VU researcher says pay, grants can help solve nurse shortage
By JACK HURST
The Tennessean, June 2, 2002
An evolving nursing shortage that eventually will paralyze the nation's health-care operations can be averted by a ''policy commitment'' from national to local levels, a distinguished Nashville medical researcher said last week.
Lawmakers, federal agencies, ''the private sector, the Medicare program, employers, nurses and ''even the military'' must become involved, said Peter Buerhaus, senior associate dean for research at the Vanderbilt School of Nursing and co-author of findings published Thursday in the New England Journal of Medicine.
''Without nurses, they (all) are going to be in big trouble, and the military is worried,'' Buerhaus said.
Buerhaus and Jack Needleman of the Harvard School of Public Health led a massive study of 6 million patients at 800 hospitals in 11 states.
They found that shortages of registered nurses already are affecting the care of both medical and surgical patients in the 200 lowest-staffed hospitals in several categories: prolonged length of hospital stay, increased infection, pneumonia, shock or cardiac arrest and gastrointestinal bleeding. The shortage also means a decreased chance of any of those events being noticed by hospital staffers in time to prevent death.
The Vanderbilt researcher said that the antidote for this worsening illness in the nation's health-care system can be found in higher pay for nurses, wide advertisement of the need for them, and grants and scholarships making it easier for them to get an education. But research done by Buerhaus and his colleagues and sent to Congress last fall with five other studies so far has seen resultant legislative efforts sidetracked in a conference committee for six months.
Groups and firms closer to the problem are no longer ignoring it. Buerhaus noted that the American Hospital Association recently released a report on the nurse work force, the Joint Commission on the Accreditation of Healthcare Organizations has assembled a task force to study it, and Johnson & Johnson has inaugurated a two-year, $20 million campaign to promote the profession.
In Tennessee, hospitals are developing recruiting strategies. Retiring Deputy Health Commissioner (and registered nurse) Ann Duncan said many are offering sign-on bonuses for nurses who agree to stay at hospitals for six months and other bonuses for those staying three years.
''There's a large health-care industry-not just hospitals-competing for nurses,'' said Duncan, who this week becomes head of the Tennessee Center for Nursing, a private nonprofit corporation to study and develop solutions to nursing problems.
''Other people recruiting registered nurses are home-health agencies, schools, public health (offices) in all 95 counties, insurance companies using them for case management, rehab centers, mental health (facilities).
''Unfortunately, some of these other places cannot be so generous in the salaries they offer. Then the schools of nursing have to have nurses as faculty, and the same problem is facing the schools of nursing as is facing nursing in general.''
Buerhaus said the accelerating nursing deficit is occurring at a time of a burgeoning health-care system and the inexorable aging of the American population it serves.
Because of the rise of the managed-care industry, he said, prospective patients who are ''less sick'' are being denied hospitalization, so that those admitted are ''sicker'' and ''older'' on average than they were two or three years ago.
''So they require a lot of nursing care,'' Buerhaus said. ''The (nurse's) work has increased in intensity and there's more of it.''
That is one reason the impending crisis has developed, he said, and he went on to list several others:
* The number of under-30 RNs in the work force has ''dropped like a stone over a cliff''-41%-in the past 15 years, so that now just 9% of all the RNs working in America are age 29 or under. Twenty years ago, that age group was nearly 35%.
* Intensive care units and other high-stress departments that traditionally have attracted younger RNs now increasingly are having to be staffed by older ones, with the ''oldest'' nurses ''working in operating rooms and post-anesthesia recovery units.'' Buerhaus said he and his colleagues have ''found that these older RNs are well into their 50s and have been retiring'' because ''their bodies just can't take it anymore.''
* The booming national economy of the late 1990s encouraged the spouses of the overwhelmingly female nursing population to encourage their wives to ''switch from full time to part time or just leave altogether.''
* Taking into account the rate of inflation, the wages of RNs have fallen in all but two years since 1993 on a national basis-''so as wages have not been rising and (work) demand has been increasing on nurses, this has created an incentive for nurses not to work.''
Buerhaus said projections based on research by himself and his colleagues show that the nation will lose 450,000 nurses by 2020, ''which would paralyze the system.''
Meanwhile, that same system will be under the ''pressure'' of caring for ''all these aging Baby Boomers.''
''It's going to affect us (all) personally,'' Buerhaus said.
''This one's got us in the bull's-eye.''
Jun 6, '02
teamRN, we are all professionals. Being a union of nurses does not diminish that - especially not when what we have obtained by unionizing is a measure of control over our professional practice & the hospital decisions that affect it. If you already have that without having to fight tooth & nail for it, thats great! Id keep that job!! Magnet award winning hospitals are like that & some of them are not unionzed either. They have a different philosophy than most other administrators & their staff nurses dont have to fight for every inch. They usually have no nursing shortage either - because they show how much they value RNs - compensate them well, view them as equal partners & include them in the decision making. Unfortunately, most of us work for corporate vultures who have said nurses are just a dime a dozen - & thats how they treat us.
The ANA has described collective bargaining for RNs as a "professional imperative" and the most important thing we can do to safeguard our professional practice and our patients.
The strength of any union depends on the leadership & the involvement of the members. In ours, there is no outside third party speaking for us - the staff nurses themselves are "the union" & we speak for ourselves at our facility - with the strength of a collective voice, the expertise & resources of our organization, & union labor laws behind us - something we did not have when we spoke individually (& were ignored) without being unified as a recognized organization of nurses. By us unionizing, the employer was forced by law to pay attention to us & share control with us.
I have been an RN for 20 yrs too - things have changed since you & I first came into the profession. Individual nurses now are talking till theyre blue in the face about unsafe conditions and are being ignored - the suits are not changing their unsafe, abusive practices for them & they dont have to. Nurses who dont have any other option just leave the job or the profession. But unionized nurses have the protection, resources, & support to fight for our profession & force administrators to change these practices. Thats how change is happening & the standard is being raised. The media blitz bringing the crisis to the publics & legislators attention has been thanks to the unions & associations of nurses across the country. They are also responsible for just about every piece of federal & state legislation that addresses the issues of the nursing crisis & unsafe working conditions.
It would be wonderful to work in a place where you could just go to the administrator & say "listen, 18 hrs forced overtime is dangerous - we cant be doing that." And the administrator says "ok I respect your professional opinion so there will be no such thing as forced overtime in this facility - and the nurses will have manageable, safe pt ratios too AND an aide to assist them".
But for most of us, thats not what happens - unless you are a union of nurses & can fight for it.
Last edit by -jt on Jun 6, '02