Substantial racial inequalities despite frequent health care contact found in treatment for opioid use disorder

Peer-Reviewed Publication

HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH

Key points:

• In a national study of Medicare beneficiaries with disability and active opioid use disorder (OUD) symptoms, White patients received and filled prescriptions for medications to treat OUD up to 80% more frequently than Black patients and up to 25% more frequently than Hispanic patients in the six months following a high-risk OUD-related event such as an overdose or infection

• Across racial groups, patients visited health care providers a similar number of times in the six months post OUD event—indicating that disparities in treatment do not stem from disparities in seeking care

Boston, MA—In the wake of an opioid-related event such as an overdose, infection, or detox admission, White patients received medication for opioid use disorder (OUD) up to 80% more frequently than Black patients and up to 25% more frequently than Hispanic patients, according to a new study led by researchers at Harvard T.H. Chan School of Public Health. Across racial groups, patients made a similar number of visits to health care providers in the six months following such an event—indicating that disparities in treatment are not explained by low contact with care.

“Opioid overdoses are rising faster in the Black population than in any other racial group: In 2021, they surpassed overdose rates in the White population for the first time in decades. And rates of overdose in the Hispanic population have recently risen by 40%,” said lead author Michael Barnett, associate professor of health policy and management. “We need to understand barriers to obtaining life-saving addiction treatment for minority populations to address this huge demographic shift and public health crisis.”

The study will be published in the May 11, 2023 edition of the New England Journal of Medicine.

While racial disparities in addiction treatment have been identified by previous studies, little of this research examined the full range of medications for OUD or accounted for non-recommended medications like opioid analgesics and benzodiazepines, both of which are associated with substantial risk for OUD patients. To fill in these gaps, researchers pulled a random 40% sample of Medicare beneficiaries with disability—a group of Americans among the most affected by OUD—who experienced at least one acute OUD-related event between 2016 and 2019. Using the Medicare claims, researchers observed 25,904 OUD-related events—15.2% of which occurred among Black patients, 8.1% among Hispanic patients, and 76.7% among White patients.

In 180 days following these events, Black patients received and filled a prescription for buprenorphine, a lifesaving therapy for OUD, 12.7% of the time; Hispanic patients, 18.7% of the time; and White patients, 23.3% of the time. Naloxone, a drug for reversing overdoses that has few restrictions on its distribution (in contrast to buprenorphine), followed the same pattern: Black patients received and filled a prescription after 14.4% of OUD events; Hispanic patients, 20.7%; and White patients, 22.9%. In a follow-up analysis using data from 2020 to 2021, researchers found that these differences were not explained by differing access to methadone by racial/ethnic group. Black patients received and filled these prescriptions after 8.3% of OUD events; Hispanic patients after 11.2% of OUD events; and White patients after 8.6% of OUD events.

Despite well-known and substantial risks, prescriptions for opioid analgesics and benzodiazepines were received and filled frequently. Prescriptions for opioid analgesic were received and filled after 23% of OUD-related events regardless of race. But prescriptions for benzodiazepines were received and filled by Black patients 23.4% of the time, by Hispanic patients 29.6% of the time, and by White patients 37.1% of the time.

“Skyrocketing rates of overdoses in minority groups are unlikely to shift without a major overhaul in the addiction treatment system,” said Barnett. “Addressing the overdose crisis and racial disparities in addiction will likely require community-specific interventions that engage with minority populations and the clinicians who serve them to reduce stigma and bolster trust.”

Ellen Meara, professor of health economics and policy at Harvard Chan School, was a co-author.

Funding came from National Institute on Drug Abuse grants R01 DA049757, R01 DA048533, and P30 DA035772 and National Institute on Aging grant K23 AG058806.

“Racial inequality in receipt of medications for opioid use disorder,” Michael L. Barnett, Ellen Meara, Terri Lewinson, Brianna Hardy, Deanna Chyn, Moraa Onsando, Haiden A. Huskamp, Ateev Mehrotra, Nancy E. Morden, New England Journal of Medicine, May 11, 2023, doi: 10.1056/NEJMsa2212412

Visit the Harvard Chan School website for the latest news, press releases, and multimedia offerings.

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Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.

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JOURNAL

New England Journal of Medicine

DOI

10.1056/NEJMsa2212412 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Racial inequality in receipt of medications for opioid use disorder

ARTICLE PUBLICATION DATE

11-May-2023

Impacts of YouTube on loneliness and mental health

Peer-Reviewed Publication

GRIFFITH UNIVERSITY

Frequent users of YouTube have higher levels of loneliness, anxiety, and depression according to researchers from the Australian Institute for Suicide Research and Prevention (AISRAP).

Dr Luke Balcombe and Emeritus Professor Diego De Leo from Griffith University’s School of Applied Psychology and AISRAP sought to understand both the positive and negative impacts of the world’s most used streaming platform on mental health. 

They found the most negatively affected individuals were those under 29 years of age, or who regularly watched content about other people’s lives.

Lead author Dr Luke Balcombe said the development of parasocial relationships between content creators and followers could be cause for concern, however some neutral or positive instances of creators developing closer relationships with their followers also occurred.

“These online ‘relationships’ can fill a gap for people who, for example, have social anxiety, however it can exacerbate their issues when they don't engage in face-to-face interactions, which are especially important in developmental years,” he said.

“We recommend individuals limit their time on YouTube and seek out other forms of social interaction to combat loneliness and promote positive mental health.”

Dr Balcombe said the amount of time spent on YouTube was often a concern for parents, who struggled to monitor their children’s use of the platform for educational or other purposes.

For the purpose of the study, over two hours per day of YouTube consumption was classed as high frequency use and over five hours a day as saturated use.

The study also determined more needed to be done to prevent suicide-related content being recommended to users based on algorithms for suggested viewing. 

While ideally, people shouldn’t be able to search for these topics and be exposed to methods, the YouTube algorithm does push recommendations or suggestions based on previous searches, which can send users further down a disturbing ‘rabbit hole’. 

Users can report this type of content, but sometimes it may not be reported, or it could be there for a few days or weeks and with the sheer volume of content passing through, it's almost impossible for YouTube’s algorithms to stop all of it.

If a piece of content is flagged as possibly containing suicide or self-harm topics, YouTube then provides a warning and asks the user if they want to play the video.

“With vulnerable children and adolescents who engage in high frequency use, there could be value in monitoring and intervention through artificial intelligence,” Dr Balcombe said.

“We’ve explored human–computer interaction issues and proposed a concept for an independent-of-YouTube algorithmic recommendation system which will steer users toward verified positive mental health content or promotions.

“YouTube is increasingly used for mental health purposes, mainly for information seeking or sharing and many digital mental health approaches are being tried with varying levels of merit, but with over 10,000 mental health apps currently available, it can be really overwhelming knowing which ones to use, or even which ones to recommend from a practitioner point of view.

“There is a gap for verified mental health or suicide tools based on a mix of AI-based machine learning, risk modelling and suitably qualified human decisions, but by getting mental health and suicide experts together to verify information from AI, digital mental health interventions could be a very promising solution to support increasing unmet mental health needs.”  

The full study, ‘The Impact of YouTube on Loneliness and Mental Health’, can be accessed online at https://www.mdpi.com/2227-9709/10/2/39.

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JOURNAL

Informatics

DOI

10.3390/informatics10020039 

METHOD OF RESEARCH

Systematic review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The Impact of YouTube on Loneliness and Mental Health

Higher mortality rate for Porton Down veterans involved in chemical weapons research

Peer-Reviewed Publication

LANCASTER UNIVERSITY

 

IMAGE: GAS MASK PROTECTION AGAINST A CHEMICAL ATTACK view more 

CREDIT: LANCASTER UNIVERSITY

Military veterans involved in chemical warfare agent research at Porton Down faced a 6% higher mortality rate than similar veterans who were not involved.

The research from the King’s Centre for Military Health Research (KCMHR) at King’s College London, in partnership with Lancaster University, is published in the International Journal of Epidemiology.

Researchers compared the medical records of 16,721 male UK veterans who participated in the ‘Service Volunteer Programme’ from 1941-1989, comparing them with 16,228 non-Porton Down veterans, placing a particular focus on the most common causes of death and types of cancer.

They found that these military veterans had higher rates of mortality from diseases of the genitourinary systems (for example, kidney disease), as well as deaths attributable to alcohol, but found little evidence of an association between attendance at Porton Down and higher rates of overall cancer incidence.

Porton Down first opened during World War I in response to the use of chemical weapons. Since 1916, over 20,000 service personnel have exposed to low doses of chemical warfare agents and their antidotes, some of which are known to be carcinogenic. This has raised questions over the long-term impacts on the health of veterans attached to the Program.

While there was only a small increased risk overall, the researchers did find that veterans who took part in the Porton Down Volunteer Program between 1960-64 were at significantly greater risk of dying from a range of causes including cancerous tumours, diseases within the circulatory system, and smoking related deaths.

The researchers suggest that health providers need to be aware of the specific health issues connected to military veterans, and the wider population, who may have been exposed to chemical warfare agents.

Dr Tom Keegan, one of the study’s authors and a Senior Lecturer in Epidemiology from Lancaster Medical School said: “Military personnel were exposed to over four hundred different types of chemicals over the course of the programme, so we now want to investigate whether particular chemicals are associated with increased risk of poorer health.”

Dr Gemma Archer, from KCMHR, the study’s first author said: “Veterans of the Porton Down Service Volunteer Program were often exposed to small doses of chemical agents designed to be used in war. Our study followed the health of veterans for over fifty years, and we are thankful that it indicates that the large majority of veterans were unlikely to have come to harm. A small number of veterans did appear to have higher rates of death and a variety of other illnesses, and it is something that healthcare professionals need to be mindful of when treating victims of chemical exposure.” 

Professor Nicola Fear, co-director of KCMHR and the study’s senior author said: “There has, for some time, been a question mark hanging over the volunteers who contributed to the research of Porton Down. While it is reassuring that our study found no evidence of increased risk of cancer in veterans who attended Porton Down, the 6% higher rate of all-cause mortality compared to veterans who didn’t attend Porton Down is not something that should be overlooked”.

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JOURNAL

International Journal of Epidemiology

DOI

10.1093/ije/dyad050 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Mortality and cancer incidence in UK military veterans involved in human experiments at Porton Down: 48-year follow-up

ARTICLE PUBLICATION DATE

11-May-2023

Pediatric clinical studies’ underfunding risk

Peer-Reviewed Publication

UNIVERSITY OF GOTHENBURG

 

IMAGE: JENNY KINDBLOM, SAHLGRENSKA ACADEMY AT THE UNIVERSITY OF GOTHENBURG. view more 

CREDIT: PHOTO BY JOHAN WINGBORG/UNIVERSITY OF GOTHENBURG

A clinical study with children as participants entails extra costs often omitted in the initial budget. Clinical studies involving children are thus at risk of being undercompensated, new research shows.

Kids will be kids when they take part in clinical studies, as at other times. Sometimes they need a break to do something else for a while before the next study session can start. With children as study participants, researchers also need to involve more people — frequently two legal guardians— and this, too, boosts the time a study requires.

The person responsible for the current study is Jenny Kindblom, associate professor (docent) at the Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and senior consultant clinical pharmacologist at Sahlgrenska University Hospital.

Kindblom and her colleagues at the Hospital’s clinical trials unit for children and adolescents had long noticed that, in budget proposals from the pharmaceutical companies to cover study activities performed at the hospital, activities in pediatric clinical studies were often undercompensated. This pattern emerged clearly when the researchers embarked on a more structured type of work, supported by a team member with expertise in budget and contract issues.

Studies costing 59 percent more

The article in Acta Paediatrica is based on ten clinical studies with children as participants, and their true costs proved to be 59 percent higher, on average, than the total initial budget in the proposal from the pharmaceutical company sponsoring the trial. The problem was that the studies were based on adults and had not been adapted to the paediatric setting.

Child studies require extensive planning and coordination with various people, including some around the child. In addition, child studies often comprise a great many investigations, with staff and resources from various units.

“In implementing the study, you need to have the child on your side. Forcing kids to participate in study activities never works. You need to adjust to what the child can cope with — and sometimes have a break and a bit of rest and recreation,” Kindblom says.

Younger children, unlike adults, may also need to be sedated during, for instance, a magnetic resonance imaging (MRI) scan or bowel examination. Anesthesia comes with a wide range of input requirements from different units, which makes the activity more time-consuming.

Budget processing important

The study’s first author is Stavros Koulizakos, the team expert in charge of budget and contractual matters for the pediatric clinical studies underway at Sahlgrenska University Hospital. He describes the major gaps between budgeted and actual costs as follows.

“The budget items that generate the biggest discrepancies are, first, the expenses involved in clinical trials; second, the estimated time required for the study activities; and third, the costs of examinations.”

The researchers emphasize that drug companies are enormously important for driving development in the direction of new and improved medicines, for children and adolescents as well as adults. Nevertheless, the compensation for study activities must be as much as possible representative of the study costs  for the Hospital and the respective companies alike.

Kindblom again:

“There’s a definite risk of fewer studies being conducted because of underfunding. An increased risk of pediatric studies not reaching completion has been observed. To an extreme extent, undercompensation can contribute to this outcome. But an even more clearcut consequence is for the health care services to engage in paediatric trials sponsored by  drug companies, without getting compensation. It’s not a reasonable state of affairs,” she concludes.

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JOURNAL

Acta Paediatrica

DOI

10.1111/apa.16808 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Paediatric clinical trials need paediatric clinical trial budgets

International Nurses Day: World’s oldest children’s nursing organization recognizes outstanding contributions to the care of children and young people

Grant and Award Announcement

SAGE

 

IMAGE: ABPN TEA PARTY-GOVERNANCE AND DEVELOPMENT BOARD view more 

CREDIT: ASSOCIATION OF BRITISH PAEDIATRIC NURSES

At a recent event to celebrate the Association’s 85th Anniversary, the Association of British Paediatric Nurses awarded Honorary Fellowships to eight children’s nurses in recognition of their outstanding contribution to the nursing care of children and young people.

The 2023 Honorary Fellows

• Ann Bisbrown Lee for services to children’s nursing and for many years’ service to the Association of British Paediatric Nurses, especially in leading marketing and conference activities.
• Professor Steven Campbell for services to children’s nurse education and to the Association of British Paediatric Nurses as the first Editor of the Association’s journal, the Journal of Child Health Care.
• Rachel Cooke for services to children’s nursing, especially in the field of children’s palliative care and childhood bereavement services in the UK and overseas. 
• Norman Long for services to children’s nurse education and for many years’ service to the Association of British Paediatric Nurses as the finance officer.
• Professor Bertha Ochieng for services to children’s nursing and child health, especially in the field of community empowerment and engagement of socially disadvantaged populations.
• Dr Gerri Sefton for services to children’s nursing, especially in the field of paediatric intensive care and children’s nursing research.
• Fiona Smith for services to children’s nursing in the UK and globally, including playing a key role in establishing the Paediatric Nursing Associations of Europe.
• Clinical Associate Professor Michael Tatterton for services to children’s nursing and children’s nurse education, especially in the field of children’s palliative and community care.

Caron Eyre, ABPN Chair, said “This year’s ABPN Fellows are each of an extremely high calibre and have made inspirational improvements to the care of babies, children and young people.”

Professor Bernie Carter, President of the ABPN, said “The appointment of our Honorary Fellows acknowledges the amazing and diverse work undertaken by children’s nurses in practice, education, academia, research and leadership. We are immensely proud of their achievements and welcome them as special members of our ABPN family”.

Stress-management interventions may help individual healthcare workers for at least a year

Interventions aimed at reducing work-related stress for individual healthcare workers may lead to improvements in how people cope with stress up to a year later.

Peer-Reviewed Publication

COCHRANE

Interventions aimed at reducing work-related stress for individual healthcare workers may lead to improvements in how people cope with stress up to a year later. Findings from a Cochrane review of the latest available evidence build on the conclusions of a previous review in 2015 that found low-quality evidence that interventions, such as cognitive behavioural training (CBT), mental and physical relaxation, were better than none.

The researchers included 117 studies of the effects of different interventions on stress alleviation in the current review, of which 89 studies were new. These 89 studies were published between 2013 and 2022. A total of 11,119 healthcare workers worldwide were randomised to different interventions, and stress was assessed by questionnaires measuring stress symptoms in the short term (up to three months after an intervention ended), in the medium term (between three and 12 months) and long-term (follow-up after more than a year).

The review from Cochrane, a collaboration of independent, international experts, looked at interventions at the level of the individual healthcare worker that focused attention either on the experience of stress, or away from the experience of stress. Strategies for focusing attention on the stress included CBT, and training on assertiveness, coping and communication skills. Interventions that focus attention away from the stress included relaxation, mindfulness meditation, exercise such as yoga and tai chi, massage, acupuncture, and listening to music. The researchers wanted to see whether different types of interventions were better than no intervention in reducing stress.

The healthcare workers in the studies were experiencing low to moderate levels of stress and burnout, which can lead to physical symptoms such as headaches, muscle tension or pain, but also mental symptoms, such as depression, anxiety, impaired concentration and emotional and relationship problems.

Sietske Tamminga, assistant professor in public and occupational health at Amsterdam University Medical Centre, Amsterdam, The Netherlands, who led the research said: “Healthcare workers often deal with stressful and emotional situations in patient care, human suffering, and pressure from relationships with patients, family members and employers, as well as high work demands and long working hours.

“We found that healthcare workers might be able to reduce their stress by means of individual-level interventions such as cognitive behaviour training, exercising or listening to music. This may be beneficial for the healthcare workers themselves and it may spill over to the patients they care for, and the organisations they work for. The effect may last for up to a year and a combination of interventions may be beneficial as well, at least in the short term. Employers should not hesitate to facilitate a range of stress interventions for their employees. The long-term effects of stress management interventions remain unknown.”

The researchers say that larger, better-quality studies are needed to look at both the short- and long-term effects of individual level interventions in order to increase the certainty of the evidence.

“We need more studies on interventions addressing work-related risk factors both at the individual and organisational level,” said Dr Tamminga. “It might be even more beneficial to improve working conditions themselves, instead of only helping individuals to deal better with heavy psychosocial burdens. For example, employers could address problems of understaffing, over-work and anti-social shift patterns. If you’re dedicated to change, you need to change the underlying risk factors rather than focusing on the symptoms.”

Limitations of the research include: the estimates of the effects of individual-level stress management interventions may be biased because of a lack of blinding of the participants in the included studies; many studies were small; and there were too few studies that focused on specific factors that can cause stress in the workplace.

Studies have reported that between 30% to 70% of physicians and nurses and 56% of anaesthesiologists experience burnout symptoms as a result of their work. Previous research has tended to focus on a particular type of intervention in specific groups of healthcare workers. The authors of this Cochrane review write: “To the best of our knowledge there are no up-to-date reviews that examine the effectiveness of various types of individual-level interventions aimed at reducing stress in various healthcare workers to provide a more complete overview.”

Dr Tamminga concluded: “There is already a shortage of healthcare workers due to high turnover rates, and effective prevention of stress and burnout may help to reduce this.”

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JOURNAL

Cochrane Database of Systematic Reviews

DOI

10.1002/14651858.CD002892.pub6 

METHOD OF RESEARCH

Systematic review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Individual-level interventions for reducing occupational stress in healthcare workers

Health worker shortages strongly linked to excess deaths

Especially from neglected tropical diseases and malaria, maternal and neonatal disorders, diabetes and kidney diseases

Peer-Reviewed Publication

BMJ

Shortages of health workers such as doctors, nurses and midwifery staff are strongly associated with higher death rates, especially for certain diseases such as neglected tropical diseases and malaria, pregnancy and birth complications, diabetes and kidney diseases, finds an analysis of 172 countries and territories, published by The BMJ today.

The results show that, although inequalities in health workforces have been decreasing globally over the past 30 years, they continue to have a substantial impact on death rates globally - and the researchers say targeted action is needed to boost health workforces in these priority areas.

The term human resources for health (HRH) refers to a range of occupations, including doctors, nurses, midwives, dentists and other allied professions and support functions designed to promote or improve health. 

This workforce is key to achieving the goal of universal health coverage by 2030.

Although several studies have analysed the relation between HRH density and deaths, studies on inequalities in total and specific HRH types and relations with specific causes of death from a global perspective are scarce.

To address this, researchers used data from the Global Burden of Disease Study 2019, United Nations Statistics, and Our World in Data to measure the associations between HRH and all cause and cause specific deaths in 172 countries and territories representing most of WHO’s member states. They also explored the inequalities in HRH from 1990 to 2019.

Globally, the total health workforce per 10,000 population increased, from 56 in 1990 to 142.5 in 2019.

In 2019, the total health workforce was distributed unevenly and was more concentrated among countries and territories that ranked high on the human development index (a summary measure of education, health, and income).

For example, Sweden had the highest access to HRH per capita (696.1 per 10,000 population), whereas Ethiopia and Guinea had less than one ninth of the global HRH level, with 13.9 and 15.1 workers per 10,000 population, respectively.

The all cause aged standardised death rate decreased from 995.5 per 100,000 population in 1990 to 743.8 per 100,000 in 2019. And for most of the 21 specific causes of death analysed, the number of deaths per 100,000 population declined from 1990 to 2019, except for those due to neurological and mental disorders, skin diseases, and muscle and bone disorders. 

The death rate for HIV/AIDS and sexually transmitted infections increased from 2 per 100,000 population in 1990 to 3.6 per 100,000 in 2000, but then decreased steadily to 3.4 per 100,000 population in 2019.

The risk of death due to gut infections, neglected tropical diseases and malaria, diabetes and kidney diseases, and disorders of pregnancy and birth was more pronounced (between 2 and 5.5 times higher) in countries and territories with low or the lowest health worker density than in those with the highest density.

This is an observational study, so can’t establish cause, and the researchers point to several potential limitations in the data that might have influenced their results, although the associations were similar after further analysis, suggesting that the results are robust.

As such, they conclude: “Our findings highlight the importance of expanding the financing of health and developing equity oriented policies for the health workforce to reduce deaths related to an inadequate HRH.”

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JOURNAL

The BMJ

DOI

10.1136/bmj-2022-073043 

METHOD OF RESEARCH

Observational study

ARTICLE TITLE

Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study

ARTICLE PUBLICATION DATE

10-May-2023

COI STATEMENT

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the National Nature Science Foundation of China, National R and D Key project, and National Science and Technology Project on Development Assistance for Technology, Developing China-ASEAN Public Health Research and Development Collaborating Center for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Majority of nurses attribute well-being struggles to staffing shortages

FAU, Cross Country Healthcare’s third annual report shows one-third of nurses plan to leave the profession in the next two years

Reports and Proceedings

FLORIDA ATLANTIC UNIVERSITY

 

IMAGE: A NEW REPORT SHOWS ONE-THIRD OF NURSES PLAN TO LEAVE THE PROFESSION IN THE NEXT TWO YEARS. view more 

CREDIT: ALEX DOLCE, FLORIDA ATLANTIC UNIVERSITY

Cross Country Healthcare, Inc. (NASDAQ: CCRN), a market-leading, tech-enabled workforce solutions platform and advisory firm, in collaboration with Florida Atlantic University, today announced the results of its annual survey of nursing professionals and students.

The study found that although nurses are passionate about doing meaningful work and earning a good income, only one-third of nurses plan to remain in the profession for the foreseeable future, and about one-fourth plan to leave in just one to two years from now. The survey, conducted in collaboration with FAU’s Christine E. Lynn College of Nursing, found that more than half of nurses claim there is insufficient staff to meet demand, which they regard as the worst part of the profession, resulting in burnout and feeling overworked.

May is Nurse Appreciation Month and Mental Health Awareness Month, and to help address some of the mental health struggles facing our nurses today, Cross Country Healthcare is launching the Check Your Vitals initiative, asking nurses to check their vitals, or overall health and well-being, while offering tips and strategies for nurses on maintaining both mental and physical wellness. As part of the campaign, nurses are encouraged to wear green to show support for mental health awareness and post their green on social media using the hashtag #checkyourvitals.

“We had hoped that at this point past the pandemic, we would see improvement in the sentiment of our nurses, but that’s simply not the case,” said John A. Martins, president and CEO of Cross Country Healthcare. “The decision to choose nursing is more of a calling than a job. Nurses are tireless in their passion for quality patient care, no matter how challenging their working conditions may be. But the profession has reached a breaking point, and it is well past time that industry leaders come together to create reform to revitalize this essential profession.”

According to the survey, nurses reported experiencing symptoms of anxiety (46 percent), insomnia (35 percent), and depression (32 percent). Most employed nurses (83 percent) do not utilize mental health or well-being counseling, despite employers offering such services. The leading cause for poor mental health was staffing shortages (71 percent), followed by a lack of support resources (55 percent). The nurses’ experience with the COVID-19 pandemic has added to feelings of discontent, and nearly 2 in 5 employed nurses said it dramatically increased their desire to leave the profession.

The findings come as the United States Health Resources & Services Administration predicts a national projected shortage of 63,720 full-time registered nurses in 2030 and a projected shortage of 141,580 fulltime licensed practical nurses in 2035.

With regard to mental health in nursing students, 61 percent said their school offers mental health and well-being resources, including student assistance programs, gyms and fitness resources, counseling, food and nutrition services, and a mental health and well-being hotline. Forty-seven percent of students use the mental health offerings from their school, and 53 percent find them useful. When asked if they were satisfied with their decision to become a nurse, 93 percent of student nurses said they are.

“Despite the many challenges and stressors that have contributed to burnout and nurses being on the brink of a breaking point in their professional careers, nurses and nursing students remain overwhelming satisfied with their career choice,” said Safiya George, Ph.D., Holli Rockwell Trubinsky Eminent Dean and Professor, FAU’s Christine E. Lynn College of Nursing. “Nurses have endured and thrived over the years. The profession as a whole will need a lot more investment of human capital as well as fiscal and other supportive resources moving forward. This national survey has helped to identify innovative ways to improve quality of work and life for current and the next generation of nurses.”  

The Christine E. Lynn College of Nursing offers accredited programs at all levels to prepare and train students, including Bachelor of Science in Nursing (B.S.N.), Master of Science in Nursing (M.S.N.), Doctor of Nursing Practice (DNP) and Ph.D. programs. A BSN-DNP program with a psychiatric mental health nurse practitioner concentration and post-graduate dermatology and telehealth certificate courses, and other concentrations that combine innovation and technology also are offered to address health care provider shortages. 

“Nurses are struggling and have been for years now. They are overworked and understaffed, and addressing their well-being challenges must be a critical priority for health care leaders,” said Hank Drummond, Ph.D., M.Div, B.A., RN, senior vice president, and chief clinical officer. “The patient experience is only as good as the caregiver experience, so we need to ensure our caregivers are well and cared for, both physically and emotionally.”

Other survey findings include:

 

• Nearly 1 in 5 employed nurses don’t know if they would follow the same career path if they could talk to their former selves.
• Most nurses overwhelmingly believe that increased pay rates/incentives are necessary to attract and retain staff and increase flexible scheduling.
• While many health care organizations offer opportunities for growth and development, 1 in 3 nurses are unaware if their employer has such opportunities, and 1 in 5 said their employer does not.
• The most common well-being programs offered include employee assistance programs, hotlines, employer-paid health care, flexibility and time off.
• Employed and unemployed nurses greatly believe in the value of national licensure.

 

To help address some of the challenges facing the nursing profession today, Cross Country Healthcare recommends five ways to revitalize the profession, including:

• Create new opportunities for education:
  • Identify new pathways at the high school, undergraduate and postgraduate levels to expedite the supply of nurses.
  • Recruit more nursing faculty to educate and train the next generation of nurses.
• Offer flexibility and awareness of growth opportunities:
  • Open every door to expedite the transition from the university to the hospital floor and offer more fluid career paths that match individual skills and ambitions to evolve and grow with the person.
• Invest in retention strategies and well-being initiatives that matter:
  • Focus on enriching current and future nurses’ working conditions and well-being to ensure long-term satisfaction and subsequent retention.
• Technological innovation will drive the future:
  • Use technology to understand better equitable workforce distribution, workflow management, employee satisfaction and well-being, and patient safety.
• Explore innovative staffing models:
  • Explore innovative and flexible staffing models, including travel and per-diem nurses, to provide agility and continuity of quality patient care.

 

- FAU -

About the Study

This national survey, titled, "The Future of Nursing: At the Breaking Point,” was conducted with nearly 1,500 nursing professionals and students at health care and hospital facilities. The online survey was conducted between Feb. 22 and April 14, in partnership with FAU’s Christine E. Lynn College of Nursing.

 

About the Christine E. Lynn College of Nursing

FAU’s Christine E. Lynn College of Nursing is nationally and internationally known for its excellence and philosophy of caring science. The College was ranked No. 11 nationwide by US News and World Report in 2021 for “Best Online Master’s in Nursing Administration Programs” and No. 32 for the “Best Online Master’s in Nursing Programs.” In 2020, FAU graduates earned a 95.9% pass rate on the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) and a 100% AGNP Certification Pass Rate. The baccalaureate, master’s and DNP programs at Florida Atlantic University’s Christine E. Lynn College of Nursing are accredited by the Commission on Collegiate Nursing Education. The College is the only one in the U.S. to have all degree programs endorsed by the American Holistic Nursing Credentialing Corporation.

 

About Florida Atlantic University:
Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University serves more than 30,000 undergraduate and graduate students across six campuses located along the southeast Florida coast. In recent years, the University has doubled its research expenditures and outpaced its peers in student achievement rates. Through the coexistence of access and excellence, FAU embodies an innovative model where traditional achievement gaps vanish. FAU is designated a Hispanic-serving institution, ranked as a top public university by U.S. News & World Report and a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.fau.edu.

 

About Cross Country Healthcare

Cross Country Healthcare, Inc. is a leading tech-enabled workforce solutions and advisory firm with 36 years of industry experience and insight. We solve complex labor-related challenges for customers while providing high-quality outcomes and exceptional patient care. As a multi-year Best of Staffing® award winner, we are committed to an exceptionally high level of service to our clients, our homecare, education, and clinical and non-clinical healthcare professionals. Our locum tenens line of business, Cross Country Locums, has been certified by the National Committee for Quality Assurance (NCQA), the leader in healthcare accreditation, since 2001. We are the first publicly traded staffing firm to obtain The Joint Commission Certification, which we still hold with a Letter of Distinction. Cross Country Healthcare is rated as the top staffing and recruiting employer for women by InHerSights, and Certified™ by Great Place to Work®.

 

For three consecutive years, Cross Country has received the Top Workplaces USA award from Energage and has also been recognized with the Top Workplaces Award for Diversity, Equity & Inclusion Practices and the Top Workplaces Awards for Innovation and Leadership. Cross Country has recently been awarded the Women Executive Leadership Elevate Award, recognizing gender diversity in our Boardroom. We have a history of investing in diversity, equality, and inclusion as a key component of the organization’s overall corporate social responsibility program, closely aligned with its core values to create a better future for its people, communities, and its stockholders.

 

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METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The Future of Nursing: At the Breaking Point

ARTICLE PUBLICATION DATE

11-May-2023