Is the Nursing Shortage Ending?

Several of the responses to the topic and my comments on my referred to pages seem to imply some sort of hostility by me towards the foreign nurse. "That's why they call it a free country" was one comment that stands out, as though I am in absence of that awareness, or in opposition to its implication.
Nothing was said that would imply that foreign nurses seeking to emmigrate are unwelcomed by me...I refer to them as hardworking in the page that commentator perhaps accessed, and know them to be dedicated. Personal choice is highly regarded by me, but I also know that their personal choice is sometimes forced by desperation. Many of them, if able to receive good enough pay, and access to clinics and supplies, might experience a very different response to enticements to leave their home, family, towns and native society for the long haul.[who hasn't worked with a Filippina who describes nursing school and the subsequent need to work in a hospital to gain her experience WITHOUT PAY driving her to consider more forcefully emmigration to any country?]. I happily and with much excited anticipation volunteered for a clinic in Nicaragua, but I am not, unlike the nurses coming to us, forced to leave my family to go live in that or any foreign country for the long term just to earn a reasonable wage and have access to supplies, or even a hut in which to perform my work.

Surely we as nurses are concerned if not for the individuals of foreign nations who are losing nurses to care for them, then at least the ability to control epidemic disease that threaten larger regions.

In support to the entire world's nurses, alternative methods for meeting nursing needs in all nations must be met by changes ocurring in those nations. Many of these countries are VERY, VERY poor. I am suddenly struck by a vision, and although the thought is indeed dreamy, it is worthwhile to consider the good to be derived from the establishment by State Nursing Associations with "sister-nurse" countries in a meaningful, effective and public consciousness raising way. These "Sister-Nurse" arms of the SNAs could meaningfully serve both the nurses and the populations they care for, while it would also advance the perception by the public and others in the health care industry in far more effective positions of lobbying power, of the compassionate, creative and insightful concern given form by each State Nurse Association and in absence of any motivation beyond commitment to nurses and public health.
It would also concretely affect nurses and the populations they serve, inch by inch, 52 countries at a time.

These sister-nurse arms of the SNAs, not unlike the basic concept of Doctors Without Borders or other more nursing based philanthropic entities providing nursing support to specific countries, could involve themselves in economic appeals to their substantial membership, could organize voluntary committes overseeing the collection and shipping of cast-off equipment [think as simply as ALL those inexpensive one time use stethescopes that could EASILY be decontaminated or the small plastic cups used to measure additives to a mixture destined for a patient and never contaminated, merely in need of cleaning[used ALOT in the NICU]. Cast-off drugs [yes drugs] from the entities in which we are employed could be of enormous value [our expiration dates allow a safety period of unfit use occuring before the time when deterioration is bound to occur-to the poor country in need of them, a slightly out of date cast-off drug without loss of potency is WAY better than no drug at all. Thrust could include formation of emmisary support groups sending personnel to help organize, support or train clinic staff. The provision of one computor to a regional nursing center would allow access to the wealth of useful medical/nursing literature available on the web and gee, imagine if direct discussion with those of us speaking of foreign nurses and what it is they needed could occur from a regional center in say, California's sister-nurse country the Philippines: " the stethescopes have been a great help, but we need more portable B/P cuffs for the such and such provincial clinic "
Cool huh?, to think that we could help in that way.

In addition, the "sister-nurse" arm of the State Nursing Association would seek to promote legislative mandate to support the nurses of those countries, as in economic support when directed at a country by our nation to include specific monies earmarked for the nurses and their employment venues there [a needed rural nursing clinic's establishment ie] .

As for America, the supply of foreign nurses is finite, and we can NOT hope to meet our need for nurses from this one impoverished-by-numbers source, no matter how welcoming we as nurses are to them. ONLY by improving the environment [also addressed in my pages and very complex indeed] and earnings [the other alpha factor fueling our shortage receiving much attention there] will we hope to encourage a consistent and uninterrupted supply of new nurses to our ranks, and decrease the recitivism so detrimental to our nation, and our remaining nurses.

If you reread my comment, you'll notice that I was responding to a direct quote from Suzanne who, I thought, was discussing foreign nurse issues in general.

It wasn't meant to imply anything else.

Sorry Liz, that I thought differently. Certainly the concept of free will freely exercised is important to the entire discussion, and the comment important, while my response reflected lack of understanding of your intent.My apologies.

We keep hearing of foreign nurses flooding the market. I am not sure if most of you are aware that by July, 2004, all health care personnel coming to work in the US will be required to pass English exams that will make them comparable to native-born speakers, except physicians. Not all nurses that want to emigrate to the US have poor working conditions. They actually do more pediatric heart valves here ( in Thailand) because of genetic heart disease. Many CT fellows from the US are actually sent here because of that. Almost any medical procedure that is done in the US is done here in Bangkok. Most of their medical equipment is actually from the US.

I am not pushing for foreign nurses, just that I believe that everyone should have a chance to set their goals and be able to live in a free world if they desire.

Did I miss something? Noone implied all foreign nurses come from poor countries. And Who said free will should not be excercised? What has been said, certainly I have said it, is that the nations HARDEST hit by the recruitment are the poorest nations most in need of them, and this is indisputable fact. I am getting to feel that few people in here deem that worthy of concern at all, yet if a review of literature is done, you will find it is very much of concern to many countries, some of them with precious little resource to change the hemmorhage into a trickle.

Yes, Thai nurses with whom I have worked have obvious advanced training as they are immediately able to accomodate to the most intensive of hospital environment, but I have yet to encounter a foreign nurse who is NOT. And I, for one, have never worked with a foreign nurse unable to speak English fluently. We are indeed getting the best educated, and the best of foreign nurses. Lucky us. But there is reason for so much press regarding the negative effect in poor countries from which any nurse, regardless of her ability to manage the newest and highest tech procedure, is recruited, easily accesable by google search, and often including excerpts from newspapers in that home country quoting local nursing leadership and citizen appeal for legislative mandate to encourage nurses to stay.

I am not sure you are addressing my last post, but I did utilize the example of nurses leaving the poorest of home countries as I described a nascent vision, and without meaning to imply that the nurses coming from abroad all come from countries relying on medical personnel maybe, maybe not present in ramshackle village clinic huts without equipment!! But that IS the case for the many poorest countries losing their nurses not necessarily to America, but to their better paying neighbor countries, while that neighbor country has nurses recruited to a better paying country 1,000 miles away, while that country has nurses that are recruited to someplace else paying more. It's an endless cycle because the image, environment and salary in the homecountry for nurses just about everywhere is like ours: Insufficient to meet local market demand.

Suzanne,
I am really interested in your experience in Thailand.What a great experience you must be having. How did you get there? Its supposed to ba a truly lovely country with beautiful people inside and out. It also puts you in a unique position regarding foreign nursing experience. I sort of shot off that last post a bit defensively, and I wanted to say that I'm not sure I have seen anything in the literature about our country being flooded by foreign nurses. I don't think we are and would like to read any source that says we are- from what I understand, we are having trouble competing with other wealthy nations for any foreign nurses from any country, rich or poor.

I have been coming to Thailand for over 16 years, originally to go scuba diving and fell in love with the country. I have had an apartment here for the past 4 years, and would commute, this time last year I just decided to move here for good. I had several friends that wanted to work in the US and they were getting taken advantage of by alot of companies making all types of promises to them, actually lying most of the time. Telling them that they won't need to take any English exams, and they can take NCLEX as soon as they arrive in California, but then IF they want to study English they would have to do it over there at a much higher expense and out of their own pocket. So I moved here and set up a school to train nurses in "Conversational English" to help with taking care of English speaking patients here and for taking care of them in the US. They do not teach critical thinking methods in the schools here, they have to ask the doctor for EVERYTHING. So they are learning to be more assertive, learning about American culture and foods, etc. We also do a lot of presentations so that they are always improving their communication skills. And I am quite impressed by tghe group that I have now. I have another full-time program and a part-time program beginning in January. But best of all, I never have to shovel snow or start a cold car in the morning. I can actually view my penthouse from my office, well within walking distance. My groceries get delivered to my home. I have two large terraces with all different types of gorgeous flowers and palm trees, etc. Quite spoiled here, so much so, that I would find it quite hard to actually live in the US again, but I have made that choice, no one made it for me. The nurses here actually have to sometimes work all three shifts in one week and their manager can give them mandatory overtime at the last minute, doesn't matter if they already worked 50 hours that week. You can work days, go home and sleep, go back for nights, then with afternoons on the following day and they think that is normal. You would never find me doing it............if any of you are over on this side of the world and would like to come in and guest lecture to some wonderful nurses about where you work, we would love it!!! I will be back in the US in March for AORN, are any of you planning on attending?

Thanks

I tend to agree with PIE. I have been a critical care nurse for over 35 years. The only solution that has been applied in all of these years is to bring in foreign nurses. (bandaid) Very little if anything has been done to make working conditions better and keep salaries/benefits attractive. As we all have seen the working conditions and salaries/benefits have gotten worse. YES, erosion is a big word.

What is the cause of this? Nurses not united, not demanding enough. State/national nursing associations not strong enough and not paying enough attention to the frontline nurse. Hospital lobbying associations spending huge sums to change laws to make it easier for them make huge profits on our backs!!!

What is the solution??? Nurses should become independent practioners in a much broader sense, more nurses should be on hospital boards, CEOs of hospitals, etc. (Nurses cannot even charge for the work that they do unlike almost any other area of the hospital) More nurses to make the decisions that have been made by others (which we have allowed to occur) for too long.
Mentorships need to be created and made stronger. The list could go on and on.

Lee1 wrote "What is the solution??? Nurses should become independent practioners in a much broader sense, more nurses should be on hospital boards, CEOs of hospitals, etc. (Nurses cannot even charge for the work that they do unlike almost any other area of the hospital) More nurses to make the decisions that have been made by others (which we have allowed to occur) for too long. Mentorships need to be created and made stronger. The list could go on and on."

I could not agree more. The fact that bedside nurses do NOT sit on hospital boards and that such a concept is destined at present to be perceived as radical to the extreme, is a clear indication of the distance nurses are kept, and THEMSELVES maintain by not demanding it, from the power structures in which their profession is involved. Yet this is NOT radical, and neither is it unreasonable. Nurses constitute the service which is for sale in the hospital environment, let there be NO mistake about that...yet we remain excluded from the decision making powers fiscally dependent in entirity upon our presence in the hospital environment. MDs always serve on those boards, giving voice and filter to the decisions being made. WHY have nurses not demanded the same? While physician [primarily surgeon actually] owned hospitals mushroom presently in an effort to distance themselves from the profit erosion of their OWN procedure reimbursements , it is my desire to see nurse owned hospitals develop. By the way, those physician owned hospitals see much more profit for their physicians, but their pay to nurses does not vary from the local norm.Noone sees to us, and we must see to ourselves.


Billing for specific tasks is a concept worthy of pursuit, and in contemplating it in the past, I have been at times excited and at times overwhelmed, for I fear it would create a paper trail so overwhelming to the nurses providing the tasks that it would fail to improve their situation, and add more frustration to the mix. And yet, what else IS to be done? While hospitals limit our numbers in order to attempt greater and ever more harrowing "efficiencies', they provide mandated seminars on "how to be polite in the worst possible environment" [that's what I call them anyway]. The patient, Doctor, supervisor and/or other harried worker is therein given the nomer "client" and we have been taught in role play how to be responsive listeners, skilled users of win-win communication,etc--- whatever they call it, it does NOT address the fact that its hard to give full attention, without evidence of time constraint to everyone addressing us in the current structure of our work environment and the current demand by management upon our time to meet the duties of our daily job.
Despite the fact that the appropriate response to the strongly advocating family of Bed 2 [who may use legitimate complaint, may have right completely on their side, or may be excessive in their demands while also notching it up abit with veiled liability threat-who of us hasn't seen THAT work?] to increased attention and time beyond what is phsycially possible for the nurse assigned is "have you considered private duty?". But if I gave that [my imagined response] as my answer in those role playing seminars, i'd likely lose my job."Clients" are far removed from the cost of health care being entirely expectant of third party reimbursement for the services they choose to oversee in a scenario such as the above. Management is far removed from the concerns and complaints of nurses in safely and completely meeting the client's needs.Nurses in the meantime are far removed from any position of voice in the system which depends upon them and in which they are always exposed to the front line while seen as a bottom line.

How interesting to read this 2003 thread in 2009. Very eye opening and thought provoking.
I had naively thought there was a nursing shortage these past several years, until autumn of 2008 when I kept reading about hiring freezes in hospitals in USA due to poor economy. Plus, I only learned about and joined allnurses.com in September 2008.
I graduated from nursing school (4 year program) in 2004. All I ever heard about during my 4 years at college was "nursing shortage, nursing shortage, nursing shortage". And to think, this thread was written in 2003, by nurses who knew better.

I guess the truth is that there is NOT a shortage of Americans who are licensed as RNs or LPNs. But that there is often a shortage of nurses who are willing to work in patient care, or capable of working full time as a nurse at the bedside. When the economy is good and unemployment is low, nurses leave the profession. When the economy tanks and we experience a recession, then the "nursing shortage" is fixed because nurses return to nursing. Right? Also, from what I read, we have an increased number of new nurses who just graduated from various nursing programs in 2006, 2007, and 2008. So, we do NOT have a shortage of people who have graduated from nursing school. But we certainly do have a shortage of nurses who have worked full time doing patient care / bedside nursing for 10 years or longer. Right?