Address nursing shortage before it's too late
By Suzanne Gordon and Steve Early, 8/29/2001
HE 13-week strike at Brockton Hospital by members of the Massachusetts Nurses Association may have ended happily for 450 nurses and their patients. After the intervention of state legislators, local officials, and US Senators Edward M. Kennedy and John F. Kerry, an agreement was reached with management that gives registered nurses at Brockton more adequate staffing and new protection against mandatory overtime.
Unfortunately, the gains made in this settlement, along with those won after a 45-day strike at St. Vincent Hospital in Worcester last year and in several other contracts, will lead to better working conditions for only a minority of Massachusetts nurses. Thus it will not end the ongoing work stoppage here and elsewhere by tens of thousands of RNs who have responded to understaffing, forced overtime, and unsafe patient loads by leaving the profession. Their mass exodus has produced a nationwide nursing shortage of crisis proportions.
According to the American Hospital Association, there are more than 126,000 vacancies for RN positions around the country. About 80 percent of all hospitals are reporting RN shortages. Because of our aging population, demand for nursing services is increasing at a steady rate, but nursing school enrollments in baccalaureate programs are down for the sixth straight year.
Some studies predict a shortage of one million nurses by 2010 - a 20 percent shortfall in demand just as baby boomers start to make their dramatic entry into the market for elder care services.
Unlike other hospital personnel shortages - involving pharmacists, radiology, and lab techs, for example - the current RN shortage is not a cyclical phenomenon related to the until-recently-strong economy and the existence of other job opportunities. According to a new report by Fitch IBCA, Duff & Philips, a corporate credit rating firm, registered nurses are abandoning the field because of fundamental dissatisfaction with working conditions.
They are leaving behind a work force that is both aging - only 31 percent of nurses today are under 40 - and often demoralized. Indeed, RNs themselves are now discouraging friends and relatives from going into the field, warning nursing students that they have made the wrong career choice, and advising recent graduates to escape bedside care as quickly as possible.
As Fitch informs its client hospitals, any long-term solutions to the shortage problem must focus on changing the fundamental nature of the job and improving retention of current employees.
Wooing RNs back to bedside roles, plus providing incentives for young men and women to enter nursing in the first place, will cost money for more staff, improved salaries, nursing school scholarships, and expansion. Real, as opposed to cosmetic, workplace change also requires giving nurses a much greater say in how care is delivered. They must be able to negotiate how many hours they work, how many patients they care for, how much care those patients receive, and how much continuing education they will need to cope with ever-changing technology and treatments.
New schedules and day-care facilities must be developed that will enable members of a still predominantly female profession to juggle their work and family obligations more easily. Veteran nurses, who need relief from the burdens of bedside care, must be able to make a transition into less physically demanding assignments as they get older so they can continue to mentor younger colleagues.
To extend the scope of union-negotiated protections, key improvements will have to be legislated through limits on mandatory overtime, minimum nurse-to-patient ratios, and restrictions on the now common and potentially dangerous hospital practice of floating RNs from one unit to another, regardless of their training or job background.
Opposition to such measures among health care managers is fierce, as demonstrated in Brockton. That's why dedicated caregivers - those who have chosen to fight intolerable conditions rather than flee them - have been forced to wage recent strikes at hospitals and nursing homes around the country.
Their courage and sacrifice has done more than a ream of academic studies to dramatize the causes and consequences of the nursing shortage.
Nurses are calling on the public to support their struggle because they know that we are all patients at some point in our lives, with a big stake in securing nursing care on the scale needed in the years ahead.
If we all wait until we are old, ill, or otherwise incapacitated in a health care facility without enough RNs, it will be too late to do much about the nursing shortage except keep pushing the buzzer next to the bed.
Suzanne Gordon is the author of ''Life Support: Three Nurses on the Front Lines.'' She will be a guest speaker at the Michigan Nurses Association's annual convention in October 2001. Steve Early works for the Communications Workers of America union.