DEAN PROMISES FAST ACTION TO AVERT A NURSING SHORTAGE
Governor Howard Dean today proposed a five-point plan to address the current and impending nursing shortage, warning that a failure to address this crisis threatens the quality and availability of health care for years to come.
"According to a recent government report, the nursing shortage will grow from 6% in 2000 to 12% in 2010, resulting in a shortage of approximately one million nurses. * This drastic shortage comes at a time that we need nurses more than ever. This is a problem that this country can't afford to ignore - for the sake of patients and families, our health system, and nurses themselves." Dean said.
"Why do people want to become nurses?" Dean asked. "Most nurses will tell you that it's because they want to help people. Why do they leave the profession? Most nurses will tell you that it's because they can't give patients the care that they know they need. In fact, their jobs and their work conditions often stand in the way of good care. What nurses want are the things that make good patient care possible and a career in which the value of nursing is understood, supported, and fairly compensated. Imagine choosing a career because you want to care for others, making personal sacrifices and going into debt to get your education only to discover that you may be driven out of your profession long before your loans are even paid off."
"Our nursing shortage is partly a problem of "aging" - not enough young people coming into the profession. The average nurse today is about 44 years old**. But that's far from the whole story - the average nurse is also planning to leave her current job within a year, and hopes to retire within about 10 years," Dean said. "We have the perfect equation for disaster - we aren't getting enough young people - and too many of those at the height of their competence are leaving. At another level, we do not have nearly enough minorities or men in the profession."
"The symptoms are already with us. Many American hospitals have nurse staff vacancy rates in double digits - some over 20%. As the burden on nurses has increased, their health and safety on the job have become threatened. The stress and strain of large patient loads and low staffing take a toll with one result being injury rates higher than those in many heavy industries."
"Nursing is the heart of a health care system," says Dean. "If you doubt that, ask a doctor. And if any doctor doubts that, ask a patient. Day in, day out, when we are sick, scared, and in the greatest need of support, care, and technically competent help, nurses are the true helpers there, on the front line, relieving suffering and assuring safety. We know from hard research that when nurse staff ratios decrease, so does patient safety. The same happens when nurses are forced to work long beyond normal shift hours."
"The needs for care are only going to get greater. What are we going to do when the baby boomers get old and sick? What about the many vulnerable people in our society - the elderly, minority populations, children? Who's going to care for them in hospitals, nursing homes, schools, and at home? As we all know, public health threats are increasing, as well. Nurses have been the foundation for the public health system in our communities."
"How do we solve this problem?" Dean asked. "Ask a nurse. I have. And that's how I developed my plan to address the nursing shortage, which will restore new health, vitality, safety, and vigor to the nursing profession:
Governor Dean's Plan to Address the Nursing Shortage
1. Ban "mandatory overtime"
Being a nurse is tough enough work without being forced to work two 8 hours shifts in one 24-hour day. Of course, such a ban would have exceptions for cases of national or local emergency, but there's no doubt that nurses would be among the first to volunteer to work overtime in a time of crisis.
2. Improve Working Conditions and Compensation for Nurses
First, make it easier, safer, and more rewarding for nurses to care for their patients. Hold hospitals and other health care institutions accountable by setting federal minimum staffing ratios that ensure a safe number of nurses to each patient. Nurses need enough time with their patients, and adequate staffing will improve patient outcomes, improve patient satisfaction, reduce medical errors and bring nurses back to the profession
Second, provide separate Medicare reimbursement for their services. Medicare does not currently recognize the economic value of nurses, and there is no way to be sure that Medicare reimbursements to hospitals ever go to support nursing services. When Medicare starts to recognize and reimburse fairly for nursing services, private insurance companies and hospitals will too.
Third, improve workplace safety. Nurses face great physical risk, including threats of violence in emergency rooms, contagious bacteria, and lifting heavy patients from bed to chair. They need to know that their workplaces are as safe as they can be. Governor Dean will work for federal legislation to ensure nurses' workplace safety.
3. Open the Door to Nursing
The shortage of nurses won't be solved solely by addressing the problems facing our current nursing workforce. We also need to remove the barriers stopping young people from entering the profession. This means helping young people see their futures in the profession, preparing them to become professional nurses, and making sure that they can afford the education that they need.
First, recruit minorities - and men - to the nursing profession
Diversity is good for the profession, for the health care system, and for patients. And outreach to nontraditional communities will increase the number of people entering the nursing workforce.
Second, offer nurses flexible scheduling and part-time work
Almost 500,000 licensed registered nurses were not employed as nurses in 2000.* Flexible and part-time schedules might draw some back to work in the profession, and attract new, young people seeking a rewarding profession where they can successfully juggle work and family responsibilities.
Third, improve education opportunities for nurses
Governor Dean's higher education program will include special assistance for students who decide to enter nursing as a career so that no one who wishes to be a nurse will be burdened by unmanageable debt.
Governor Dean will increase support for the Federal Division of Nursing in the Department of Health and Human Services and funding through the Nurse Reinvestment Act. This program aims to improve and expand access to education - providing more well-prepared faculty, enhanced programs, and reduced barriers to education. The governor's reform agenda includes funding for scholarships and loans, preparing faculty, enhancing educational technology, and expanding pathway programs for minority and disadvantaged students.
4. Give Nurses the Help They Need To Do Their Jobs
Somewhere between 25 to 50 percent of nurses' time is spent on non-nursing work. We need to let nurses care for patients and let other personnel support them in their work. This means preventing federal health programs from allowing unlicensed or unqualified personnel to do the work of registered nurses (RNs) or licensed practical nurses (LPNs). There is a place in our health care system for many different types of health care personnel, but we shouldn't try to save money by giving nursing duties to less well qualified workers - or by using precious nursing time doing things that others can do. It won't be long before serious mistakes are made, and patients will pay the price.
We also need to reduce the paperwork burden on nurses, and Governor Dean will support legislation to simplify paperwork and reduce duplication. Federal regulations are complex enough without having to do everything twice.
5. Expand the Role of and Compensation for Independent Nurse Practitioners
All federal health programs should allow independent nurse practitioners and other advanced practice nurses to provide the health care they are educated and licensed to provide. These nurses shouldn't require the direct supervision of a physician, and need to be provided with fair compensation. Governor Dean believes that, as an internist, the majority of people he saw on a first visit could have received excellent care from a competent nurse practitioner, without his direct supervision.
Other Steps to Reform the Nursing Profession
In addition to the five specific steps above, Governor Dean will support other actions to alleviate the country's nursing crisis:
Bring nurses to rural areas and other areas of need through the National Health Service Corps and by adopting scholarship and loan forgiveness programs.
Provide incentives for hospitals and other practice settings to subsidize nursing education and provide internship and residency opportunities for new nurses.
We need to reduce the barriers to collaboration between education and practice so that our future nurses have the best possible learning experiences. Our hospitals, clinics and agencies cannot afford to bear the costs of clinical education alone -nor can our educational programs. They need the help of financial incentives to continue costly teaching programs.
Increase pay for nursing school faculty
Nursing faculty often make less than a hospital staff nurse. If there are no teachers of nursing, or if they are not excellent teachers, it won't matter how many students we are able to recruit, and those we do recruit won't be properly educated or trained.
Actively engage nursing leaders and front line nurses in the development of proactive policy and programs
We should actively support the work of the National Advisory Council on Nurse Education and Practice, and other key federal nursing advisory groups, as crucial mechanisms for assuring that future federal efforts are built on the best possible advice.
Reduce medical errors by promoting doctor-nurse communication systems that respect the value, medical knowledge, and skills of nurses
Studies in other high-risk industries have shown that improved communication leads to a significant decrease in dangerous errors.
* Projected Supply, Demand and Shortages of Registered Nurses: 2000-2020 (released on 7/30/03 by the National Center for Health Workforce Analysis, Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services). The Bureau of Labor Statistics, in an earlier report, predicted that that we will need one million new nurses by 2010 (Monthly Labor Review - November 2001) to cover new positions and replace the nurses who have retired.
** According to the 2000 National Sample Survey of Registered Nurses, the average age of an employed registered nurse is 43 and the average age of all registered nurses is 45.
http://nurses4dean.com/Dean_on_nursing_issues.htm
