care personnel. I learned about findings from a descriptive study of postanesthesia complications in New Zealand. Everything from electronic documentation to care of special perianesthesia patients was included. And that is only a snapshot of the information that was presented at this first international conference.Common ChallengesAs the keynote speaker on one day of the conference, I talked about challenges we all face, changes that are occurring in our practices, and our opportunity to choose how we will respond. I sent an email to several nurses around the globe asking about challenges they face in the perianesthesia realm. It was uncanny how similar the responses were from all over. From Denmark, a nurse said: “In nursing we fight with lack of time to nursing quality and much workload, and many nurses are unemployed. I never thought this was possible.” From the US, a nurse said: “We have the finest technology and yet we still cannot provide even basic care to the neediest of our citizens. Money, or lack of it, is the biggest challenge I see.” What are some of the common challenges facing perianesthesia nurses?▪Patients with higher acuity—Sicker patients are coming through PACUs on a regular basis, and we are asked to care for these sometimes critically ill patients with ever-decreasing staff. In the U.S. we are seeing a reduction of elective surgery due to the economy and/or increased deductibles, and that means that we see these patients in the future as more ill patients who are facing emergency surgery. As well, we are seeing an increase in the number of uninsured who come to the Emergency Department (ED) and are then sent for immediate surgery. All nurses are seeing an increased elderly population, increased co-morbidities, and patients with declining health.▪Patient safety—In the U.S. we are concerned with the nonpayment of “never” events such as surgical-site infections and ventilator-associated pneumonia. All were concerned with the noncompliance to guidelines and regulations because we are “too busy” to do it right. If this behavior continues, normalization of deviance1Odom-Forren J. The normalization of deviance: A threat to patient safety.J Perianesth Nurs. 2011; 26: 216-219Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar will occur, and we begin to think that taking these shortcuts is normal behavior. The fact that this behavior could lead to decreased safety for our patients is disquieting.▪Technology/computerization—With the proliferation of electronic health records (EHR), there is the necessary learning curve that goes along with new technology. The perianesthesia nurses who talked to me were not opposed to EMRs and see the value, but are frustrated with the lack of response to concerns when the technology is not user friendly or causes an increase in workload instead of decreasing the workload. A common theme was that electronic charting in the perioperative area does not “talk” to electronic charting in other areas of the hospital.▪ICU over flow and ED back-up—Many PACUs have become the back-up critical care unit in the facility where all patients who require a monitor and critical nursing care stay if there is no room. This leads to staffing and competency issues.▪Perianesthesia competencies—Some mentioned that perianesthesia nurses are expected to multi-task, cross train, and blend levels of care without sacrificing quality.Global Nursing ShortageThe last challenge that requires discussion is the global nursing shortage. It is interesting that the numbers show a nursing shortage while at the same time some nurses are unable to find jobs. In 2006, the nursing shortage was characterized as a shortage due to both supply and demand factors—an increasing demand for nurses as well as a decreased supply of nurses (Table 1).2Oulton J.A. The global nursing shortage: An overview of issues and actions.Policy Politics Nursing Practice. 2006; 7: 34S-39SCrossref PubMed Scopus (202) Google Scholar Oulton gave examples that presented the extent of the shortage and included figures from Europe, Germany, the Netherlands, France, Canada, the US, Jamaica, and Africa. She attributed the shortage to nurses leaving jobs who are unhappy with the working conditions, retirement of much of the nursing workforce, an aging nursing faculty which hampers the ability to educate enough nurses, and global migration especially a problem in low economic countries such as Africa.2Oulton J.A. The global nursing shortage: An overview of issues and actions.Policy Politics Nursing Practice. 2006; 7: 34S-39SCrossref PubMed Scopus (202) Google Scholar As Yun et al stated in an article on the nursing shortage in China, “A nursing shortage is not a single problem for a single country.”3Yun H. Jie S. Anli J.A. Nursing shortage in China: State, causes, and strategy.Nurs Outlook. 2010; 58: 122-128Abstract Full Text Full Text PDF PubMed Scopus (107) Google ScholarTable 1Global Nursing Shortage∗Based on data from reference 2.Increased demand Increased acuity of care Aging population Globalization and growing private sector High public trust in nursesDecreased supply Aging nursing workforce Shrinking applicant pool Unfavorable work milieu∗ Based on data from reference 2Oulton J.A. The global nursing shortage: An overview of issues and actions.Policy Politics Nursing Practice. 2006; 7: 34S-39SCrossref PubMed Scopus (202) Google Scholar. Open table in a new tab So how do we interpret this nursing shortage in light of the decreased available jobs for nurses? Buerhaus and Auerbach, in a recent article, discuss the recession’s effect on hospital employment of nurses.4Buerhaus P.I. Auerbach D.I. The recession’s effect on hospital registered nurse employment growth.Nurs Econ. 2011; 29: 163-167PubMed Google Scholar An increase in RN employment in 2006-2008 of 250,000 full-time equivalents (FTE) occurred exclusively in hospitals. Approximately half of those FTEs were RNs who were over the age of 50. Buerhaus & Auerbach believe that during the economic downturn, one of the US’ worst economic downturns, many RNs who were not working rejoined the workforce because either the spouse or partner lost his or her job or was at risk for losing the job. Now older RNs account for about 60% of the total increase of employed RNs. The challenge to replace these RNs with new RNs as the older RNs retire or quit the workforce when the economy recovers is a long-term concern.4Buerhaus P.I. Auerbach D.I. The recession’s effect on hospital registered nurse employment growth.Nurs Econ. 2011; 29: 163-167PubMed Google ScholarSo, even though the current situation is not dire in terms of a nursing shortage, there are future global concerns for nursing. The International Council of Nurses outlined some global strategies to reverse the nursing shortage and these should not be forgotten in the interim: 1) macroeconomics & health funding—priority on basics such as roads & sanitation; 2) workforce policy and planning; 3) positive practice environments and organizational performance; 4) recruitment and retention; addressing maldistribution within countries and out-migration; and 5) nursing leadership.2Oulton J.A. The global nursing shortage: An overview of issues and actions.Policy Politics Nursing Practice. 2006; 7: 34S-39SCrossref PubMed Scopus (202) Google ScholarSo what are the answers? I talked about many challenges, but no answers! Each one of us confronts one or more of these issues on a daily basis. I believe it is going to take strong leadership from the ranks of nurses—perianesthesia nurses included, to solve the complex and tangled challenges that are before us. It would serve us all for nurses internationally to unite to work on these complex issues together. I look forward to our new international perianesthesia connections forged at this most significant event and to positive outcomes and answers to complex challenges. THE VERY SUCCESSFUL International Conference of PeriAnesthesia Nurses (ICPAN) was held October 2 to 5 in Toronto, Canada. What a treat to network and learn together with anaesthetic, recovery and perianesthesia nurses from around the world. We say so often now that the world is only getting smaller, and I saw evidence of that at the ICPAN meeting. I was able to meet some nurses with whom I had been chatting on a regular basis as part of the inaugural conference committee—and I was able to put faces with names. Some nurses I met were just excited to hear about an international conference where they could discuss their own practices and learn from others. I learned about end-of-life care in Ireland and how it affects perianesthesia nurses, and how we can better care for those patients and families. I learned about the crisis in Greece and how it is affecting nurses and other health care personnel. I learned about findings from a descriptive study of postanesthesia complications in New Zealand. Everything from electronic documentation to care of special perianesthesia patients was included. And that is only a snapshot of the information that was presented at this first international conference. Common ChallengesAs the keynote speaker on one day of the conference, I talked about challenges we all face, changes that are occurring in our practices, and our opportunity to choose how we will respond. I sent an email to several nurses around the globe asking about challenges they face in the perianesthesia realm. It was uncanny how similar the responses were from all over. From Denmark, a nurse said: “In nursing we fight with lack of time to nursing quality and much workload, and many nurses are unemployed. I never thought this was possible.” From the US, a nurse said: “We have the finest technology and yet we still cannot provide even basic care to the neediest of our citizens. Money, or lack of it, is the biggest challenge I see.” What are some of the common challenges facing perianesthesia nurses?▪Patients with higher acuity—Sicker patients are coming through PACUs on a regular basis, and we are asked to care for these sometimes critically ill patients with ever-decreasing staff. In the U.S. we are seeing a reduction of elective surgery due to the economy and/or increased deductibles, and that means that we see these patients in the future as more ill patients who are facing emergency surgery. As well, we are seeing an increase in the number of uninsured who come to the Emergency Department (ED) and are then sent for immediate surgery. All nurses are seeing an increased elderly population, increased co-morbidities, and patients with declining health.▪Patient safety—In the U.S. we are concerned with the nonpayment of “never” events such as surgical-site infections and ventilator-associated pneumonia. All were concerned with the noncompliance to guidelines and regulations because we are “too busy” to do it right. If this behavior continues, normalization of deviance1Odom-Forren J. The normalization of deviance: A threat to patient safety.J Perianesth Nurs. 2011; 26: 216-219Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar will occur, and we begin to think that taking these shortcuts is normal behavior. The fact that this behavior could lead to decreased safety for our patients is disquieting.▪Technology/computerization—With the proliferation of electronic health records (EHR), there is the necessary learning curve that goes along with new technology. The perianesthesia nurses who talked to me were not opposed to EMRs and see the value, but are frustrated with the lack of response to concerns when the technology is not user friendly or causes an increase in workload instead of decreasing the workload. A common theme was that electronic charting in the perioperative area does not “talk” to electronic charting in other areas of the hospital.▪ICU over flow and ED back-up—Many PACUs have become the back-up critical care unit in the facility where all patients who require a monitor and critical nursing care stay if there is no room. This leads to staffing and competency issues.▪Perianesthesia competencies—Some mentioned that perianesthesia nurses are expected to multi-task, cross train, and blend levels of care without sacrificing quality. As the keynote speaker on one day of the conference, I talked about challenges we all face, changes that are occurring in our practices, and our opportunity to choose how we will respond. I sent an email to several nurses around the globe asking about challenges they face in the perianesthesia realm. It was uncanny how similar the responses were from all over. From Denmark, a nurse said: “In nursing we fight with lack of time to nursing quality and much workload, and many nurses are unemployed. I never thought this was possible.” From the US, a nurse said: “We have the finest technology and yet we still cannot provide even basic care to the neediest of our citizens. Money, or lack of it, is the biggest challenge I see.” What are some of the common challenges facing perianesthesia nurses?▪Patients with higher acuity—Sicker patients are coming through PACUs on a regular basis, and we are asked to care for these sometimes critically ill patients with ever-decreasing staff. In the U.S. we are seeing a reduction of elective surgery due to the economy and/or increased deductibles, and that means that we see these patients in the future as more ill patients who are facing emergency surgery. As well, we are seeing an increase in the number of uninsured who come to the Emergency Department (ED) and are then sent for immediate surgery. All nurses are seeing an increased elderly population, increased co-morbidities, and patients with declining health.▪Patient safety—In the U.S. we are concerned with the nonpayment of “never” events such as surgical-site infections and ventilator-associated pneumonia. All were concerned with the noncompliance to guidelines and regulations because we are “too busy” to do it right. If this behavior continues, normalization of deviance1Odom-Forren J. The normalization of deviance: A threat to patient safety.J Perianesth Nurs. 2011; 26: 216-219Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar will occur, and we begin to think that taking these shortcuts is normal behavior. The fact that this behavior could lead to decreased safety for our patients is disquieting.▪Technology/computerization—With the proliferation of electronic health records (EHR), there is the necessary learning curve that goes along with new technology. The perianesthesia nurses who talked to me were not opposed to EMRs and see the value, but are frustrated with the lack of response to concerns when the technology is not user friendly or causes an increase in workload instead of decreasing the workload. A common theme was that electronic charting in the perioperative area does not “talk” to electronic charting in other areas of the hospital.▪ICU over flow and ED back-up—Many PACUs have become the back-up critical care unit in the facility where all patients who require a monitor and critical nursing care stay if there is no room. This leads to staffing and competency issues.▪Perianesthesia competencies—Some mentioned that perianesthesia nurses are expected to multi-task, cross train, and blend levels of care without sacrificing quality. Global Nursing ShortageThe last challenge that requires discussion is the global nursing shortage. It is interesting that the numbers show a nursing shortage while at the same time some nurses are unable to find jobs. In 2006, the nursing shortage was characterized as a shortage due to both supply and demand factors—an increasing demand for nurses as well as a decreased supply of nurses (Table 1).2Oulton J.A. The global nursing shortage: An overview of issues and actions.Policy Politics Nursing Practice. 2006; 7: 34S-39SCrossref PubMed Scopus (202) Google Scholar Oulton gave examples that presented the extent of the shortage and included figures from Europe, Germany, the Netherlands, France, Canada, the US, Jamaica, and Africa. She attributed the shortage to nurses leaving jobs who are unhappy with the working conditions, retirement of much of the nursing workforce, an aging nursing faculty which hampers the ability to educate enough nurses, and global migration especially a problem in low economic countries such as Africa.2Oulton J.A. The global nursing shortage: An overview of issues and actions.Policy Politics Nursing Practice. 2006; 7: 34S-39SCrossref PubMed Scopus (202) Google Scholar As Yun et al stated in an article on the nursing shortage in China, “A nursing shortage is not a single problem for a single country.”3Yun H. Jie S. Anli J.A. Nursing shortage in China: State, causes, and strategy.Nurs Outlook. 2010; 58: 122-128Abstract Full Text Full Text PDF PubMed Scopus (107) Google ScholarTable 1Global Nursing Shortage∗Based on data from reference 2.Increased demand Increased acuity of care Aging population Globalization and growing private sector High public trust in nursesDecreased supply Aging nursing workforce Shrinking applicant pool Unfavorable work milieu∗ Based on data from reference 2Oulton J.A. The global nursing shortage: An overview of issues and actions.Policy Politics Nursing Practice. 2006; 7: 34S-39SCrossref PubMed Scopus (202) Google Scholar. Open table in a new tab So how do we interpret this nursing shortage in light of the decreased available jobs for nurses? Buerhaus and Auerbach, in a recent article, discuss the recession’s effect on hospital employment of nurses.4Buerhaus P.I. Auerbach D.I. The recession’s effect on hospital registered nurse employment growth.Nurs Econ. 2011; 29: 163-167PubMed Google Scholar An increase in RN employment in 2006-2008 of 250,000 full-time equivalents (FTE) occurred exclusively in hospitals. Approximately half of those FTEs were RNs who were over the age of 50. Buerhaus & Auerbach believe that during the economic downturn, one of the US’ worst economic downturns, many RNs who were not working rejoined the workforce because either the spouse or partner lost his or her job or was at risk for losing the job. Now older RNs account for about 60% of the total increase of employed RNs. The challenge to replace these RNs with new RNs as the older RNs retire or quit the workforce when the economy recovers is a long-term concern.4Buerhaus P.I. Auerbach D.I. The recession’s effect on hospital registered nurse employment growth.Nurs Econ. 2011; 29: 163-167PubMed Google ScholarSo, even though the current situation is not dire in terms of a nursing shortage, there are future global concerns for nursing. The International Council of Nurses outlined some global strategies to reverse the nursing shortage and these should not be forgotten in the interim: 1) macroeconomics & health funding—priority on basics such as roads & sanitation; 2) workforce policy and planning; 3) positive practice environments and organizational performance; 4) recruitment and retention; addressing maldistribution within countries and out-migration; and 5) nursing leadership.2Oulton J.A. The global nursing shortage: An overview of issues and actions.Policy Politics Nursing Practice. 2006; 7: 34S-39SCrossref PubMed Scopus (202) Google ScholarSo what are the answers? I talked about many challenges, but no answers! Each one of us confronts one or more of these issues on a daily basis. I believe it is going to take strong leadership from the ranks of nurses—perianesthesia nurses included, to solve the complex and tangled challenges that are before us. It would serve us all for nurses internationally to unite to work on these complex issues together. I look forward to our new international perianesthesia connections forged at this most significant event and to positive outcomes and answers to complex challenges. The last challenge that requires discussion is the global nursing shortage. It is interesting that the numbers show a nursing shortage while at the same time some nurses are unable to find jobs. In 2006, the nursing shortage was characterized as a shortage due to both supply and demand factors—an increasing demand for nurses as well as a decreased supply of nurses (Table 1).2Oulton J.A. The global nursing shortage: An overview of issues and actions.Policy Politics Nursing Practice. 2006; 7: 34S-39SCrossref PubMed Scopus (202) Google Scholar Oulton gave examples that presented the extent of the shortage and included figures from Europe, Germany, the Netherlands, France, Canada, the US, Jamaica, and Africa. She attributed the shortage to nurses leaving jobs who are unhappy with the working conditions, retirement of much of the nursing workforce, an aging nursing faculty which hampers the ability to educate enough nurses, and global migration especially a problem in low economic countries such as Africa.2Oulton J.A. The global nursing shortage: An overview of issues and actions.Policy Politics Nursing Practice. 2006; 7: 34S-39SCrossref PubMed Scopus (202) Google Scholar As Yun et al stated in an article on the nursing shortage in China, “A nursing shortage is not a single problem for a single country.”3Yun H. Jie S. Anli J.A. Nursing shortage in China: State, causes, and strategy.Nurs Outlook. 2010; 58: 122-128Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar So how do we interpret this nursing shortage in light of the decreased available jobs for nurses? Buerhaus and Auerbach, in a recent article, discuss the recession’s effect on hospital employment of nurses.4Buerhaus P.I. Auerbach D.I. The recession’s effect on hospital registered nurse employment growth.Nurs Econ. 2011; 29: 163-167PubMed Google Scholar An increase in RN employment in 2006-2008 of 250,000 full-time equivalents (FTE) occurred exclusively in hospitals. Approximately half of those FTEs were RNs who were over the age of 50. Buerhaus & Auerbach believe that during the economic downturn, one of the US’ worst economic downturns, many RNs who were not working rejoined the workforce because either the spouse or partner lost his or her job or was at risk for losing the job. Now older RNs account for about 60% of the total increase of employed RNs. The challenge to replace these RNs with new RNs as the older RNs retire or quit the workforce when the economy recovers is a long-term concern.4Buerhaus P.I. Auerbach D.I. The recession’s effect on hospital registered nurse employment growth.Nurs Econ. 2011; 29: 163-167PubMed Google Scholar So, even though the current situation is not dire in terms of a nursing shortage, there are future global concerns for nursing. The International Council of Nurses outlined some global strategies to reverse the nursing shortage and these should not be forgotten in the interim: 1) macroeconomics & health funding—priority on basics such as roads & sanitation; 2) workforce policy and planning; 3) positive practice environments and organizational performance; 4) recruitment and retention; addressing maldistribution within countries and out-migration; and 5) nursing leadership.2Oulton J.A. The global nursing shortage: An overview of issues and actions.Policy Politics Nursing Practice. 2006; 7: 34S-39SCrossref PubMed Scopus (202) Google Scholar So what are the answers? I talked about many challenges, but no answers! Each one of us confronts one or more of these issues on a daily basis. I believe it is going to take strong leadership from the ranks of nurses—perianesthesia nurses included, to solve the complex and tangled challenges that are before us. It would serve us all for nurses internationally to unite to work on these complex issues together. I look forward to our new international perianesthesia connections forged at this most significant event and to positive outcomes and answers to complex challenges. Jan Odom-Forren, PhD, RN, CPAN, FAAN, is a Perianesthesia Nursing Consultant in Louisville, KY, and is an Assistant Professor at the University of Kentucky, Lexington, KY.