I recently read two interesting articles that supports the contention that providing a living wage to CNAs improves the quality of care at nursing homes.  The Dickinson Press reported that the booming oil industry in North Dakota has caused a bidding war for workers resulting in a shortage of workers for nursing homes.  The average statewide pay for a certified nursing aide with experience at a nursing facility is $13.58 an hour.  Fast food workers are getting $18 an hour.

“The staffing is in crisis in many areas of the state, especially in northwest North Dakota,” said Shelly Peterson, president of the North Dakota Long Term Care Association, which represents nursing homes and care facilities. “We’re not staying competitive, and we’re below the market,” she added. “We need funding to ensure we have the staff.”

Last year, 14 percent of nursing facilities stopped admissions because of insufficient staffing, and 68 nursing facilities reported 751 openings as of July, according to figures from the North Dakota Long Term Care Association.

However, the higher wages improves the quality of the staff employed by the nursing home.  Inspections of North Dakota nursing homes resulted in the lowest number of serious deficiencies in a review of reports for all 50 states.  North Dakota nursing homes had one serious deficiency during the past three years, and had the lowest rate of serious deficiencies in the nation. North Dakota’s rate of serious deficiencies per nursing home was 0.01.

See article at Inforum here.


The Kaiser Health News reported the potential for a shortage of nursing homes for the babyboomers. The first baby boomers hit age 65 last year. By 2030, 20 percent of the U.S. population will be at least 65, up from 13 percent today. In that same period, the number of 85-year-olds will increase more than 50 percent and the number of 100-year-olds nearly triple. But the number of nursing homes dropped almost 9 percent from 2000 to 2009.

 However, many babyboomers will stay at home and will be healthy enough to avoid the need for skilled care. Less construction of new nursing homes and the aging baby boom generation may cause full occupancy at many nursing homes. 

Several trends are cutting into the number of nursing homes. Many homes were constructed during the 1960s under Lyndon Johnson’s Great Society programs. Often those homes are closed because they are old or, with their long hallways and large, multi-resident rooms, don’t fit what current residents want, says Robert Kramer of the National Investment Center for the Seniors Housing and Care Industry.  From 2007 to 2011, the number of under-construction nursing home units (the sections of a facility that provide only nursing care) declined by a third.

Residing at a nursing home is not cheap. The median annual cost of a private U.S. nursing home room rose to $77,745 in 2011; up almost 30 percent from 2005. People without chronic conditions have less costly options;it takes about $43,500 yearly to pay for a home health care aide who doesn’t have specialized medical skills, and $39,000 to live in an assisted living facility that provides help with activities of daily life like cooking, but doesn’t necessarily offer health care services.

If nursing homes continue to be squeezed, they may need to continue to understaff. A November 2011 report by the University of California-San Francisco concluded that poor quality of care is already endemic in many nursing homes, especially the largest for-profit chains where staffing levels have been cut the deepest to save money.


The nursing home industry has complained for years that understaffing was caused by the lack of available nurses.  It is a myth.  That’s the upshot of a study in the policy journal Health Affairs. The authors, economists from RAND Health and Dartmouth College and a nursing professor from Vanderbilt University, found a significant upswing in the number of young women (aged 23-26) choosing nursing as a career between 2002 and 2009.  Funding for nurse training programs tripled between 2001 and 2010, from $80 million per year to $240 million.

It will be the largest cohort of registered nurses ever observed.  In fact, the 62 percent increase means that the ranks of registered nurses are expected to grow at roughly the same rate as the population between now and 2030. One reason cited by the researchers are accelerated degree programs designed to appeal to people who already have degrees in other fields. These programs can get nurses trained and ready to practice in as little as a year in some cases.

In 2010, according to the study, 55,000 qualified applicants were turned away — up from 16,000 in 2003.


Candy Goulette is senior regional editor for ADVANCE who wrote an article about new legislation that may reduce the nursing shortage.  See below.
If Paul Revere was a nurse, his anthem would have been, "The shortage is coming! The shortage is coming!"Ask any nurse and you’ll hear that refrain over and over. Despite the perception there are more nurses than slots for them to fill, there are places across the country struggling to find nurses to care for patients. In response to the difficulty some inner-city neighborhoods and rural areas have in attracting nurses, two legislators have introduced bills to make finding those nurses a little easier.
Temporary Fix
Rep. Lamar Smith (R-TX) introduced US HR 1933, a bill that would amend the Immigration and Nationality Act to modify the requirements for admission of non-immigrant nurses in health professional shortage areas. Specifically, the bill reauthorizes the H-1C temporary nurse Visa program allowing foreign nurses to come to the U.S. to work in areas deemed health professional shortage areas for 3 additional years.
The H-1C program began in 1999 and was reauthorized in 2006. It allows qualifying hospitals to employ temporary foreign RNs who are not immigrating to the U.S. for 3 years. Under terms of the 2006 legislation, only 500 H-1C visas were issued in each of the 3 years the legislation covered (2006-9). Sponsoring employers were charged a $250 fee for each visa issued. HR 1933 would lower the quota from 500 per year to 300 per year while extending the program through 2015. 

To be considered for the program, a nurse must either have a full and unrestricted license to practice in the country in which she received her nursing education and have passed the exam from the Commission on Graduates for Foreign Nursing Schools or have gone to nursing school in the U.S. In either case, the RN must have a full and unrestricted license to practice in any state in the U.S. and be fully qualified and eligible for licensure in the state in which she would practice. The nurse would have to have been lawfully admitted to the U.S., not have been employed without authorization since coming to the country and have a prospective employer file a petition for new employment before her temporary visa expires.
HR 1933 passed the House by a vote of 407-17 and is currently being debated in the Senate; the president has said he would sign the legislation on Senate passage.
Another View
HR 1929 (Rep. James Sensenbrenner, R-WI) amends the emergency visa status for nurses to address the shortage across the country in a more permanent way. Under terms of this proposed law, 20,000 RNs could apply for immigrant visas that would allow them to come to the country to work and bring their immediate families. The bill limits the secretary of state to issue the visas as a one-time proposition. The bill would allow any foreign national who is a physician or other healthcare worker who has been lawfully admitted to the U.S. to apply.
Instead of the $250 charge in HR 1993, Sensenbrenner’s bill would charge employers $1,500 per visa, which would go to funding U.S. nursing programs.
The additional funding would be used to start the Domestic Nursing Enhancement Account in the Treasury, which would be distributed by the Health Resources and Services Administration through the Public Health Service Act. Funding would be used to increase the number of faculty by offering grants to nurses working toward master’s or doctoral degrees who agree to serve as faculty. Each full- or part-time student in a graduate program could apply for $1,800 annually. Students would also qualify for grants, with $1,405 available for full- or part-time students in BSN or MSN programs that don’t lead to teaching. Full- or part-time ADN students would be eligible for $966 annually.


Sarah Gaines writes articles for http://www.rntomsnprograms.net/, a website dedicated to providing students with the information and tools needed in order to pursue their RN to MSN programs.


She asked us to share the latest article she posted called 15 Startling Statistics About the History of Nursing. Below are my favorites:

1895 Nursing Abundance: An article entitled, “Ambulance Work and Nursing,” published in 1985, stated that there was a nursing abundance at that time: “It was the popular fad of the day, and women all over the country became ‘nursing mad.’ They abandoned their household duties and eagerly sought for admittance into the various training establishments. They donned more or less appropriate costumes, and astonished their stay-at-home sisters by the facility with which they employed abstruse medical terms, and by their gruesome stories of the horrors of the operating room and wards.” 
Geneva Convention: The United States had not been a party to the Geneva Convention of 1864, which made the International Red Cross possible. Clara Barton saw the need for the Red Cross in America and plunged into the task of creating it. She carried out this enterprise practically single handed, educating the public through brochures and speeches and paying calls to cabinet heads and Congressmen.

Navy Nurses: The Department of the Navy announced in October 1978 that it would begin assigning women to duty aboard ships. The action was in accord with Navy-sponsored changes to legislation governing the assignment of women contained in the Fiscal Year 1979 Defense Authorization Bill. The action also was in accordance with an applicable judicial decision.

Nurse’s Cap: The nurse’s cap was derived from the nun’s habit and developed over time into two types: A long cap, that covers much of the nurse’s hair, and A short cap, that sits atop the nurse’s hair (common in the United Kingdom). While nurse caps all but disappeared in the U.S., nurses’ caps can still be found in many developing nations, as well as some countries where women still make up the overwhelming majority of nurses.

Nursing Shortage Stats: According to the American Public Health Association’s educational campaign, which addresses shortage of nurses, history has shown that the growth of the nursing supply has not kept pace with the evolving needs of the healthcare industry. Demand for nurses will grow by 40 percent between 2002 and 2020, while the supply will increase by only 6 percent over that same period. Factors that drive the growth in demand for nurses include an 18 percent growth in the population, a larger number of the elderly, and medical advancements. Alternative job opportunities have contributed to the slow growth of people entering the nursing profession as well.

As concerns at the White House and Capitol Hill mount about zero jobs growth in the U.S. economy, the Alliance for Quality Nursing Home Care (Alliance) urged President Barack Obama and the newly appointed Congressional "Super Committee" to view Medicare not just as a vital seniors’ health program, but also as a key driver of local jobs that has now enabled the U.S. nursing home sector to become America’s second largest health facility employer and a cornerstone of local employment from coast to coast.

Noting the New York Times report on August 17 that deep government funding cuts have "led many in the health industry to caution that it cannot be relied upon to keep hiring workers," Alan G. Rosenbloom, President of the Alliance, said the fact nursing homes employ 1.7 million Americans and generate $201 billion annually in economic activity should give pause to those who view Medicare as solely a program ripe for further cuts to meet deficit reduction targets. "Medicare is far more than just a key national health program, and serves as a cornerstone of rural, suburban and urban employment throughout America," Rosenbloom stated. "We encourage our national leaders to recognize and respect the dual benefits of Medicare as both a program crucial to the health and welfare of our seniors and a program that can reliably grow jobs…"




A new publication from the Robert Wood Johnson Foundation (RWJF) that focuses on a number of efforts at the state level to increase the number of nurses in the United States.  Experts predict that by 2025, the nation will facing a nursing shortage of about a quarter of a million nurses.  


The most recent issue of Charting Nursing’s Future, the Robert Wood Johnson Foundation (RWJF) publication series focused on policy ideas with the potential to transform patient care. In particular, it focuses on state-level partnerships that have created promising models and actual results.


The partnership efforts have included:


· Bringing the business community and others into a coalition supporting expansion of capacity to secure a bigger state appropriation.

· Strong gubernatorial leadership to coordinate a series of reforms, including web-based management of clinical placements for nursing students, and the creation of a statewide nursing corps to rapidly educate faculty and students;

· Multi-state partnerships among community colleges and baccalaureate programs to bridge the gaps between programs offering associates degrees and BSNs;

· Alliances of nursing programs from institutions around the state, including an alliance of rural programs, to share curriculum, administrative resources, faculty, admissions standards, and relying on web-based instruction and mobile simulators to maximize reach; and

· A focused program of distance-learning, web-based simulation and other approaches to overcome geographical challenges.


Using a broad range of tailored approaches, these and other state-level partnerships are creating more effective advocacy for policy and regulatory change; redesigning educational programs by deploying revised curricula, new technology and updated clinical education models; and increasing faculty capacity and diversity.


In this effort, the Center to Champion Nursing in America, a joint initiative of AARP and the Robert Wood Johnson Foundation, is providing technical assistance to 30 states now implementing efforts to expand nursing school capacity.  If you’re interested in more information, contact  202.371.1999.



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The Chicago Tribune recently had an article talking about the shortage of qualified and compassionate nurses in Indiana.  The article states that Indiana’s nursing homes are facing critical shortages of registered nurses and nurses aides.  An industry survey found nursing homes in this state had the nation’s highest vacancy rate for registered nurses last year, and the rate for vacant aide positions was the eighth highest in the nation.

Advocates for seniors agreed with the urgent need for more nurses and aides. An AHCA survey released last month found 26.0 percent, or more than a quarter, of registered nurse positions in nursing homes were vacant last year on June 30. The survey found that 13.7 percent of certified nurses’ aides slots – about one in seven – also were empty on that day. The national vacancy rate for nurses was 16.3 percent and for nurses aides, 9.5 percent.  This hurts the quality of care since many nursing homes will hire anybody and not fire anyone even if caught abusing or neglecting residents.

What we’re seeing over and over again is there’s a direct link between quality and staffing.   With unqualified or incompetent staff, many nurses get burnt out or over worked which leads to high turnover rates. The AHCA report estimated the two-thirds of RNs in nursing homes left their jobs last year and that 93 percent of aides did.

Michelle Niemier, executive director of the advocacy group United Senior Action of Indiana, agreed nursing homes needed more RNs and aides, but said those staffs also had to have the training, supervision and consistent hours to adequately serve residents and their families.

“The number one concern of family members is the number of well qualified, well trained, well supervised staff in nursing homes,” Niemier said.