Nursing shortage has reached critical levels. That alarming iconic statement is a sign of the times, and it is broadcast daily in the media. Of course, the crisis is blamed on the Coronavirus. Assuredly, everyone in healthcare at this moment in history, nurses specifically, is overwhelmed, overworked, overpowered, and overcome with exhaustion to the point of being totally over it. Yet this nursing crisis did not start with the first COVID case in the United States or even after the first 39 million patients diagnosed with COVID. It has been a slow, relentless, insidious scheme occurring over decades.
Do you remember the nursing shortage of the 1970’s? That’s when nurses first began to work 12 hour shifts. Was that because nurses were demanding 12 hour shifts? No, there were not enough nurses to staff three shifts. In addition, hospital administration was in favor for obvious reasons. Less staff meant less salaries and benefits, and therefore, more revenue.
About the same time period, hospital and healthcare organizations began to merge. Originally, the intention was to decrease costs and standardize care through electronic medical records, joint purchasing options, and more efficient coordination of patient care. Unfortunately, studies have shown that hospital mergers only increase costs. Huge healthcare conglomerates mean costly administrative bureaucracies, enormous marketing expenditures, and decreased competition. Decreased competition is the gold standard for business models today. When a hospital system controls the market, they can exercise their leverage to negotiate higher prices with insurance companies. As a result, Insurance companies raise rates to cover the hospital expenses, and the patient is the one who suffers due to inflated insurance premiums. Furthermore, there are fewer diverse employment opportunities for nurses and hospital consolidations slow wage growth.
How have hospital acquisitions affected nurses? Nursing satisfaction scores have decreased with hospital mergers. Nurses have more responsibility and less support staff. Not surprisingly, an increase in musculoskeletal injuries has also been reported. Twelve hour days that are consistently fourteen hour days lead to emotional fatigue and physical exhaustion. Turnover rates are high. Nurses leave, either for a change of venue in the clinical realm, which can be difficult since there is very little choice among the corporate monopolies, or sometimes to find a completely new profession. New people are hired and an already frustrated, overworked, mentally strained staff is expected to mentor new hires. It is a continuous vicious cycle. All of this results in mistrust of administrators and the organization as a whole. Obviously, this type of work environment is less than optimal.
Furthermore, multiple studies over the last two decades have demonstrated that nursing satisfaction scores demonstrate a positive correlation with patient outcomes. Aiken and associates demonstrated that hospitals with higher ratios of patients per nurse were more likely to increase the odds of nurses reporting poor quality of care and patients were less likely to rate them highly or recommend the hospital. Research studies by Perry and associates demonstrated similar results. Units with less than satisfied nurses have more medical errors, falls, nosocomial infections, and poorer patient outcomes.
Over the last 4 decades, nurses have been bombarded with overwhelming demands, increased liability, an upsurge in negative workplace experiences, even to the point of physical violence, increased work injuries, and less support and empathy from leadership. Policies and protocols dictate tedious documentation. Hospital policies, federal and state regulations, and joint commission requirements are lengthy and arduous. Provider organizations and private insurance have adversely impacted the delivery of nursing care. Who has time to care for patients when the list of duties and requirements grows exponentially? In truth, nursing care is no longer meeting the physical and emotional needs of the patient, instead we cater to the demands of an indifferent corporate system that monitors profit margins and struggles to constrain litigation. A prime example of corporate disregard for nurse demands is being expected to go to other units to work, units we have not been trained on, units that have certain responsibilities we cannot perform due to lack of training or certification. What does that mean? Another nurse has to help the nurse who has been pulled to the unit, performing various tasks such as administering chemotherapy, explaining orthopedic medical devices, or just helping her find the correct supplies. This situation only increases the workload for both nurses, which means increased anxiety and emotional stress. What is the likelihood that nurses will give a positive rating to those types of work environments? As previously stated, a dissatisfied nurse is a dissatisfied patient.
Another flagrant disregard for nurses is the lack of representation on hospital boards. There are 3.8 million registered nurses compared to approximately 1 million medical doctors in the United States, but what is the composition of the hospital board? It is very disappointing to discover that hospital boards are made up of doctors and business leaders. Nurses are front line caregivers and should be included in developing patient care policy. Nurses are essential to everyday patient care and they understand better than anyone the daily operation of a hospital, but there is an obvious lack of nurses on hospital boards across the country. In fact, there is a definite scarcity of nurses, pharmacists, respiratory therapists, and physical therapists, the staff that are the matrix of the hospital environment.
Surprisingly, the hospital workforce has grown by nearly 75% between 1990 and 2012, according to an article in the Harvard Business Review, but for every sixteen non-doctor workers, ten of those are management and administrative roles. At first glance, one would assume the remaining six are nurses, which is still a negative percentage, but the real facts are even worse. The remaining six are the entire clinical staff, including nurses, allied health professionals, medical assistants, and care coordinators. Is it safe to say there are too many captains and not enough crew? Sadly, nurses have been advocating for safe staffing guidelines for over 20 years without any meaningful change, but the non-clinical workforce has increased significantly. Not only do the executive positions multiply, but corporate salaries continue to skyrocket. Still hospitals choose to understaff frontline workers and demand unrealistic expectations at the expense of the staff and the patient.
Nursing is a call to care. It is a passionate commitment to care for those who are sick, injured, disabled, or dying, as well as offer support to their family members. Unfortunately, the healthcare model of today does not feel that same level of responsibility. The idea that caring for patients is a selfless, noble profession dictated by a higher calling no longer exists. Healthcare is defined by a business model, governed by corporate executives that have never even had an opportunity to see a patient much less observe the daily workings of a hospital.
Our healthcare system, in the name of progress, quality patient care, and strategic cost reduction, has exploited nurses and left patients without adequate resources to obtain satisfactory healthcare or even maintain a healthy lifestyle. Nurses are required to work long hours, they are expected to work in areas in which they are not adequately trained, and there is never enough staff to physically care for patients much less educate them regarding a diagnosis, prescribed medications, or discharge instructions. The end result is that patients suffer harm due to hospital medical errors, and patients are discharged without necessary education or supplies.
Changes are long overdue. Just as Nightingale commanded a new dialogue around nursing and patient care 150 years ago, today’s nurses must come to the forefront of designing safe patient care strategies. We must demand access to equitable healthcare for everyone, we must demand a seat at the table of corporate boardrooms, we must demand a safe supportive work environment for ourselves which ultimately delivers safe and supportive care for all patients. To achieve our goals, nurses must stand united as a powerful voice and advocate in our workplace, our schools, and our communities, and petition our state and federal legislatures to advance the cause of safety for nurses and patients. Time is of the essence.
References/Resources
Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States
Changes in quality of care after hospital mergers and acquisitions.
The impact of workplace violence on medical-surgical nurses’ health outcome: A moderated mediation model of work environment conditions and burnout using secondary data.
Chapter 24: Restructuring and mergers. Patient Safety and Quality: An evidence-based handbook for nurses.
The downside of health care job growth.
Nurses on Boards Coalition. Nurses on Boards: The time for change is now.
The effects of nursing satisfaction and turnover cognitions on patient attitudes and outcomes: A three-level multisource study.
