Abstract
BackgroundA nursing shortage in the United States has resulted in increased workloads, potentially affecting the quality of care. This situation is particularly concerning in long-term care (LTC) facilities, where residents are older, frailer, and may be receiving multiple medications for comorbidities, thus requiring a greater commitment of nurse time. We conducted a survey of LTC nurses to determine how much of their time each week is spent managing newly started and stable warfarin-treated residents.MethodsForty LTC nurses validated the questionnaire to determine what protocols/procedures are involved in warfarin management. Twenty LTC nurses completed the survey, quantifying the time they spend on procedures related to warfarin management, and how often they performed each procedure for each resident each week.ResultsThe nurses reported that 26% of their residents were receiving warfarin; the majority (approximately 75%) of these residents began warfarin after admission to the facility. On average, the nurses spent 4.6 hours per week for treatment procedures and monitoring patients initiating warfarin therapy and 2.35 hours per week for each resident who was stable on warfarin therapy on admission. Overall, to care for an average number of newly initiated and stable warfarin patients in a medium-size LTC facility, staff nurses are estimated to spend 68 hours per week.Study limitations include the potential for bias because of the small sample size, representativeness of the sample, and the possibility of inaccuracies in respondents’ self-reported time estimation of warfarin-related procedures.ConclusionsIn the context of a well-documented and expanding nursing shortage in the United States, the substantial use of time and resources necessary to initiate, monitor, and manage warfarin treatment in elderly LTC patients is of concern. Until the problem of understaffing is resolved, implementation of therapies that are simpler and require less nursing time—e.g. the use of new oral anticoagulants in the place of warfarin—may be a way to free up nursing time for other essential care tasks.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-015-0058-x) contains supplementary material, which is available to authorized users.
Highlights
A nursing shortage in the United States has resulted in increased workloads, potentially affecting the quality of care
Based on the self-time estimation responses of 15 Registered nurse (RN) and five Licensed practical nurse (LPN), our study showed that nurses in long-term care (LTC) facilities in the United States spent an average of 2.4 hours per week (2.4 hours per patient) performing warfarin initiation procedures, 1.05–2.4 hours per week (25–28 minutes per patient) performing warfarin monitoring tasks, and 1.3 hours per week (57 minutes per patient) performing procedures related to warfarin management
The LTC setting would seem to be ideal for warfarin therapy, because laboratory monitoring, compliance, dose adjustment, and drug-drug interactions can be controlled for, our study found that the estimated time taken by nurses to perform procedures involved in such management requires substantial resources
Summary
A nursing shortage in the United States has resulted in increased workloads, potentially affecting the quality of care. This situation is concerning in long-term care (LTC) facilities, where residents are older, frailer, and may be receiving multiple medications for comorbidities, requiring a greater commitment of nurse time. A shrinking economy appears to have eased the nursing shortage, but with an anticipated 32 million Americans gaining access to healthcare services as a result of the Patient Protection and Affordable Care Act, the need for nurses will become even more pressing and is projected to outstrip nurse availability [2,3].
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