Nursing Jobs & Education Shortage Continuing

The United States Department of Labor’s Bureau of Labor Statistics has released its 2010-11 outlook for the nursing profession. The department notes that registered nurses (RNs) constitute the largest healthcare occupation with a total of 2.6 million jobs in 2008. Approximately 60% of all nurses work in hospitals. Another 8% of jobs were in physician offices, 5% in home healthcare, 5% in nursing care facilities, and 3% in employment services. Job opportunities are rated as excellent regarding growth in the demand for nurses in the healthcare industry. Many employers are reporting shortfalls of nursing staff and are having difficulties attracting nurses to their facilities.

Median wages for RNs were approximately $62,500 in 2008. The highest 10% of nurses earned an average of approximately $92,500. Nursing remains attractive because many employers offer flexible work schedules, child care, educational benefits, and bonus programs. 21% of nurses are union members. Looking to the future, an increase in educational opportunities for students to train in the nursing profession is essential to meet upcoming demand. Lack of available space for qualified applicants at nursing schools persists and is fueling an increasing shortage of filled nursing positions.

The numbers are staggering. In 2008 there were 2,618,700 nurses in the US. It is projected that there will be a need for 3,200,200 by 2018. That's a creation of 581,500 new nursing positions, a 22% increase. However, the rate of employment growth is not projected to be even across all nursing healthcare settings. Growth of nursing jobs in hospitals is expected to grow only 17% while growth in physician’s offices will grow at a 48% rate. This is attributed to the slow growth of inpatients (patients remaining in the hospital over 24 hours), earlier discharges, and an increase in outpatient procedures. Home healthcare services will grow at a rate of 33%, nursing care facilities at a 25% rate, and RN jobs in employment services at a 24% rate. An aging population combined with financial pressures on hospitals to release patients earlier will drive the growth rate of residential care facilities and home healthcare. A spike in job growth is anticipated for nurses providing care for the long-term rehabilitation of stroke and head injury patients and also patients suffering from Alzheimer’s disease.

Nursing education is continuing to run into difficulties. A continuing increase in nursing education applicants has caused many nursing schools to reject qualified applicants due to a shortage of nursing faculty. An increase in availability in nursing schools and nursing continuing education programs could help meet the growing demand. Hospitals will also face difficulties in attracting nurses to their facilities. Although the growth in new nursing jobs at hospitals is expected to be only 17%, the high turnover rate of existing jobs will drive shortages. The largest shortages are expected in rural areas and inner city regions. An especially high demand is expected for advanced practice specialties in nursing: clinical nurse specialists, nurse practitioners, nurse-midwives, and nurse anesthetists. In many areas, nurses will represent a substantial percentage of primary care providers to the public.

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FDA Suspends Vaccines Contaminated with Virus

The FDA recommends suspending the use of Rotarix vaccine which is manufactured by the pharmaceutical company GlaxoSmithKline. A US research team has detected viral contamination of the vaccine. This prompted the FDA warning to suspend usage of Rotarix in the USA until further notice. Rotarix is an oral vaccine given to infants to prevent rotavirus disease. Rotavirus can cause diarrhea and dehydration and is responsible for over 500,000 infant deaths annually worldwide. Countries with low incomes have the highest mortality rate. It is estimated that prior to rotavirus vaccination programs, over 50,000 hospitalizations occurred annually in the USA due to this disease. The FDA reports that dozens of deaths occurred in the USA annually prior to initiation of vaccination programs.

The FDA notes that there is no evidence of a safety concern from the contaminated Rotarix vaccine. The suspension of its use is viewed as a preventative measure. The FDA will conduct research into the viral contamination issue to determine whether the PCV1 contaminant is an intact virus or merely DNA fragments. Additional recommendations concerning the vaccine will be made in about one to two months when the FDA is convening an expert panel to look into this issue. The FDA will report this information to patients, doctors, nurses, and the World Health Organization (WHO) as information surfaces.

The Director of the Centers for Disease Control and Prevention speculates that many countries will continue to use the Rotarix vaccine until further information becomes available. Citing dangers of rotavirus, the director anticipates that the vaccine warning will be weighed against the threat of the disease. In balance, he feels that many countries will risk the potential dangers of the vaccine to prevent rotavirus outbreaks. RotaTeq vaccine, manufactured by Merk pharmaceuticals, is not affected by this FDA warning. RotaTeq is also used to prevent rotavirus and no viral contamination has been discovered in this product.

Obama's Health Insurance Covers California Children & COBRA

A recent study at the University of California, Los Angeles, reveals that 8.2 million Californians are without health insurance. This is a 28% increase from the 6.4 million uninsured Californians in 2007. The UCLA Center for Health Policy Research study notes that approximately 2 million Californians lost health insurance coverage from 2008 to 2009 bringing the total to over 8 million uninsured. Currently, 25% of all California residents do not have health insurance. The study cites rising unemployment rates and health insurance premium increases as major contributing factors to this problem. The study was funded by the California Endowment and The California Wellness Foundation. The California Endowment is a private organization dedicated to improving health care coverage and health benefits. The California Wellness Foundation helps California citizens by providing grants for healthcare, health education, and disease prevention.

The federal government eased the strain on recently unemployed workers by providing subsidies for health insurance coverage under COBRA through the American Recovery and Reinvestment Act of 2009 (ARRA). ARRA was signed into law by President Obama. This helps to maintain health insurance coverage for large numbers of unemployed workers. COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) is a law passed by the US Congress and signed by President Reagan. The law mandates that insurance companies give employees the option to continue health insurance coverage after leaving or losing employment. Despite the infusion of federal assistance through the ARRA, many cannot afford the COBRA health insurance premiums and lose their health insurance anyway. However, the UCLA study concluded the utilization of COBRA by laid-off employees doubled with the addition of the federal ARRA assistance. The federal subsidy to COBRA health insurance coverage made continuing health insurance coverage possible for large numbers of people.

1.1 million children in California did not have health insurance in 2007 rising to 1.5 million children in 2009. The study noted that public coverage expanded to assist children thereby keeping the rate of uninsured children relatively low in comparison to adults. The Medi-Cal and Healthy Families programs provide what the study describes as a “substantial safety net” for children. Approximately one out of every three children in California receive their healthcare benefits through the Healthy Families or Medi-Cal programs. Due to lack of funds, the Healthy families program was forced to freeze enrollment. Governor Schwarzenegger is pushing for the elimination of the Healthy Families program and reducing Medi-Cal benefits to the minimum amount required by federal law. The UCLA study notes that “an immediate increase in federal support for the state’s Medi-Cal and Healthy Families programs would stabilize the health care safety net. In addition, national health care reform could help stabilize health insurance markets in the state and provide more, and more stable, opportunities for Californians to obtain affordable health insurance coverage.”

The American Recovery and Reinvestment Act of 2009 (ARRA), also known as “the Stimulus”, was passed into law by President Barack Obama on February 17, 2009 and provides the federal government with the means to increase federal health insurance subsidies to Californians. The Stimulus cut federal taxes and expands unemployment benefits, education spending, healthcare benefits, energy sector investments, and infrastructure development. The ARRA stimulus is intended to create jobs and promote investment during the current economic recession. This is Keynesian economics which argues that government spending can compensate for a drop in consumer spending during economic downturns. No Republicans in the US House of Representatives voted for the bill. Three Republican Senators voted for the ARRA. Although the bulk of the ARRA focuses on stabilizing and promoting economic development, it also includes limitations on executive compensation in banks receiving federal assistance. The ARRA provides tax cuts and expands healthcare spending. Medicaid received over $85 billion and COBRA received nearly $25 billion. ARRA expands medical care for the military and their families, funds prevention and wellness programs, contributes to the Veterans Health Administration, funds healthcare services on Indian reservations, promotes health related research at the NIH (National Institutes of Health), expands payments for Community Health Centers, and funds the development of health information technology.

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FDA & GAO Agree on Nanotechnology in Food Supply

In a report by the GAO (Government Accountability Office), the FDA allows spices, artifical flavors, vitamins, minerals, preservatives, trans fats in partially hydrogenated oils, and nanomaterials into the U.S. food supply without review or inspection. These substances and many other substances are categorized as GRAS (Generally Recognized As Safe). The GRAS category allows companies to add substances, including newly developed chemicals, into foods without the FDA’s approval or knowledge. Companies are not required to identify nanomaterials and other GRAS substances added to food products such that neither the consumer nor the FDA knows what ingredients are contained within foods.The GAO urges the FDA (Food and Drug Administration) to strengthen its oversight of the U.S. food supply.

Companies may add engineered nanomaterials (materials manipulated at the molecular level) and other GRAS substances into foods without notifying the FDA. Companies may make their own determination of whether or not a food is GRAS and are not required to tell the FDA if the substance exists or how the GRAS determination was made. The GAO notes that substances previously categorized as GRAS have been banned due to health hazards. The GAO report states, “FDA does not know to what extent, or even whether, companies track evolving scientific information about their GRAS substances. FDA's approach to regulating nanotechnology allows engineered nanomaterials to enter the food supply as GRAS substances without FDA's knowledge.” The GAO report also notes that all foods containing engineered nanomaterials are regulated in many countries including Canada and the European Union but not in the U.S. .

Sodium cyclamate, an artificial sweetener, was a GRAS substance banned by the FDA. Sodium cyclamate was discovered by a graduate student at the University of Illinois when he was working on the synthesis of an anti-fever drug. The student’s cigarette came into contact with the cyclamate when he placed it on the lab bench. When he resumed smoking, the graduate student discovered that the cyclamate had a sweet taste from the flavor it imparted to his cigarette. Research connecting sodium cyclamate to cancer and testicular atrophy caused the FDA to pull sodium cyclamate from the market. Although the FDA took action against sodium cyclamate, the GAO asserts that the FDA is unresponsive to most concerns from individuals and consumer groups concerning GRAS substances in the U.S. food supply. In 11 citizen petitions submitted to the FDA between 2004 and 2008, the FDA came to a decision on only one of these investigative complaints.

The GAO recommends that the FDA develop a strategy to identify GRAS ingredients in foods and how companies determine GRAS status for their foods. The GAO also recommends that the FDA develop a strategy for reconsidering GRAS ingredients already present in the food supply and to develop an approach for handling engineered nanomaterials. The FDA agrees with the GAO findings and notes that they are beginning an internal deliberation regarding GRAS substances.