Nurse Leaders report - HealthLeaders Media

INDUSTRY
SURVEY
HEALTHLEADERS MEDIA 2012
Nurse Leaders report
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healthleaders media industry survey 2012 Nurse Leaders report page 2
About This Survey
The HealthLeaders Media Industry Survey 2012 was conducted by the HealthLeaders
Media Intelligence Unit. In October 2011, an online survey was sent to the HealthLeaders
Media Council and select members of the HealthLeaders Media audience.
The study is based on four concurrent surveys: Senior Leaders, Finance Leaders,
Physician Leaders, and Nurse Leaders. In addition, data has been extracted and
reports created based on CEO title, community and rural status, and service lines.
The surveys included some common questions for all respondents and some questions
directed at leaders in specific segments.
A total of 1,070 completed surveys are included in the overall survey analysis. The
margin of error for a sample size of 1,070 is +/- 3.0 percentage points at the 95% confidence
interval. A detailed breakout of completed surveys by report is listed below.
Percentage totals do not always add up to 100% due to rounding.
Report
Number of
Completed
Surveys
Sampling Variance
at the 95%
Confidence Interval
Overall Cross-Sector Report 1,070 +/- 3.0%
Senior Leaders Report 468 +/- 4.5%
Finance Leaders Report 117 +/- 9.1%
Physician Leaders Report 136 +/- 8.4%
Nurse Leaders Report 296 +/- 5.7%
CEO Report 117 +/- 9.1%
Community & Rural Leaders Report 468 +/- 4.5%
Service Lines Report 1,017 +/- 3.1%
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healthleaders media industry survey 2012 Nurse Leaders report page 3
Addressing the
Disrespect Disconnect
Of
Nurse
Leaders
Surveyed
Smooth working relationships among nurses and physicians are
seen as vital to increasing value in healthcare delivery, but there
is a vast divide in the perception of how doctors treat nurses, the
HealthLeaders Media Industry Survey 2012 reveals.
23
percent
Rate their
organization’s nursing
staff as very strong
13
percent
Rate their
organization’s physician
staff as very strong
41
percent
Say nursing staff salary
increases are at least a
year away
49
percent
Say their hospital is
moving toward more
advanced-level nurses
in clinical operations
When asked how pervasive is physician
abuse or disrespect of nurses, there was a
clear disconnect between the two. While
42% of nurse leaders said it was common,
only 13% of physician leaders said it was
common. Likewise, 58% of nurse leaders
said it was uncommon, while 88% of
physician leaders said it was uncommon.
Pam Kadlick, RN, BS, MBA, MSN,
vice president of patient care and chief
nursing officer for 112-staffed-bed Mercy
St. Anne Hospital in Toledo, OH, says she
is surprised at what she cited as a high
level of disrespect reported by the nurse
leaders.
The findings illustrate fundamental
“ineffective communication or having
different expectations” among the two
groups, with physicians sometimes
having a misperception of nurses’ roles,
and nurses in conflict with physicians
over the “misunderstanding of what
needs to be done at a given time,” Kadlick
says. She acknowledges that such
communication problems could manifest
themselves when a physician “cuts off” a
nurse’s suggestion or comment.
“I do believe nurses and physicians are
on two different pages when it comes to
communication,” Kadlick adds. “Time
is a commodity for physicians today.
When they present to do rounds, they
want to have pertinent data given to
them. Nurses have a tendency to give
a very detailed report, more than what
a physician may want to hear; hence,
the physician may interrupt, seem to be
abrupt, even rude at times.”
When confronted as being rude or
disrespectful, a physician often would
be “truly taken aback, as they do not see
it this way,” Kadlick says. Referring to
reports of alleged abuse, Kadlick says she
believes that “while there are validated
incidents of true disrespect for nurses by
physicians, these incidents are minimal.”
As health systems improve care
coordination and increase the roles of
nurse navigators, Kadlick says she expects
the communication between nurses and
doctors to get better.
“I do see it improving on the acute
care level, with care coordinators working
with primary care physicians,” Kadlick
says. “As you add care coordinators
and change the delivery models, you
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healthleaders media industry survey 2012 Nurse Leaders report page 4
will see registered nurses more at the
bedside than tied to the computer, and
the communication will be getting
better. You have more advanced nurse
practitioners popping up in the acute
care settings. We are getting there, but
still moving at a snail’s pace.
“Physicians have acknowledged how
important it is to have that mid-level
provider to help them with their greatest
commodity—time,” Kadlick says.
But as health systems work to improve
value-based care, nurses see themselves
as becoming increasingly important to
coordinate care and should have more
of a stake in care delivery, the survey of
nurse leaders shows. Indeed, nearly one
in 10 respondents say he or she believes
nurses will help save healthcare, though
most (28%) say they see hospitals as
the key to righting the healthcare ship,
followed by the government (13%).
While most healthcare leaders
acknowledge that the industry is in a
mess, not one lays the blame on nurses. Of
the more than 1,000 survey respondents,
most say government is the culprit (40%),
followed by health plans (22%), and even
6% cited physicians.
Nurse leaders are in sync with their
colleagues in blaming the government
for industry woes (37%), followed by
health plans (23%), physicians (8%),
hospitals (5%), vendors (3%), patients
(1%), technology (1%), and nurses (0%).
“I think when they start pointing
fingers at who is to blame, why nurses
aren’t pointed out is because they aren’t
reimbursed by third-party payers,” says
Kadlick. “They aren’t seen as the ones
“Nurses have a tendency to
give a very detailed report,
more than what a physician
may want to hear; hence,
the physician may interrupt,
seem to be abrupt, even rude
at times.”
delaying discharges in acute care settings
or ordering unnecessary diagnostic tests
in the outpatient facilities.”
In an area of disconnect between
nurses and doctors, about 77% of nurse
leaders said in the survey that the quality
of their organization would be positively
affected by increasing the scope of care
for nurses, while only 10% thought it
would worsen. When physician leaders
were asked that question, 48% said it
would improve, while 26% said it would
worsen.
As nurses become more involved in
coordinated care and multidisciplinary
approaches, Kadlick says the impact
of nurses on quality will be more
fully appreciated. “The nurses can do
more—add value to the interaction
with physicians and for patients’ care,”
Kadlick says.
According to the survey, patient
experience and satisfaction is the top
priority among nurse leaders; 72% rank it
among their top three priorities. Next is
clinical quality and safety at 55% and cost
reduction and process improvements at
45%.
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healthleaders media industry survey 2012 Nurse Leaders report page 5
“I think nurses believe they could have
a voice to make things better, although I
think it’s misleading to think they can fix
it,” Kadlick says. “The only true way to do
that is to get all the shareholders together
to put out a model, and everyone has a
voice in planning.”
With the advent of healthcare reform,
it’s a chance for the industry to recognize
the evolving role of nurses, Kadlick says.
“When I see the patients coming
into the acute care setting, and the baby
boomer nurses starting to retire, new
nurses are being recruited,” Kadlick says.
“It’s time to be more proactive for nurses
with patients and providers.
“Nurses as a whole should take
responsibility to be more involved in care
coordination; it’s that opportunity for us
today,” Kadlick adds.
—Joe Cantlupe
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healthleaders media industry survey 2012 Nurse Leaders report page 6
1. Overall, how do you assess the current state
of the healthcare industry?
Right track
2. Overall, how do you assess the current state of
your own organization?
Undecided
Undecided
31%
22%
24%
Wrong track
47%
Wrong track
Right track
17%
59%
Base: 296
Base: 296
3. Rank your organization’s top three priorities for the next three years.
1st Rank choice 2nd Rank choice 3rd Rank choice Combined Top 3 Rank
Patient experience and satisfaction 39% 21% 12% 72% 1
Clinical quality, safety 25% 17% 14% 55% 2
Cost reduction, process improvement 10% 16% 19% 45% 3
Payment reform, reimbursement (VBP, accountable care) 8% 16% 14% 38% 4
Technology (IT, EMR, clinical technology) 5% 12% 9% 26% 5
Physician-hospital alignment 5% 6% 9% 20% 6
Leadership, organizational development 1% 3% 7% 11% 7
Revenue cycle 2% 3% 2% 7% 8
Strategic marketing 2% 2% 4% 7% 9
Regulatory issues (PPACA, ICD-10, HIPAA, HITECH, Stark, Antitrust, etc.) 1% 2% 4% 7% 10
Service lines 1% 2% 3% 6% 11
Capital (access, planning, projects, M&A, philanthropy) 1% 1% 3% 5% 12
Base: 296
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healthleaders media industry survey 2012 Nurse Leaders report page 7
4. Will your organization be part of an accountable care
organization within the next three to five years?
5. Which ACO model will you be a part of?
100
Yes
52%
75
59%
No
48%
Base: 296
50
25
0
Medicare
Shared Savings
program
13%
CMS
Pioneer
5%
Commercial
23%
Other
Base: 154
(Among organizations that will be part of an ACO
within the next three to five years.)
6. Regarding clinical quality improvement, which of the
following areas represents the single greatest strategic
challenge for your organization?
Improving patient experience,
including patient flow
Care coodiantion,
continuum of care
Reducing avoidable
readmissions, complications
Hiring quality staff
Performance metrics
Care episode payment bunding
Medication reconciliation
Medical home
Transparency of quality data
Infection control
9%
9%
5%
5%
3%
3%
2%
24%
21%
19%
0 25 50 75 100
Base: 296
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healthleaders media industry survey 2012 Nurse Leaders report page 8
7. Rank your organization’s top three drivers of healthcare costs.
1st Rank choice 2nd Rank choice 3rd Rank choice Combined Top 3 Rank
Government laws and mandates 27% 18% 15% 59% 1
Labor costs 28% 12% 15% 55% 2
Information technology 12% 17% 10% 40% 3
Clinical technology 8% 13% 11% 32% 4
Overutilization of services 5% 9% 10% 24% 5
Physician inefficiency 4% 7% 8% 19% 6
Patient lack of responsibility 5% 5% 7% 17% 7
Health plan overhead 3% 6% 6% 15% 8
Supply chain variation, including medical devices 4% 4% 6% 14% 9
Pharmaceuticals 2% 5% 5% 13% 10
Malpractice insurance, litigation 1% 1% 4% 7% 11
Hospital errors 1% 2% 2% 5% 12
Base: 296
8. How would you rate the current quality/status of these aspects of your organization?
Very strong Strong Neutral Weak Very weak
Dedication to mission 43% 39% 13% 5% 1%
Patient safety 25% 53% 16% 4% 1%
Fiscal management 24% 48% 21% 6% 0%
Medical quality 23% 52% 17% 8% 0%
Nursing staff 23% 48% 20% 9% 1%
Prospects for growth 21% 41% 28% 9% 0%
Strategic planning 18% 43% 25% 13% 2%
Patient experience 17% 48% 25% 9% 1%
Construction/capital improvements 15% 40% 28% 13% 5%
Process improvement 14% 53% 18% 14% 2%
Physician staff 13% 42% 31% 12% 2%
Care coordination 11% 46% 22% 20% 2%
Physician recruitment and retention 10% 36% 34% 17% 2%
Dealing with uncompensated care 8% 30% 39% 22% 1%
Reducing variability 6% 30% 43% 20% 2%
Base: 296
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healthleaders media industry survey 2012 Nurse Leaders report page 9
9. Describe your overall job satisfaction.
10. Why can’t the healthcare industry solve its own
problems?
100
Too much self-interest among
the different stakeholders
66%
75
50
51%
Lack of incentive to innovate
or deliver value
Industry has become too
big to manage
9%
8%
25
0
26%
Very
Satisfied
10% 10%
3%
Satisfied Neutral Dissatisfied Very
dissatisfied
Still a cottage industry with
no central core leadership
Industry will find a solution
with more time
Other
5%
4%
8%
0 25 50 75 100
Base: 296
Base: 296
11. Who’s most to blame for the healthcare
industry mess?
The government
Health plans
Physicians
Hospitals
Vendors
Patients
Technology
Nurses
Other
8%
5%
3%
1%
1%
0%
37%
23%
22%
0 25 50 75 100
12. Who’s going to save the healthcare industry?
Hospitals
The government
Nurses
Patients
Technology
Health Plans
13%
9%
9%
8%
5%
1%
0%
28%
Physicians
Vendors
Other 27%
0 25 50 75 100
Base: 296
Base: 296
13. Is your organization cutting back on high-level,
high-price technology for any service lines?
Yes
23%
No
77%
Base: 296
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healthleaders media industry survey 2012 Nurse Leaders report page 10
14. Please rate the following service lines for revenue growth potential within your organization in the next three to five years.
Grow 6% or
more
Grow 1%–5% Remain flat Decline 1%–5%
Decline 6% or
more
NA
Geriatrics 25% 40% 20% 2% 1% 12%
Emergency medicine 22% 43% 16% 1% 1% 17%
Hospitalists 20% 40% 18% 2% 0% 20%
Orthopedics 19% 39% 21% 4% 0% 17%
Cancer/oncology 18% 40% 14% 3% 0% 24%
Heart (cardiology, cardiovascular, pulmonary
medicine, vascular surgery)
18% 38% 20% 3% 1% 21%
General surgery 15% 42% 24% 2% 1% 17%
Imaging/radiology 14% 49% 21% 4% 1% 12%
Primary care 14% 41% 27% 4% 1% 13%
Women's health, OB/GYN 13% 41% 23% 3% 1% 19%
Pain management 13% 39% 32% 2% 0% 14%
Wellness 12% 39% 25% 4% 1% 19%
Physical medicine and rehabilitation 11% 40% 31% 3% 1% 14%
Intensive care 11% 36% 29% 3% 0% 20%
Spine 8% 27% 27% 3% 1% 33%
Neurosurgery 8% 23% 24% 3% 0% 42%
Sports medicine 7% 26% 27% 2% 1% 38%
Psychiatry 6% 24% 30% 6% 2% 32%
Pediatrics 3% 19% 36% 9% 4% 28%
Sleep 2% 23% 39% 7% 1% 28%
Transplant center 2% 10% 16% 2% 1% 68%
Base: 296
15. How would your organization be affected by increasing the scope of care for nurses?
Quality of care
Reimbursement
100
100
75
77%
75
50
50
53%
25
10%
13%
25
19%
27%
0
Improve Worsen Stay the same
0
Improve Worsen Stay the same
Base: 296
Base: 296
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healthleaders media industry survey 2012 Nurse Leaders report page 11
16. How pervasive is physician abuse or disrespect of
nurses at your organization?
17. When was the last time nursing staff received
salary increases?
100
88%
100
75
50
42%
58%
75
50
61%
25
13%
25
20% 18%
0
Common
Uncommon
0
Within the
past year
More than one
year ago
More than two
years ago
According to Nurses
Base: 296
Base: 296
According to Physicians
Base: 136
18. When do you expect nursing staff will next receive
salary increases?
100
75
50
25
0
22%
Within
six months
37%
Within one year
41%
At least a
year away
Base: 296
19. Which best describes your organization’s budget for
nurse staff training and professional development for
the coming year?
100
75
50
25
0
19%
25%
56%
Will increase Will decrease Will stay about
the same
Base: 296
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healthleaders media industry survey 2012 Nurse Leaders report page 12
20. Will you focus on nurse retention in the next
12 months?
100
21. What is your organization’s status regarding ANCC
Magnet Recognition Program® designation?
100
75
69%
75
50
25
0
Yes, we need to
work to ensure the
nursing workforce
is retained and
committed
26%
No, we would like
to, but do not have
the funds to do so
6%
No, the economy
is too bad for nurses
to look for new jobs
Base: 296
50
25
0
14%
Already
designated
4%
Application
process under
way; hope to
receive designation
within
a year
10%
Application
process
under way;
hope to be
designated
within five years
25%
Plan to apply
in next two
years
47%
No plans
to apply;
see no
value
Base: 296
22. What is the primary reason for your interest in applying
for ANCC Magnet Recognition Program® designation?
23. Is your hospital moving toward more advanced-level
nurses in clinical operations?
It is a priority for senior
leadership to demonstrate
quality care and patient
outcomes
It is a priority for senior
leadership to stay
competitive in our local
market
24%
61%
Yes
No
51%
49%
It is a grassroots process
driven by our nursing staff
15%
0 25 50 75 100
Base: 296
Base: 156
24. Does your organization track and respond to the
reasons that nurses leave your organization?
25. Which of the following best describes your place
of employment?
Hospital
66%
No
Yes
33%
67%
Base: 296
Health System
(IDN/IDS)
Long-term
care/SNF
Physician Org (MSO,
IPA, PHO, Clinic)
Ancillary, Allied Provider (Home
Health, Lab, Rehab Post-Acute)
Health Plan/Insurer
(HMO/PHO, MCO/PBM)
Government, Education/
Academic
15%
8%
4%
4%
2%
2%
0 25 50 75 100
Base: 296
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healthleaders media industry survey 2012 Nurse Leaders report page 13
26. Which best classifies your place of employment by
the number of beds?
100
27. Which best classifies your place of employment by
the number of sites within your organization?
100
75
75
50
25
0
36% 36%
14%
12%
2%
1–50 51–199 200–499 500–999 1,000+
50
25
0
42%
30%
19%
9%
1–5 6–20 21–49 50+
Base: 196
(Among hospitals)
Base: 43
(Among health systems)
28. Is your healthcare organization in a rural area?
29. Is your hospital a community hospital?
Yes
42%
No
24%
No
58%
Yes
76%
Base: 296
Base: 196
(Among hospitals)
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healthleaders media industry survey 2012 Nurse Leaders report page 14
30. What best describes your primary market area?
WEST MIDWEST NORTHEAST
Pacific Mountain West North Central East North Central
13%
3%
11% 15%
Middle New
Atlantic England
15% 7%
WA
NH
ME
OR
CA
AK
NV
ID
AZ
UT
MT
WY
CO
NM
ND
MN
SD
NE
KS
IA
MO
OK
AR
TX LA
VT
WI
MI
NY
PA
IL IN
OH
MS AL GA
KY
WV VA
TN
NC
SC
NJ
DE
MD
MA
RI
CT
FL
HI
National
1%
Other
2%
West South Central East South Central South Atlantic
10% 18%
6%
SOUTH
Base: 296
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healthleaders media industry survey 2012 Nurse Leaders report page 15
31. Which best describes your type of organization?
For profit
32. Please indicate your age range.
100
25%
75
50
49%
34%
Non-profit
75%
Base: 296
25
0
3%
35 or
younger
13%
1%
36–45 46–55 56–65 66 or older
Base: 296
33. What is your gender?
Male
13%
Female
88%
Base: 296
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