Roberta Adams writes bi-weekly column for healthleaders.com. Here is another column offering solutions.
Problem solving: The Nursing Process
By Roberta B. Abrams, RNC, MA, LCCE, for HealthLeaders.com, May 29, 2001 http://www.healthleaders.com/news/fe...ontentid=20068
The daily newspapers, weekly news magazines, and professional journals all regularly provide testimony to the shortages of healthcare providers. Nurses, pharmacists, physicians, rehabilitation therapists - the ranks of providers are dwindling.
At the same time, the population, here and around the world, is aging. The ability to maintain life, for all parts of the age spectrum, continues to increase. In the coming decade, the number and percent of people aged 65 or older is projected to surge, with a concomitant decrease in the caregiver population, ages 18 to 64. A recent study published by the University of Illinois College of Nursing tells us that: "the ratio of potential caregivers to the people most likely to need care decreases by approximately 40% between 2010 and 2030."
We have a current crisis in healthcare. That crisis will not spontaneously disappear. Portents for the future of healthcare are grave. The good news is that there are a growing number of people who are aware of the problem and sense the burgeoning need for action. Let's look at some of those proffered solutions from A Nurse's Viewpoint.
It is interesting to me to explore the responses our state and federal legislatures have made to the problem. They're into the timeworn - and not very effective - actions of the past: Throw money at it. There are bills in many states, and in Congress, to increase enrollment in schools of nursing by providing scholarships and other financial aids. Interesting but not in and of itself effective. The ranks of applicants to schools of nursing have dropped precipitously. Women, who comprise 92% of the nursing workforce, have experienced a vast increase in their career options. Today's high school graduates pursue degrees in medicine, engineering, business, electronics and a host of other professions that they perceive to be more rewarding, more stimulating, and less demanding than nursing.
Further complicating the situation is the realization that, just as there are severe shortages in all other aspects of nursing, there is a growing shortage of nursing faculty. Nursing education is a stimulating occupation. Its rewards are many - none of them financial. Today's nursing faculty, as with all other nurses, is aging. Many of them will have retired before the full impact of the shortage hits in 2010. Recruitment and retention of qualified, experienced faculty is another part of the solution to the nursing crisis.
Another legislative initiative deals with facilitating the importation of nurses from other countries. Again, an interesting reaction, with some short-term benefits, but not usually considered a long-term solution. There are language barriers, custom barriers, and disparities in practice to overcome. If we bring in a significant number of nurses from other lands, what happens to their families? What happens to care in their countries? Is this reasonable? Is it ethical? Is it practical? We have done this for years on a limited scale. We know the problems. The solutions are not as well detailed. Our assessment of the current nursing crisis has many facets. They can be summarized as follows:
*Technology has improved our abilities to treat patients and prolong life.
*Our population is aging; in 2010 the baby boomers will have achieved their seniority.
The elderly have increased needs for healthcare.
*The population available to become healthcare providers is shrinking.
The part of the population that usually becomes nurses has other choices, which they currently perceive to be more attractive.
*There is a direct corollary between professional nurse staffing and patient outcomes.
*There is, therefore, a need to change nursing's image, professional attributes, and working conditions to attract and retain a population of nurses sufficient for the healthcare of the nation.
Plans to ameliorate the current and projected crisis in nursing cannot depend on nursing alone. The current crisis in nursing was produced by disparate elements of the society in which we live. The solution must also be vested in that society. Solving the crisis in nursing requires a multi-faceted, multi-disciplined approach. It will be a risk-taking venture which requires the support of educators, policy makers, providers, insurers, and technological experts. The system of providing healthcare must change.
The solution begins with the youth of society. We need to create a bond between elementary and middle school teachers and experienced nurses. We need to help those teachers develop a real understanding of, and appreciation for, nursing. As a high school student, I remember several of my teachers who indicated, beyond any possibility of misunderstanding, that they believed my interest in nursing would not make full use of either my intellect or my abilities. That was, and is, not an isolated occurrence. If educators deprecate nursing, how can we attract the caliber of candidate that we so desperately need?
We need to interest young students in healthcare careers. We need to revive (and revise) the Future Nurses Clubs - transform them into health career clubs, and involve our youth in the many forms of careers that healthcare offers. We need to teach the three "C's" - communication, collaboration, cooperation - before they begin their formal healthcare education. We need to expose them to mentors who will encourage and nourish their career aspirations so they enter that part of their education with a clear idea of where they are going and a realistic appreciation of what they will do.
We need to revisit nursing curricula to ensure that we include all that is necessary to begin clinical practice. The focus needs to be on the biopsychosocial mode of provision of healthcare, including care throughout the spectrum from wellness to death. We probably each can find things in the existing curricula that are not really cogent (I'm thinking about the course in physics that I was compelled to take). We need to ensure that the faculty who teach these courses are fully prepared for what they do and are not only skilled in the subject matter, but also in the principles and practices of nursing education.
We need to improve working conditions in healthcare facilities. We need to create a more professional and appropriate work environment not just for the nurses, but for all providers of patient care. We must increase salaries and benefits to recruit and retain the highest possible caliber of providers. We must so structure the governance of the healthcare facility that we empower the providers to do those things that are in the best interests of patient care.
We must also seek to attract a more diverse work force into nursing. Our predecessors thought of nursing as "women's work." It is - and it is also the work of men, of first careers, second careers, and so forth. We need to open our doors to all who have the intellect, the will, the commitment, and the compassion to provide care for those who are in need of care.
We should regularly review practice patterns to ensure their cogency and focus on optimal possible outcomes for care. We should consistently research technological phenomena to ensure that we are practicing in a cost effective and quality dedicated environment.
What about the cost?
Somewhere out there, one or two administrative managers are shaking their heads. "What is she talking about? Does she know the costs involved in these endeavors?" I think I do. I also am aware of the current costs of nursing turnover, of unplanned patient readmissions, of litigation, of closing beds because of staff shortages, of hiring "travelers" or agency nurses to fill holes, and of mandatory overtime. Those items not only have a fiscal load, but an emotional burden as well. If we are to retain nurses and other caregivers, if we are to entice new individuals to careers in healthcare, we must change the practice environment. It needs to become health promoting - both for patient and caregiver.
While we are recreating the care environment, let us focus on relationships involving the caregivers. Collaborative practice was just emerging from its infancy in the last decade when it was offered up on the alter of expediency. There was no time for the involved meetings. There were no funds to support the efforts involved. Collaborative practice, clinical ladders, continuing professional education, and shared governance were allowed to deteriorate into meaningless phrases. They need to be made whole, need to be made real - need to support the new environment for healthcare.
So, we have the beginnings of a plan. The elements must be carefully thought through, and put forth with due diligence. Education, practice, research: the pyramid for patient care must be rebuilt - and it needs to begin now.