Low morale, budget cuts hit nursing profession hard
By Kelly Yamanouchi Medill News Service
Posted on August 26, 2001
Nursing has a morale problem.
Debra Pilgrom, a nurse for 21 years who works for Melmedica Children's Healthcare, says what she and many nurses want is enough time with each patient to fulfill all their health needs. But in the throes of budget cuts and a shortage of nurses in acute care at hospitals, that can be difficult to get.
At a hospital, Pilgrom said, "you're overloaded, you're following up behind people. Every day more and more people are added to your workload. At the end of the day, you realize all the things you haven't gotten done, and you feel bad, but you're only one person, so what can you do?"
The pressure has left many nurses unhappy, feeling overloaded by paperwork and left with little time at the bedside with patients. Eventually, some nurses move out of hospitals, where they are needed most, or out of nursing altogether for other jobs, draining the nursing profession even more.
Of those who continue to practice nursing, many are like Pilgrom, who decided to leave hospital work. She moved to home care for more flexible hours. Melmedica in Schaumburg has 500 nurses like her in the Chicago area providing pediatric home health care
In a 2001 American Nurses Association survey, 75 percent of nurses said they think that deteriorating working conditions have led to a decline in the quality of nursing care at their facilities over the past two years. More than 54 percent of nurses surveyed by ANA said they would not recommend nursing to their children or friends.
"Morale has decreased over the last five years dramatically," said Nancy Shepherd, a nurse for 25 years who works in the emergency room at Provena St. Joseph Hospital in Joliet. "A lot of the decrease is because of the working conditions and the expectations we cannot meet."
"The pressure is on hospitals to decrease costs," said Susan Macfarlane, director of human resources at Lake Forest Hospital. With nursing often making up the largest budgetary expense, it's a likely area to face cuts.
Hospitals put much of the blame on the Balanced Budget Act of 1997, which called for $115 billion in cuts by 2003 from Medicare, the federal health program for the elderly. Hospitals say the actual cuts could amount to even more.
The implications have caused enough concern that nurses are supporting legislation to alleviate the problem.
There are 136,000 nurses in Illinois, and about 6,100 are unionized under the Illinois Nurses Association, which is supporting a bill passed by the state House of Representatives aimed at improving working conditions in hospitals. The legislation, similar to bills introduced in other states, would require better assessment of how many patients hospitals can handle and prohibit mandatory overtime, according to Carol Jenkins, INA's interim executive director.
Pam Robbins, chair of the INA's economic and general welfare commission, says low morale in nursing is a deterrent to students considering future careers.
"When they listen to what's going on in the workplace, right now they're told it's really hard work. I don't get any lunch, I don't get any break," Robbins said.
No improvement is in sight. Enrollment in nursing degree programs has declined for the past five years, said Elizabeth Ritt, dean of the College of Professional Education and Continuing Studies and a professor of nursing at North Park University in Chicago.
That could mean even more nursing positions left open in years to come. Already, there are 126,000 open positions for registered nurses at hospitals nationwide, according to an American Hospital Association survey.
"I just don't think nurses are recognized for their contribution to health care as much as they should be, and it's frustrating," said Connie Schulz, who conducted a survey of nurses in Chicago who have changed jobs for a North Park University dissertation on nurse job satisfaction.
Nearly 20 percent of licensed registered nurses are not working in nursing, according to a survey by the federal Health Resources and Services Administration.
The nurse shortage has been the focus of discussions in Congress, where legislation has been introduced to fund nurse scholarships and support nursing education.
Karen Gunter, Melmedica's president, said her nursing staff is growing, but it's still not enough.
"Nurses are working a lot of hours, maybe time that they could be spending with their families. From a morale point of view, that's probably one of the biggest issues facing nurses," Gunter said. "Nursing has always gone through peaks and valleys, and this one just didn't go away."
Low prestige of the profession contributes to the exodus of nurses, and is a problem that isn't easily solved, even if hospitals are fully staffed.
For Pilgrom, a plus is that she feels "very important" to the patient in home care. "At the hospital, you're talked down to, you don't get the respect," she said. "Your position isn't as important as far as the doctor is concerned."
Visiting patients at home, however, "you have time to do the little things - holding a child's hand, singing a silly song. Little things that make a child's life right - you don't have time for that in a hospital," Pilgrom said.
While many nurses say patients seem to appreciate their work, "nurses are not looked on as professionally as they should be by doctors," said Deanna Kusmerz, another nurse at Melmedica. "I don't understand it."
To be sure, some say there are hospitals that have worked hard to keep nurse staffing levels up and to provide good working conditions. Some of the efforts to mitigate the problem show up in help wanted advertisements.
"You see enormous sign-on bonuses of five and 10 thousand dollars," Gunter said. In fact, the high demand has helped some nurses control their working conditions better, such as nurses who refuse to drive farther than a few miles to home care jobs.
At Lake Forest Hospital, for one, nurses say they aren't affected by shortages.
"Lake Forest has it pretty good. I think we're pretty well staffed" because the hospital keeps a low patient-to-nurse ratio, said acute care nurse Jan Kelley. "It's a good place to work; the people here are very caring."