The Oncological Nursing Society held the 26th Conress and responds in this statement to the Nursing Shortage and effects to this speciality area.
ONS Responds to the Nursing Shortage
Patricia M. Clark, MSN, RN, CS, AOCNŽ
Oncology nurses across the globe are reporting a significant shortage of cancer care and a negative impact on the quality of care available. At first glance, the problem seems simple: too many patients and too few nurses. However, in oncology nursing, the shortage is more complex than simple mathematics.
There is a disturbing trend developing that affects the quality of cancer care delivered. As oncology units disband, patients are mixed into the general hospital population, and more nononcology nurses are providing care to cancer patients. Many of these nurses may not have the theoretical background or training to deliver this care properly. With decreased lengths of stay and more acute cancer care delivered in the ambulatory clinics and at home, the growing need for experienced, highly skilled oncology nurses is not being met.The Oncology Nursing Society (ONS) recently held its 26th Annual Congress in San Diego, California, and outlined some of the problems that nurses are facing and ways that ONS is working as an organization to address the shortage.At a press conference held in San Diego, ONS President Paula T. Rieger RN, MSN, AOCNŽ, FAAN, from Bellaire, Texas, stated that this nursing shortage is "very different" from past shortages. This shortage may be longer and more severe because of the aging of nurses in practice, shortages in ancillary professions, and the global nature of the shortage. Compounding this problem are the changes in patient care related to the managed care environment. Rieger pointed out that, "on paper there may be enough nurses, but the decreasing level of oncology expertise may cause significant problems in delivering quality cancer care."With the number of new nurses qualifying for state licenses rising only slightly, the demand for nurses, particularly oncology nurses, is soaring. ONS Chief Executive Officer Pearl Moore, RN, MN, FAAN, reported that the US Labor Department projects a shortage of 450,000 nurses in 7 years. Recent studies have projected an even more severe shortage. "We have a problem of attracting young woman and men into nursing that we haven't had in the past," said Moore. The situation has the federal government looking for new methods and incentives to recruit nurses. Professional organizations like ONS have joined the fight to maintain the specialty of oncology nursing.
Stressed Oncology Nurses
Recent surveys have shown that a majority of nurses still love nursing but feel physically and emotionally drained by longer hours, forced overtime, bigger workloads, and sicker patients. The Hart Report, a survey conducted in April 2001 of more than 900 current and former nurses, by Peter D. Hart Research Associates on behalf of the Federation of Nurses and Health Professionals, suggests the Labor Department shortage estimate could be low. ONS Board Member Marcia Satryan, RN, MSN, OCN, from Altoona, Pennsylvania, reported that "1 in 5 nurses who are working in hospitals and clinics say they are going to leave nursing within the next 5 years." Traditionally, financial incentives such as sign-on and "stay" bonuses have been effective in relieving the shortage. However, most of the nurses interviewed at the conference did not want more money. They wanted to have a "life" and some balance between their personal lives and their job. Flex time and options for telecommuting were also reported to be valued by today's work force. These are not options for the traditional nurse working in a clinical role, again making hospital-based jobs less attractive."I have never been so unhappy as an oncology nurse, I work under terrible conditions, and always have to cover clinics that are not my own," said an ONS member from the Midwest who works as a nurse practitioner. "I am so stressed out and physically exhausted at the end of the day." Even though she loves nursing, this nurse says she may "pack it in."
Dwindling Supply and Increased Demand
The discouragement may extend beyond today's oncology nurses. Brenda Nevidjon, RN, MS, AOCNŽ, Associate Clinical Professor in the Health Systems Leadership and Outcomes Division of Duke University School of Nursing, Durham, North Carolina, told the audience at a well-attended session on recruitment and retention that many women who may have once been candidates are avoiding the profession. The hospital setting is the most common area for new graduate nurses to begin their careers. There are currently 1.8 million nurses working in hospitals, and this is where the shortage is being most acutely felt. If steps are not taken to correct it, all practice settings will be affected in some way."Academically gifted young women who in the past chose nursing as a career are now welcome in the traditionally male-dominated professions of medicine, law, and business," Nevidjon said. At her press conference, Paula Rieger added that "salaries are low compared to other professionals for nurses just starting out and salary compression makes nursing less attractive." Nevidjon pointed out that the general patient population is aging, which is also causing the demand for nurses to become greater than ever.Traditional solutions such as sign-on bonuses and the recruitment of foreign nurses, solutions used to help prior nursing shortages, have proved ineffective in combating the current global shortage. Because the shortage is so severe, bonuses will only redistribute the shortage, creating what has been termed a "mobile shortage." Clearly, the fix is more complicated than throwing money at the problem. Fundamental changes in the education, recruitment, and retention of nurses is critical to address the shortage in the long term. A nurse from Turkey, interviewed for this article, said "it is just as bad, if not worse, in my country. We are trying to keep our nurses [in Turkey]. The laws today make it hard to travel to the US to work.
"Older and Unrecognized Nurses
There is significant pressure to act quickly. The average age of a registered nurse increased from 37 years in 1983 to 42 years in 1998. More nurses are closer to retirement. Pearl Moore reported that the average ONS member was 48 years old. Approximately one third of the nursing workforce is over 50 years of age and the average age of full-time nursing faculty is 49 years. A study published in the July 2000 issue of JAMA predicts that 40% of nurses will be 50 years old or older by 2010. "Currently, about 60,000 nurses get state licenses annually, but thousands of others quit or retire," Moore said. "We've had the lowest increases...for many, many years," she added.Many nurses are feeling undervalued. Regina Cunningham, RN, MSN, AOCNŽ, a Director of Nursing in New Brunswick, New Jersey, told the news conference that stressful working conditions are definitely taking a toll. "Things are so bad that sometimes my staff leave work in tears," she said. "I am working to make my cancer center a Mecca for oncology nurses and am fighting to get them the salaries and benefits that they deserve." Many hospitals are offering "concierge services" such as plumbers, maids, valets, dry cleaning, and better child care options to aide nurses in their home life and to keep up their morale.
What Can Be Done?
Throughout the meeting, a number of initiatives were described that addressed the ONS's role in combating the nursing shortage.Increase Enrollment in Nursing ProgramsSince the mid 1990s, enrollment in nursing school has been dwindling. According to the American Association of Colleges of Nursing, enrollments in bachelor's degree programs (BSN) have declined for the last 5 years in the United States. The number of nurses interested in advanced training, such as master's degrees and nurse practitioner programs, was also down. Many efforts are underway to recruit high school students into nursing. A member of the San Diego ONS chapter described a project called "Nurses Now." Local hospitals have donated more than $1.3 million to support the addition of faculty and student openings at San Diego University School of Nursing.
The ONS Foundation has increased significantly the number of bachelor's degree and master's degree scholarships to defray the cost of nursing education. The society is also a proponent of unique distance education programs for nurses and currently offers many continuing education programs via its Web site. Recruitment and RetentionIn 2000, ONS commissioned a "workforce" study to further define the scope of oncology nursing practice. The study is nearing completion and the results will help guide the ONS position statement on the nursing shortage that will be released by the society in the near future.Recruitment of nurses into the organization itself is also a priority for ONS. Increasing member satisfaction through innovative programs like a customized dues menu and a virtual community program for every ONS chapter and special interest group are just 2 ways that ONS hopes to meet the goal of increased membership.
Improve the Image of the Oncology Nurse
ONS recognizes that public opinion about nursing is shaped by what the public sees or reads in the media. Pearl Moore reported that nurses rank very high as trusted professionals in the United States. In fact, they are ranked higher than physicians. However, negative images of the nurse are becoming increasingly common. There are stories of how nurses are stressed out or "on the verge," images of nurses on strike over unsafe working conditions, and even stories of nurses who kill patients. There is also a fundamental lack of basic knowledge about the nursing role. Sadly, the role of a nurse is often still portrayed in the media as one that is secondary to physician colleagues.ONS is working to become the collective voice of oncology nurses in the media. For the first time, a media briefing was held at the annual Congress. The Society has hired a public relations manager and will be creating a "media room" on the Society's Web site, ONS Online. ONS is also partnering with other nursing organizations under the umbrella of the "Nurses for a Healthier Tomorrow" campaign to portray an image of the nurse that is attractive to young people.
Washington is very concerned about the nursing shortage. US senators are trying to create legislation to attract more nurses. "This is a big problem," said Joe Karpinski, communications director for the Senate Health and Education Labor and Pensions Committee, which held a hearing on the nursing shortage on May 17, 2001. "The goal is to find out what the federal government might be able to do." Senator Edward Kennedy and others on the committee have discussed funding to recruit and train nurses from disadvantaged populations. Regulatory and policy issues are also heightening the effects of the nursing shortage. At the session titled, "Playing the Reimbursement Game to Win." Lee Mortenson, President of the Association of Community Cancer Centers (ACCC), reported "nurses find they are spending more time with paper than with patients." This is very unsatisfying, as most nurses are attracted to the profession because of the "people" contact. Mortenson believes that technology will improve this problem, but cautioned that those using electronic systems report that they are not necessarily spending less time documenting.ONS supports the review of the federal and state support to nursing programs to increase the enrollment of students. In light of the federal budget surplus, it is a good time to visit Capitol Hill and lobby for increased support for schools of nursing and special scholarships to recruit students for basic and advanced nursing education. Recruiting men and women of minority ethnicities is a priority. ONS strongly encourages grassroots lobbying efforts of the membership and provides the tools to do so via the Legislative Action Center located on their Web site.
ONS will be sponsoring a congressional briefing on June 19, 2001, in Washington, where the position statement and the workforce study will be discussed in detail.There is no quick fix for the nursing shortage, and it is predicted it will get worse before it gets better. ONS is committed to the delivery of quality cancer care and, as an organization, is taking a leadership role in preserving the specialty of oncology nursing.
Rieger P, Satryan M, Lamkin L. Recruitment and retention: how to hold on to the nurses that you care about. Program and abstracts of the 26th Congress of the Oncology Nursing Society; May 17-20, 2001; San Diego, California. Discussion Session.
Federation of Nurses and Health Professionals. The nursing shortage: perspectives from current direct care nurses and former direct care nurses. Available at: http://www.aft.org/fnhp/downloadfiles/Hart_Report.pdf.
Accessed May 25, 2001.
Buerhaus P. Implications of an aging registered nurse workforce. JAMA. 2000;22:2948-2954.
Rieger P, Moore P. Media briefing on the nursing shortage. Program and abstracts of the 26th Congress of the Oncology Nursing Society; May 17-20, 2001; San Diego, California. Press Room.
Kucher K. 6 hospitals to help fund 'Nurses Now!': $1.3 million effort to boost graduate in the field. The San Diego Union-Tribune. June 9, 2000:B1.
James M. Nursing shortage worries experts. Available at: http://dailynews.yahoo.com/h/abc/200...010518_1.html.
Accessed May 24, 2001.
Mortenson L. Playing the reimbursement game to win. Program and abstracts of the 26th Congress of the Oncology Nursing Society;
ONS Online http://www.ons.org/xp6/ONS/Login/Splash.xml