Prognosis poor in nursing shortage

[Chellyse]

I know some of this may be repetitive but this article was just too good not to post here.:) Finally, the truth is quoted...

Michele

Prognosis poor in nursing shortage

Sunday, September 09, 2001

By Ford Turner

Of The Patriot-News

Nurse Kelli Diodato, less than two years out of Penn State University, worked at Harrisburg Hospital and had to care simultaneously for up to eight heart patients. People with "all kinds of IVs and chest tubes and lines in their arteries."

Diodato calls it "ridiculous." Four patients, she says, might have been an appropriate number.

One night last year, a supervisor insisted Diodato take responsibility for nine patients at one time. That night, she decided to get a new job.

She has since resigned. ***

Amy Baer quit a $24-an-hour nursing job at Harrisburg Hospital in March.

"I just wasn't able to give the care I wanted. ... I felt rushed and I didn't have time to do complete assessments the way I wanted to do them. I was overwhelmed," Baer says.

Baer recently started a new job as a $9.25-an-hour middle-school health aide. ***

Sally Long, a nurse at Harrisburg State Hospital, says she has watched mentally ill people go to other hospitals for medical problems, only to lie in the emergency room -- sometimes for days -- until the hospitals have staffed, non-emergency beds available.

"In the last few months I've seen it happen half a dozen times, and really one time is too many," she says. ***

Ask a hospital nurse, hear a disturbing story.

Piece the stories together, form a disturbing portrait.

Hospital nurses in central Pennsylvania are running themselves ragged in the face of a national nursing shortage.

They speak of stress, understaffing, and a widespread belief that the health care system puts money ahead of patient care. Veteran registered nurses -- the backbone of hospital nursing staffs -- are resigning in large numbers. Relatively few people are coming into the profession; hospital managers patch holes by hiring "temp" nurses and even by recruiting overseas.

Of some three dozen midstate nurses interviewed by The Patriot-News, many say the shortage is compromising patient care, directly or indirectly.

They aren't alone.

Concern has grown nationwide over how patients are faring in the face of a shortage dramatized by some startling statistics:

Put a registered nurse in every one of the 106,537 seats at Penn State's Beaver Stadium, and cram about 20,000 more onto the football field -- that's how many nurses it would take to solve the nation's shortage.

The number of people passing the national registered-nurse exam dropped 23 percent in the past five years, from about 98,000 to about 75,000, according to the General Accounting Office.

Enrollments in Pennsylvania nursing schools -- those offering standard entry-level programs -- has dropped by more than 35 percent since 1995, from about 5,800 to 3,800, according to the American Association of Colleges of Nursing.

More than 40 percent of U.S. hospital nurses reported dissatisfaction with their jobs in a University of Pennsylvania study.

Two recently released studies -- one by Harvard and Vanderbilt universities, the other by the federal government -- concluded that care improves when more nurses are available. Although there have been nursing shortages in the past, this one is expected to last longer and hurt more. It is a numbers problem: The demand for nurses will surge as baby boomers reach their senior years. At the same time, the number of women between ages 25 and 54 -- the traditional core of the nurse work force -- is expected to remain unchanged.

But studies and statistics fail to convey the human side of nurses' everyday struggles.

Opportunities grow:

"Sometimes I come home and I cry," says one nurse who has worked at both Harrisburg and Holy Spirit hospitals. "People are really sick and they need good care." ***

"We feel kind of torn. We want to give the best care we can, and we do, but you fly around like a crazy person," says Christy Clippinger, a 36-year-old registered nurse who works in the operating room at Harrisburg Hospital.

***

Many things get blamed for the nursing shortage, including more opportunities for women outside of nursing, discontent among nurses, and staff cuts as managed care squeezes hospital finances.

With enrollment at U.S. nursing schools down from about 74,000 in 1995 to 58,000 last year, there are "fewer nurses in the educational pipeline," says a spokesman for the American Association of Colleges of Nursing.

The urgent question: Why?

"Girls aren't going into nursing anymore," says Lebanon resident Marie Garman, a licensed practical nurse for 35 years. "I don't know if they think it's demeaning or what, but it's not being pushed in high schools anymore, either."

Meanwhile, non-nursing opportunities for women have exploded.

Leanne Clark, a 53-year-old nurse at Harrisburg Hospital, says that when she got out of high school "a woman either became a teacher, a secretary, a beautician or a nurse."

The wives of President Bush and Gov. Tom Ridge are librarians.

Today, women have opportunities in business, the military -- just about any field they choose.

Meanwhile, nurses' place in the health care system has changed dramatically.

Bill Cruice, director of the Pennsylvania Association of Staff Nurses and Allied Professionals in Conshohocken, says he believes the health care industry inflicted the shortage upon itself.

When managed care, in the mid-1990s, "decided that the health system would be driven by profit -- accountants and fancy consultants peddling their wares -- the entire atmosphere of what it meant to be a professional nurse on the front lines changed," he says. "Almost overnight it made being a nurse one of the most difficult jobs in the country."

Many hospitals cut 50 or more nursing positions as they sought to reduce costs in the late 1990s, says Jessie Rohner, executive administrator of the Pennsylvania State Nurses Association.

After that, he says, nurses felt no loyalty to their former employers. It became difficult to lure them back to the hospital.

Nurses also have seen job demands increase. Not just in patient care, but in scheduling.

Overtime -- described by some nurses as "mandatory," though most hospitals reject the term -- has become a drain on their lives. Some are told to work extra shifts every week. Others stay at work after their shift ends because they are a "DL," or designated late, nurse.

"When you work so many hours, you just aren't as good as you were at 7 a.m.," says a veteran nurse in the PinnacleHealth System.

Lydia Mogel, a nurse at Penn State Milton S. Hershey Medical Center, says her colleagues come to work sick "because if they call in sick, they get an 'occurrence' ... a written record that goes in your file."

Many nurses say the exodus from their profession is linked to a sea change in health care. Profits, they say, have become more important than patient care.

Their feelings are shared by Kerry M. Fagelman, a pediatric surgeon who practices at several midstate hospitals.

The shortage of nurses, he says, is compromising care in every hospital because the number of nurses available "has a direct impact on patient care and on patient mortality."

However, Fagelman -- who spent four years in medical school, eight years as a surgeon in training, and has had a surgical practice for 19 -- says the nursing shortage is one symptom of a much larger problem of "medical economics."

In short, he says, medicine has become a business in which health insurance companies and health care organizations suck away money that should go to providers such as nurses and doctors.

Profit motive cited:

"It has come not to care, but to the dollar figure. How quickly can we get those patients in and out ... The care is not there that was there 10 years ago," says Cindy Fetchen, a 42-year-old registered nurse who works in operating rooms at Hershey Medical Center. ***

A 10-year veteran nurse at PinnacleHealth says: "It is more greed, toward money. It is a business. It is not geared toward the patient." She points to the recent shutdown of adult outpatient mental health services by PinnacleHealth as one example. ***

Another veteran PinnacleHealth nurse who requests anonymity says that, because of the nursing shortage, Harrisburg Hospital at times has had only nine of its 19 operating rooms functioning.

The crunch means patients sometimes are processed in a hurry.

The nurse says she saw surgeons ask for patients to be brought into surgery with prep work incomplete.

In April, the state fined PinnacleHealth for that very problem, along with an apparent breakdown in the procedure that surgeons use to verify the identity of some surgical patients. ***

While nurses are frustrated, they aren't complaining in a vacuum. Hospital officials acknowledge, and even echo, their complaints.

"Our job right now, as far as I am concerned, is to listen to them and understand what is going on in their work life, and try as much as we can to respond to it," says Roger Longenderfer, chief executive officer of PinnacleHealth. "We use a significant amount of agency nurses and temporary help -- that's a very short-term solution. We'd much rather have our own folks in place, but that does help fill the gaps to some degree."

"What we want to pay special attention to is working to keep enough nurses on the front lines delivering direct care," says Darrell G. Kirch, president and chief executive of Hershey Medical Center.

Julie Miksit, administrative director of nursing at Good Samaritan Hospital, says creative solutions have allowed the hospital to retain nurses and keep patient safety at a proper level. The hospital has not resorted to mandatory overtime and patient care is not being compromised, she says.

Still, nurses agree that, whether patient safety is affected or not, the shortage robs them of time to give hands-on, bedside assistance, or consoling, friendly conversation -- some of the things that drew them to nursing in the first place.

Bonuses offered:

"My sister was diagnosed with breast cancer and died a year later. That strengthened my need to nurture. Sometimes I say, 'I'm going to leave nursing,' but then something happens to make me see the rewards," says Ivy Matthews, who works in the hospice unit of the VA Medical Center in Lebanon. ***

"I wanted to be a nurse since I was little. My brother was asthmatic since he was a baby. One day I stood on the porch while he turned blue, and I didn't know what to do. I wanted to be able to do something," says Lebanon VA nurse Penny Riehl. ***

Lawmakers have heard the hue and cry of nurses.

A bill introduced in the state Legislature would limit services that may be performed by unlicensed hospital personnel. Another would protect whistleblowers who report problems at hospitals. A third would mandate the Pennsylvania Health Care Cost Containment Council to collect information on the quality of hospital care.

Rep. Pat Vance, R-Silver Spring Twp., a former nurse, said remedies for the shortage might include establishing a "career ladder" to give nurse's aides more opportunities to become nurses.

Meanwhile, hospitals are going to great lengths to recruit nurses.

Holy Spirit and other hospitals offer "signing bonuses." Lancashire Hall nursing and rehabilitation center in Manheim Twp. has recruited 18 nurses from the Philippines, and 155 other Filipino nurses could be working in area facilities within the next few months.

The real key, many agree, is to think ahead.

"Trying to market nursing as a good career is where we need to go to attract people to the field," says Good Samaritan's Miksit.

"You need to look at recruitment in high school and in junior high and have people with a positive attitude talking about it," agrees Lebanon nurse Marie Garman.

The health care system may first have to heal the day-to-day experience of those who should be their strongest recruiters: the men and women on nursing's front lines.

Care diminished:

"The treatments may be given. The bandages may be changed," says Colleen Swisher, who works in an intensive care unit at Holy Spirit. "But, when they are in pain, or they are anxious, or they are emotionally distraught ... if somebody can't be there, they aren't getting the care they deserve. And that happens all the time." ***

One 19-year veteran says she quit her full-time job at Harrisburg Hospital because, as a nurse, "What they are expecting of you is physically impossible to do safely."

Her advice to the public: "Don't get sick. I'm serious." ***

Staff writers Jeff McGaw, Monica Von Dobeneck, Marylouise Gingrich, and Erin Fitzgerald contributed to this report.

http://www.pennlive.com/news/patriotnews/index.ssf?/xml/story.ssf/html_standard.xsl?/base/news/10000278103194738.xml

[tonchitoRN]

I would not want to be a sick person in a hospital nowadays. Too risky. You are lucky if you come out alive. I have seen too many bad nurses working the floors because all the good ones left. I don't blame them. Who wants to work in such poor working conditions. Who wants to risk their license when they work so hard for it. I always laugh when I go to legal lectures and they talk about the prudent nurse. In reality, the prudent nurse does not have an unmanageable patient load with the work responsibilies of 5 ancillary workers. This mystical prudent nurse has enough ancillary staff to meet the patient's needs, has just enough patients to attend to and can be at the patient's bedside in a matter of seconds when the call bell light goes on. Are you a prudent nurse?

[Mary Cleaver]

During the nursing shortage of late 1980s and early 1990s, I functioned as a staff nurse. The nursing shortage did not seem long and before you knew it, a surplas again. Incentives, bonuses, etc. were cut back. Now, in 2001, as a Nurse Manager, I see quite a different side. This nursing shortage, from my vantage point is more severe, and I predict will last longer. Depressing? Absolutely. Like my nurses, we want to give quality care and feel we have done a good job at the end of the day. Unfortunately, shifts go by and you wonder how you make it through without hurting patients.

Now, I could go on and on about the negative, but I can't and my nursing staff can't afford to dwell on it. We work one day at a time to cover our needs, the patients needs. Where would the patients be without us? Thats what I love about Nursing. We find a way... and with a smile on most of the time. Nurses work miracles everyday. Its not an easy profession especially during shortage, but the patients, our primary reasons for choosing nursing, are counting on us.

As a nurse manager, I try to be creative with incentives for good nurses to work more and cover the needs. I remind them that our service to patients matters, that this" too will pass", and thank them for hanging in there. I also recruit every chance I get. No, I don't make the highest salary, and yes its draining most days, but its worth it. Thanks.

m.cleaver