$149M in grants awarded for primary care training, including nursing

The world of primary care is getting a major boost thanks to the Health Resources and Services Administration’s (HRSA) decision to issue over $149 million in grants. These will go to 12 workforce programs that will work to develop health professions training and prepare primary care providers to work in diverse, high-need areas. The grants will provide scholarships, support advanced nursing programs, train psychologists, and fund research.

Workforce efforts

HRSA hopes to encourage partnerships between various entities, including academic institutions, clinicians, and public health organizations, to address the additional needs of underserved communities. The workforce efforts include development of diverse, well-educated primary care providers, developing psychologists to use an integrated approach for behavioral health needs in underserved areas, clinical teaching and research improvements, and furthering primary care research.

Nursing grants

Several of the grants will allow nurses to focus on evolving their specialties. The advance education nurse traineeship will provide $22.9 million in grants to 69 programs, allowing advance practice nurses to develop their roles in primary care services for underserved communities, and the advanced nursing education grant will fund additional academic-practice partnership models for preparing advance practice nursing students to become providers. Other nursing grants include a bachelor of science in nursing (BSN) practicum, behavioral health integration, partial loan forgiveness for nursing faculty, diversity efforts, and a nurse anesthetist traineeship.

Doctors know they’re putting patients at risk, but work sick anyway

Employees come to work for different reasons while they are sick. Some are not offered paid sick leave, others do not wish to “waste a sick day on a sick day,” and some feel that even though sick leave is available, they are expected to show up anyway. In February 2016, an article in The Journal of the American Medical Association (JAMA) discussed the implications of an earlier study revealing that though the vast majority of respondents felt that they put their patients at risk while working when they were sick, the concern of letting down colleagues and patients caused them to work through it.

Toughing it out

The concept of working while sick is not a groundbreaking one. Last year, NSF International, a public health organization, conducted a survey that revealed at least 26 percent of Americans go to work while they are ill. Although most judged their fellow co-workers for coming in sick, they admit that these people are hard workers. A quarter of those that work while sick reported doing so because their boss expected it of them. The Centers for Disease Control and Prevention released findings from an Environmental Health Services (EHS) study that showed 12 percent of restaurant food workers surveyed reported working even when experiencing vomiting or diarrhea. They were more likely to work when sick if the restaurant served more than 300 meals a day, did not have a policy requiring manager notification of illness, did not have a replacement on-call, and had less experienced managers.

The state of Massachusetts passed the Earned Sick Time law, which took effect July 1, 2015, requiring companies with at least 11 employees to offer paid sick leave. Nearly a year prior, Dr. Mark Schuster, Chief of General Pediatrics as Boston Children’s Hospital and a professor at Harvard Medical School, issued his thoughts on the necessity of family leave policies in a New England Journal of Medicine (NEJM) editorial. He noted that even though sick children are encouraged to stay home from school and see a doctor if necessary, parents are often unable or experience difficulty taking their children to a doctor.

Yet what if that doctor is coming to work sick? A 2015 JAMA Pediatrics study revealed that 83.1 percent of the 536 physicians and advanced practiced clinicians surveyed worked sick at least once in the past year, with 9.3 percent working sick at least five times. They would work with diarrhea, fever, and significant respiratory symptoms. Over 90 percent did not want to let colleagues or patients down and had staffing concerns. Over half mentioned in free-text responses that they felt there was no clearly defined ‘too sick to work’ standard. In response, Dr. Schuster noted that even when a clinician has good intentions while toughing it out, that decision can make others feel that they need to do the same. He felt that a cultural shift was required, as well as providing a better sick relief system with better workload coverage.

Not there yet

The February JAMA article revived the discussion about health care providers placing their patients at risk. Physicians were more likely to report concerns about continuity of care for their patients, at odds with the knowledge that working while sick can actually harm patients. One physician said it is actually much less stressful to work while sick than to make arrangements to cover care while out. Another noted that peak performance was expected at all times, and that providers were expected to deny smaller, basic needs, such as meals and bathroom breaks, in order to be as productive as possible, so taking time off for being sick was not feasible due to a lack of accommodation. The co-authors of this follow-up discussion article called on health care systems to come up with better solutions for coverage and backup in the event of illnesses.

Nurses in high demand, shortage expected to worsen

The discussion of current and looming physician shortage has dominated talk of provider demand, but the shortage of registered nurses is also putting a strain on hospitals. The U.S. Bureau of Labor Statistics estimates that in the next five years, about 1.1 million more nurses will be needed. In addition to increased demand for health care services due to millions of previously uninsured patients gaining health care coverage through the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), the majority of registered nurses are at least 50 years old.

Demand

Large hospitals are reporting dozens of openings for nurses, which is leading them to hold recruitment fairs and offer incentives, such as signing bonuses, to fill these spots. In addition to the projected five year demand, the American Association of Colleges of Nursing (AACN) points out that one million nurses will likely reach retirement age in about 10-15 years. As patients are living longer with serious illnesses, this demand is only growing stronger. The director of the Missouri Center for Nursing said that emerging opportunities for nurses in new fields, such as insurance companies, are impacting hospitals, as well.

Faculty shortages

Nursing schools are unable to churn out more graduates because it is difficult to hire the needed faculty. Thousands of qualified applicants were turned away from nursing master’s and doctoral programs simply because there are not enough teachers. Although the nursing program at Missouri Southern State University is fully staffed, the school’s interim director said that it could expand with more faculty. According to HHS, the number of nursing graduates per year increased by about 86,000 from 2001 to 2013 due to efforts to expand programs in order to address the projected nursing shortfall.