The Real Deal

Nurses General Nursing

Published

An excellent synopsis of the situation....

The Future Nursing Workforce

By Susan King, RN, MS

Administrator, Professional Services

I recently saw an advertisement in a magazine. It was a picture of a middle-aged nurse and the caption read, Nurse Thyself. I dont remember the point of the ad or if there was a product, but it doesnt matter. What does matter is that unless we find ways to maintain an adequate nursing workforce, the caption will be our future. I dont know about you, but I want to be able to expect that nursing care will be available for me and all

those who need it now and in the future.

Right now things arent looking good for the nursing supply and considerations must target two distinct populations. First, are those of us in the profession. Next we have to think about the potential nurses who are our future.

The retention of existing professionals is a major concern to the industry. A Mercer survey in 1999 revealed that 30% of health care executives believe that nurse retention is a significant problem. In Oregon, many health care facilities are starting committees to solicit ideas about this topic. The Oregon Health Care Association, a membership organization of long-term care and assisted living facilities, has done extensive research on issues of

nurse and certified nurse assistant retention in their segment of the industry. It seems that there is no question that retention is the critical factor in dealing with the nursing shortage short-term.

What are existing nurses saying about conditions that must be changed to KEEP us?

The answers are:

Salary and benefits

Improved practice environment conditions

Quality of care

Professional autonmy

Physical demands

The industry is going to have to pay us significantly more and institute changes with us to support professional practice that is based on standards of care and quality. Workloads need to be managed by improved staffing and the availability of support services that preserve nursing care and reduce non-nursing responsibilities.

What do we know about our future workforce?

First, they are not going to be like the average nurse (age 46). The current literature describes our future in terms of Generation X and Y. These labels help describe a cohort of the population very different from the boomers. One study of Ohio college freshman revealed that they are optimistic, job and career-oriented and ambitious in terms of their desire to be well off.

They come less academically

prepared and have less interest in academic rigor. They want relevant coursework and more concrete experience. From other sources, we know that Gen X and Y value their work but want time off to have a life outside of their career. They are looking a little more conservative than the boomers and more careful about analyzing what is in it for them.

We know clearly that nursing has lost its competitive recruitment advantage now that women have virtually unlimited access to entry into all professions. We also know that many industries are able to attract individuals because of our booming economy that supports their generous salary and benefit packages. We also know that working conditions for all health professions have not been too great for about the last decade. How does that apply to those

who will be future nurses?

The fix to the nursing shortage to make our profession attractive to X, Y and eventually the Z generations will be comprehensive change, not quick fixes. In addition to the list of priorities that the existing workforce has already identified, let me add a few changes that will position the profession better in the future.

Maintain and Increase Practice and Education Standards

Unfortunately, nursing and the industry have reacted to previous shortages in very unwise ways. Remember the last one in the late 1980s when the issue of increased and inappropriate use of a variety of unlicensed workers was emerging as a major solution to insufficient licensed nursing staff. In previous decades, nursing has responded by instituting RN programs to produce a supply quicker. The reality is that nursing demands knowledge and skill

that must be based on sound standards and adequate preparation. Our current educational preparation needs to match the reality of practice.

Practice Setting Changes

Industry resources need to be shifted toward direct patient care. We can no longer afford to hope that the nurses and other health care professionals will be able to do more with the same or fewer staff resources. Nursing practice needs to be supported with professional recognition for credentials. Nurses must hold themselves accountable for focusing care on patient outcomes and our contribution to those outcomes must also be recognized and valued.

If there is any doubt, a good place to look to verify that this relates to recruitment and retention is in those facilities that have been granted Magnet status by the American Nurses Credentialling Center (subsidiary of ANA) as well as patient outcomes.

Profession and Industry Collaboration

The nursing profession and the health care industry have had some rocky times. Nursings criticism of hospitals, health care consulting firms andthe insurance industry have been justified, but we must learn how to work with employers and funders in new ways. It is in the best interest of our patients, ourselves and our employers, for example, to work together to reduce or eliminate inappropriate reimbursement for services. For example, why should

Oregon Medicare recipients and the institutions in which they receive care be paid less than those in Florida? Facilities and nurses can come up with great solutions to common safety problems that make hospitals and other settings less safe than they should be. We can also be great partners in cutting costs that dont really matter to patients or to the success of any organization.

Will nurses and the industry be able or willing to make the major changes necessary to ensure the survival of the profession? Time will tell but there really isnt a choice.

RN Shortage - NON-SOLUTIONS:

Mandatory overtime. Except in times of narrowly defined critical need or disaster, nurses believe that mandatory overtime is unacceptable, yet it is employed particularly in hospitals to make up for insufficient staff. Staff shortages are caused either by deliberate understaffing, vacations or inability to fill vacant positions. Overtime work has implications for safety and commission of errors as recognized by other occupations and professions. For

example, airline pilots and long haul truck drivers have limits on the

number of hours they can work, yet in health care nurses, physicians and others have no such requirements. Since fatigue is known to contribute to errors, mandatory overtime was identified as a major consideration in the profession's plan to reduce errors and increase consumer safety.

Understaffing. This has emerged as the primary concern among nurses in clinical practice because patient safety and acceptable outcomes depend on the availability of qualified professional nurses. A growing body of research supports this conclusion. Understaffing in today's hospitals is partially a remnant of the managed care influence on the system, which attempted to squeeze "fat" out of health care. Unfortunately, staff cuts were often identified

by the non-clinician administrators as that fat. Now as the system acknowledges the demand for services and the lack of wisdom applied to many of the approaches of managed care, staff numbers just aren't there.

Decreasing qualifications. This is a very old trick. Remember the AMA's brilliant registered care technician proposal? Or the ongoing interest among some health care executives to replace professionals with all sorts of lesser or untrained technicians and assistants? Now we have these old proposals dressed up to look different. The proposal in Congress to allow nursing homes to use uncertified helpers for such "simple" functions as feeding and

ambulation is an example. Another example is the demand for new or reopened LPN programs to train increased numbers of less expensive staff who carry a nursing license. Not the solution we need.

Importation of foreign nurses. Some segments of the industry suggest that the process for credentialing foreign nurses should be shortened and that barriers to obtaining visas should be eliminated. Never mentioned are the stories, such as the Texas experience, with a company that imported nurses and kept them isolated and used them as staff in long term care settings at very substandard wages. The effect on the patients wasn't good. While we have

seen the increased use of foreign workers in high tech, those industries are already doing all they can to attract our own. Foreign nurses aren't the problem but when an industry pays nurses less than electricians, it shouldn't be given free reign to import.

Interstate compacts. The interstate compact proposed by the National Council of State Boards of Nursing, which would virtually negate individual state standards for those who join, is being suggested as a way to assist segments of the industry hire more easily. In reality the ability to get nurses licensed in the state more quickly will do nothing if the practice settings are not attractive or financially rewarding.

It is easy to get discouraged when these proposals are offered as solutions to the nursing shortage. However, it isn't all bad news. There are shining examples of a different approach - one that values and supports nursing professionals to provide optimal care. Magnet hospitals, whose nursing services are based on collaboration, self-direction and high professional standards, report having far less difficulty in attracting and keeping nurses. The

industry should learn from them and needs to learn quickly that nurses aren't different from other professions and occupations.

http://www.oregonrn.org/services-nursing.php

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"The Nursing Shortage ... and Why It May Get Worse......" http://www.drkoop.com/news/special-reports/nurses/crisis.html

Conditions Cause Nurses to Leave

Nurses are distressed and frightened by the conditions under which they work, and many are retiring early for that reason, or leaving hospital staff work for other jobs. There is no way of collecting figures on how many, but there is abundant anecdotal evidence that it is happening often enough to contribute significantly to the current shortage of nurses.

Stopgap Measures

Recruiting nurses from other countries is one of the stopgap measures hospitals have used. Substantial numbers have come to the United States from the Philippines, Canada and western Europe. A bill passed Congress in October lifting the ceiling on visas so up to 60,000 registered nurses can come to the United States by 2002. But the nursing shortage is worldwide, and every nation from the United Kingdom to Australia has a problem of its own..........

But it will take more than better pay, more support and more recognition, Shiber and others interviewed by drkoop.com agreed. "Hospitals are not attractive places to work," Shiber said. The American Organization of Nurse Executives (AONE) report and the recommendations for improving nurses' working conditions by other major nurses' associations spell out what that means. Long shifts, mandatory overtime, crushing workloads and an ever-growing burden

of paperwork have become almost normal. The result is often chronic fatigue and eventually burnout.

How can all the problems that have been created and threaten to worsen the nurse shortage be remedied? The recommendations in the AONE report, and those by other leaders in the healthcare field, make a long list:

* More financial support, for hospitals, nursing schools and nursing students, from the federal, state and local governments.

* Better pay, which is not only higher but is scaled so as to reward experience and continuing education. Many nursing pay scales top out at 12 to 15 years.

* Better working conditions for nurses, with sufficient support and staffing to let them carry on their primary work of patient care.

* According nurses more respect and status, and involving them in policy decisions that affect their work and the welfare of patients.

* A major educational and publicity campaign to make the public, particularly potential students, aware of the central role nurses play in caring for the aging, ill and injured, and to recruit many more applicants to nursing schools.

see also:

http://www.drkoop.com/news/special-reports/nurses/shortage.html :

"Nursing Shortage Puts Patients at Risk

Inadequate Staffing Sparks Rise in Medical Errors"

"Keeping the Nursing Shortage From Getting Worse - Can a Crisis in 2010 Be Avoided?"

"An In-Depth Look at the Nursing Shortage ... and Why It May Get Worse"

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Originally posted by Tiara:

jts: Why don't you post that article from Oregon nursing assoc. everywhere! It's really interesting. You should post the link at Spectrum and MNM!

Wasnt it great Tiara?? Thats what are state associations are about. I wish everyone was part of theirs - imagine what we could accomplish???? Thats and the ones at Dr Koop are the best articles on the nursing shortage that I have ever read. Feel free to take it everywhere you go & forward to all your lists! I think I did put it on spectrum already.

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I dream of toppong out my pay at 12-15 years. We top out at 6 years at 18$ an hour US!!! It's all ridiculous. Experience should continue to be rewarded for all the years you work.

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Originally posted by fergus51:

We top out at 6 years at 18$ an hour US!!! It's all ridiculous.

Yes it is. where is that?

Most of our contracts go to 25 - 30 years.

Experience has to count for something if they want to retain veteran RNs.

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jts: Why don't you post that article from Oregon nursing assoc. everywhere! It's really interesting. You should post the link at Spectrum and MNM!

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I am in BC, Canada (the province north of Washington State). The top pay rate is 26$canadian or about 18 US$.

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Originally posted by -jt:

"The Nursing Shortage ... and Why It May Get Worse......" http://www.drkoop.com/news/special-reports/nurses/crisis.html

Conditions Cause Nurses to Leave

Nurses are distressed and frightened by the conditions under which they work, and many are retiring early for that reason, or leaving hospital staff work for other jobs. There is no way of collecting figures on how many, but there is abundant anecdotal evidence that it is happening often enough to contribute significantly to the current shortage of nurses.

Stopgap Measures

Recruiting nurses from other countries is one of the stopgap measures hospitals have used. Substantial numbers have come to the United States from the Philippines, Canada and western Europe. A bill passed Congress in October lifting the ceiling on visas so up to 60,000 registered nurses can come to the United States by 2002. But the nursing shortage is worldwide, and every nation from the United Kingdom to Australia has a problem of its own..........

But it will take more than better pay, more support and more recognition, Shiber and others interviewed by drkoop.com agreed. "Hospitals are not attractive places to work," Shiber said. The American Organization of Nurse Executives (AONE) report and the recommendations for improving nurses' working conditions by other major nurses' associations spell out what that means. Long shifts, mandatory overtime, crushing workloads and an ever-growing burden

of paperwork have become almost normal. The result is often chronic fatigue and eventually burnout.

How can all the problems that have been created and threaten to worsen the nurse shortage be remedied? The recommendations in the AONE report, and those by other leaders in the healthcare field, make a long list:

* More financial support, for hospitals, nursing schools and nursing students, from the federal, state and local governments.

* Better pay, which is not only higher but is scaled so as to reward experience and continuing education. Many nursing pay scales top out at 12 to 15 years.

* Better working conditions for nurses, with sufficient support and staffing to let them carry on their primary work of patient care.

* According nurses more respect and status, and involving them in policy decisions that affect their work and the welfare of patients.

* A major educational and publicity campaign to make the public, particularly potential students, aware of the central role nurses play in caring for the aging, ill and injured, and to recruit many more applicants to nursing schools.

see also:

http://www.drkoop.com/news/special-reports/nurses/shortage.html :

"Nursing Shortage Puts Patients at Risk

Inadequate Staffing Sparks Rise in Medical Errors"

"Keeping the Nursing Shortage From Getting Worse - Can a Crisis in 2010 Be Avoided?"

"An In-Depth Look at the Nursing Shortage ... and Why It May Get Worse"

I appreciate the lit search on how the nursing shortage is being displayedby the media. It boggles my mind in Dr. Koops website article how it says, "nurses are not about the money". The article went on to say that if we were, we would have never went into nursing. I say that this comment defies all logic. Where is the justice in that comment? I am a nurse and I am most certainly about the money. Just because I happen to enjoy helping others doesn't imply that I cannot be "about the money". I want to be paid well, I deserve to achieve an exceptional retirement package that enables me to live without financial hardship as well as to have piece of mind that I will be able to afford my health care as a retired nurse. Why are these things seen as inappropriate expectations for nurses? Are we to be penalized for wanting assurances of quality of life in our "golden years"? Will you all now join me in saying that nurses deserve better. It is a complete embarassment that health care employers do not provide these assurances for the very people that deliver health care for the life of their careers! I would like to hear more of us speaking out for better retirement and health care benefits at the end of our career. The statistics assure us that 50% of all RN's in this country are in our mid fourties already. Lets think about how we are all going to be sitting in another couple decades! We may very well find ourselves facing poverty and burdening the health care system ( if we can access it at all!). Now, think about recruitment and retention for a minute. Don't you think we have a duty to advocate and speak out for improvements in these vital benefits for the sake of attracting these future nurses from generation x, y and z? It is my hope that one day it will be common knowledge, that to be a nurse is to be assured of exquisite retirement benefits and assurances of the best health care available as a perk of working in the profession. Doesn't just make sense? It is pitiful how meager our retirement benefits are! I would love to see some 20-20 news spot interviewing some poor old nurse who is on the skids with no health care benefits after spending his or her life working in health care in the service of others!! That could really put this sad reality in perspective for people who think "nurses aren't about the money"... L. Smolarkiewicz RNC

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L.Smo RN

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Originally posted by lsmo:

Originally posted by -jt:

how it says, "nurses are not about the money". The article went on to say that if we were, we would have never went into nursing. I say that this comment defies all logic. Where is the justice in that comment?

I think the only thing logical about it is that it was said by a hospital executive. Maybe a subtle form of trying to gear our thinking away from money. That one sentence jangled my nerves too. Of course we are about money. We have to pay our bills like evryone else. Most of us have not taken a vow ofpoverty & are not living in convents. That was a ridiculous statement for her to make but the sad thing is the believe it & they want us to believe it too. I also agree with you r points about retention of experienced RNs. In the 80's, when we were younger with small children, hospitals provided incentives like on site child-care, part time hours, flexible shifts, etc to get us back to the work. Now that we are older, they need to look at what we need more now - pensions, retirement plans, improved healthcare benefits, finances & security.

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