Nursing Shortage Report

Home Health Columnist / Guide · May 17, 2002

Study authors offer perspectives on an emerging crisis in health care

http://www.rwjf.org/newsEvents/nursingInterview.jhtml

The current shortage of nurses in U.S. hospitals stems from broad societal changes and cannot be solved without fundamental reforms in the healthcare system and the nurse's role in it, say the authors of "Health Care's Human Crisis: The American Nursing Shortage," a new report funded by The Robert Wood Johnson Foundation. The authors are Bobbi Kimball, R.N., M.B.A., who works for the management consulting firm Health Workforce Solutions, and Edward O'Neil, Ph.D., M.P.A., professor of family and community medicine and dental public health and director of the Center for the Health Professions at University of California, San Francisco. Using a survey of 15 nursing-market areas, they found that nurses are in short supply almost everywhere. But offering bonuses and recruiting foreign nurses, as hospitals have done during previous shortages, will not be enough this time, they say. Incorporating technology into nurses' daily work may be key to attracting more women and men, including minorities and young adults, to nursing careers. How is this nurse shortage different from previous shortages? O'Neil: You have the retirements of nurses from the baby boom generation and the aging of the general population. You couple with that the population drop in the two generations that follow, Generation X and the 20-and-unders. There aren't going to be enough bodies to populate any work system, much less health care. Kimball: In addition, there's a mismatch of diversity. Most nurses are white women, and they do not reflect the diversity of the country. Nursing has not attracted men, and Generation X does not have a value set that makes nursing attractive to them. They value anti-institutional, non-hierarchical, flexible environments. Their image of nursing is one of cold, unresponsive institutions lacking, at least in 2002, the high-tech element and flexibility they so value. What systemic issues have not been addressed by previous reports on the nursing shortage? Kimball: They haven't looked at the way the nursing profession is integrated with the structure of the whole health-care system. That begins with nursing education and how it's organized and what it produces. It includes clear paths for career advancement and being valued as professional partners within the health care system. How can the major concerns of nurses voiced in your focus groups - including workload and powerlessness - be addressed? Kimball: The most basic way is that hospitals, nursing homes and other organizations that employ nurses need to actively solicit their opinions and hear them. All the nurses in focus groups had opinions, and they didn't feel they were being heard at the employer level. O'Neil: Hospitals have responded in a knee-jerk fashion to financial pressures by cutting the education budget or custodial assistance or clerical help. The hospital has left nurses exposed to more and more responsibility with fewer supports. And we're asking them to perform a lot of manual labor that doesn't require their skills. I understand trimming our sails and making it more efficient, but I think we have to engage the nurses directly in designing how that happens. How can the nurse shortage be solved in a lasting way? O'Neil: We need to do the short-term things: recruit nurses, pay bonuses, and improve salaries. But we really need to improve and reinvent the profession. Kimball: Policy-makers and employers, nursing educators and labor unions all need to take a serious look at how we attract young people and people of other races and genders into the profession. In addition to creating clear paths for career advancement, it's my opinion that the use of technology should be widely employed to decrease repetitive tasks and streamline clinical documentation. How can new models of nursing practice reduce the shortage? Kimball: We need new care-delivery models so nursing knowledge and skills are used at their highest level. One example would be nurses who are working in a disease-management organization, essentially managing the care of multiple people living with chronic illness. The nurse is a teacher, a coach who monitors clinical data electronically and speaks with the patients on a regular basis to help them manage their care and avoid unnecessary doctor visits or hospitalization. New inpatient care delivery models are bound to emerge soon. Why is the task urgent? O'Neil: It's urgent because there's a short-term shortage. But the real issue is, if we don't start dealing with the source of these long-term issues, the care needs of this rapidly aging population will be right on top of us and we won't have a flexible and dynamic structure to be able to respond.

oramar · May 17, 2002

It took me a while to realize that the little disasters I was experiecing at the bedside were but a forshadowing of the larger healthcare disaster to come. If you are poor or lower middle class you are already well aware of what has gone wrong. I think the well to do and the rich are starting to experience healthcare related speed bumps as the go merrily down the healthcare road.

-jt · May 18, 2002

I was watching Third Watch Monday night & they showed something that alluded to this. Of course a fictional program but it pointed out the unfairness of the system when it comes to the lower income class:

The scenario was a power outage in the summer in NYC. The paramedics were doing door to door checks on people living at home on ventilators to make sure their back up was still breathing for them. They come to the home of a well-to-do guy who has a state of the art ventilator to his trach, a generator & enough oxygen to last for hours. They reassure him & go to the next house on their list. Its pretty much a low income one-room mess with the poor trached guy hooked up to a small ventilator that failed when the power went out. No generator for him. He suffocated alone in his bed. There was a heated, true-to-life, right-on-target discussion between the paramedics on the unfairness of it all - if you have money, you get to breathe.

I love that show. Always leaves you with something to think about.

fedupnurse · May 19, 2002

I can personally attest to the fact that if you have money or connections no stone will be unturned to help you. Even if you are terminal, they will pull out all the stops. God help you if you are un or under insured. You better have a very vocal family and nursing staff or you are screwed. We serve income levels from homeless to those from homes costing 10 million. The homeless get ignored by the system, the docs. Thansk God for nurses, we do treat most the same.