FIGURE
The past few months have introduced many exciting opportunities and challenges for nurses. For instance, this year, seven nurses made Modern Healthcare's 2nd annual list of the "100 Most Powerful People in Healthcare." On September 10, the Senate unanimously agreed to accept the Mikulski/Collins amendment for nursing education funding. The final amendment would increase funding for the nursing workforce development programs of Title VIII (including the Nurse Reinvestment Act) by $50 million-a 55% increase over FY 2003 funding. This funding comes just as a new study was released in the Journal of the American Medical Association (JAMA) addressing the implications of increased educational experiences for nurses and patient outcomes.
The primary investigator for the JAMA study, Dr. Linda Aiken, a prominent nurse administrator and researcher, found higher educated nurses may cut mortality rates. At 168 Pennsylvania hospitals that employ a lower percentage of nurses with at least a bachelor's degree, reported death rates for patients undergoing surgery are higher. Facilities that had less than 10% of nurses with at least a bachelor's degree reported almost 3% mortality among patients undergoing general, orthopedic, or vascular surgery (Aiken, Clarke, Cheung, Sloane, & Silber, J., 2003).
By comparison, at hospitals where more than 70% of nurses had at least a bachelor's degree, the mortality rate was 1.5%. After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient's surgeon was board-certified, a 10% increase in the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue. The authors suggest the difference may be because university-educated nurses tend to be more proficient in critical thinking (Aiken, Clarke, Cheung, Sloane, & Silber, J., 2003).
Aiken and her research team (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002) also recently reported nurses are more likely to experience burnout and job dissatisfaction in hospitals with high patient-to-nurse ratios. They also found surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates in hospitals with high patient-to-nurse rations. 10,184 staff nurses were surveyed for the study from the same 168 Pennsylvania hospitals reported above. After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of admission and a 7% increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% increase in the odds of burnout and a 15% increase in the odds of job dissatisfaction.
How do these studies affect the 2.7 million nurses practicing in the United States and the 7,500 members of the Society of Gastroenterology Nurses and Associates (SGNA)? Clearly, these studies provide support for Nursing's Agenda for the Future (ANA, 2002). SGNA is actively involved in helping to develop work plans towards achieving nursing's goals for the future through participating in the development of Nursing's Agenda for the Future.
Ten domains for action have been identified in Nursing's Agenda for the Future: leadership and planning, economic value, delivery systems, work environment, legislation/regulation/policy, public relations/communication, professional/nursing culture, education, recruitment/retention, and diversity. Empirical data such as that provided by Aiken and her associates helps to document the importance of nursing's efforts to address the challenges and needs facing our discipline in the current environment.
As an organization, SGNA supports Nursing's Agenda for the Future through several different avenues. The SGNA RN General Education Scholarship offers generous reimbursement to a student in an accredited nursing program. SGNA research grants are available to support nurse researchers in documenting problems in delivery of care in the GI nursing setting as well as innovative strategies to address delivery of care. In fact, a recent Delphi study conducted by Dr. Joyce Griffin-Sobel, SGNA's Director of Research, helped to identify and establish research priorities that are consistent with several of the Agenda' s domains of action (Griffin-Sobel & Suozzo, 2002). SGNA Educational Course Grants support individual members' attendance at the annual course where opportunities abound to enhance critical thinking skills, network with colleagues from around the country, and share nursing knowledge.
SGNA also supports Nursing's Agenda for the Future by providing members the opportunity to develop leadership skills through service and committee participation at both the regional and national level. In addition, recent SGNA efforts to advance nursing issues include collaborations with the American Society of Gastrointestinal Endoscopy, the American Association of Ambulatory Surgical Centers, the Nurses in Washington Internship, Colorectal Cancer Roundtable, the Alliance of Nursing Organizations, the National Student Nurses Association, the American Nurses Association, the Society International Gastroenterology Endoscopy Nurses and Associates, and the Federated Ambulatory Surgical Association.
While no one would argue times are tough in the healthcare arena, these challenging times are, in fact, producing creative and ambitious interventions for addressing issues that have plagued nursing for years. Attention to educational opportunities and job satisfaction for nurses, staffing issues as they affect patient safety, and nursing's commitment to quality research are just a few outcomes of the currently stressful environment. Gastroenterology nurses must be committed to supporting SGNA both locally and nationally through our money, our time, our loyalty, and our voices. In supporting SGNA, we support the efforts of our discipline to move forward with Nursing's Agenda for the Future.
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