CNN/Modified chat transcript

[essarge]

I copied this off of the CNN site. This is a modified transcript from the chat they had yesterday. Did anyone get their questions answered during the chat?CNN’s Dr. Sanjay Gupta: U.S. Nursing shortage

Dr. Sanjay Gupta is a CNN medical correspondent and regular contributor to the weekend program "Your Health."

CNN Moderator: Has there always been a nursing shortage, or is this really a very different situation from staffing levels in the past?

Dr. Sanjay Gupta: There have been nursing shortages in the past not too different than one we're having right now. The big difference at this point is that we're seeing a problem both in the supply side and the demand side. That is, while the number of nurses has decreased there has also been a significant increase in demand as the baby boomers have become reliant on the healthcare system. So, that makes this nursing shortage different and perhaps worse than ever before.

Question from chat room: Many nurses are blaming hospital administrations for the hours and pay. How do they respond to these allegations?

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Nursing facts

Number of licensed RNs:

2,696,540 (2000)

2,558,874 (1996)

Nurses working full time:

(of the licensed population)

58.5% (2000)

59% (1996)

Average education:

2000

Diploma 22.3%

(about 609,000)

Associate 34.3%

(about 925,000)

Baccalaureate 32.7%

(about 881,000)

Master's/

Doctorate 10.2%

(about 275,000)

1996

Baccalaureate 31.8%

(about 672,914)

Master's 9.1%

(about 193,159)

Doctorate .6%

(about 14,300)

Average pay (full-time):

$46,782 (2000)

$42,071 (1996)

Source: U.S. Department of Health and Human Services

Dr. Sanjay Gupta: The American Hospital Association along with specific hospital administrators have tried different things to try and combat the nursing shortage. One of the most contentious things has been mandatory overtime. Most recently there has been legislation that has been introduced in Congress to try and ban this practice. Efforts are not being focused on trying to increase the number of nursing assistances and LPN's to try and help alleviate the burden on registered nurses.

CNN Moderator: Have there been other movements to restrict mandatory overtime before? If so, why haven't they worked?

Dr. Sanjay Gupta: There haven't been efforts that I know of at the legislative level. Specific institutions have banned mandatory overtime and gone to a system of voluntary overtime. The problem has been that sometimes there just haven't been enough nurses to fill the entire time slot and one of two things would happen. Either nursing floors would be shut down and patients even turned away or the nurses would be required to work overtime shifts. It's a tough problem.

Question from chat room: Is it legal for hospitals to require mandatory overtime?

Dr. Sanjay Gupta: It is interesting. There are many overtime protection laws that exist such as those for airline pilots. However, because of certain provisions in the law healthcare workers have been exempt from these protections. This may change however with the new legislation in the House and with the many champions of nursing on the hill.

CNN Moderator: There doesn't seem to be a similar problem for doctors -- why not? Is the pay/prestige difference a factor?

Dr. Sanjay Gupta: With regards to the hours, the problems are very similar. While there is not a perceived shortage of doctors at this time, the hours that doctors put in are not protected by the overtime protection laws. I would add that the American Medical Association is the body largely responsible for regulating and monitoring the number of slots for physician training programs. This ultimately controls the supply and demand of doctors.

Question from chat room: If reimbursement to hospitals has improved why have nursing wages stayed stagnant?

Dr. Sanjay Gupta: The reimbursements to hospitals have improved in some parts of the country, but not all. Overall, the balanced budget agreement of 1997 relies significantly on cutting medical costs as part of controlling the deficit. Therefore, it is likely that the reimbursements to hospitals will decline over the next few years.

CNN Moderator: Don't hospitals face liability issues with overworked nurses/doctors? How are hospitals dealing with the problem?

Dr. Sanjay Gupta: There certainly are liability issues and there have been lawsuits that have been presented. The lawsuits focus primarily on negligence of duty. In the past, while it has been noted that the nurse or physician may have been up for a long time, it usually was not the most important part of the case. These types of liability issues focus more on "did the harm result from negligence?"

Question from the chat room: What are your suggestions for the retention of nurses with experience? Everything is geared to the recruitment of nurses. How about keeping the ones with experience?

Dr. Sanjay Gupta: Yes, you are right. From my research it also appears that most of the programs focus on recruitment. However, it is becoming clear that the more experienced nurses have much to offer in terms of not only their skill but also perhaps their ability to teach younger nurses. Legislators on the hill have supported programs that ban mandatory overtime and perhaps more importantly allocate more money for improved salaries over the next several fiscal years.

Question from the chat room: How will the new IOM report on medical errors affect staffing ratios?

Dr. Sanjay Gupta: the American Hospital Association, the American Nursing Association and Congress, by whom it was mandated, are taking The Institute of Medicine report very seriously. It is unclear as to what changes will occur specifically due to the IOM report. Certainly it will increase public awareness about this issue and possibly lead to improved and safer conditions for patients.

Question from the chat room: What are nurse's salaries like today in comparison of say other professions?

Dr. Sanjay Gupta: We found the average nursing salary around the country was in the mid $40K range. The nurses that I spoke to indicated that the salaries had not increased in line with many of the other medical professionals.

Question from chat room: There is a rapidly growing trend in "contract" nurses (as opposed to traditional full-time employment). How does this impact the quality and cost of patient care?

Dr. Sanjay Gupta: The contract nurses and perhaps traveling nurses as well do tend to offer a wide breadth of experience. The interesting thing that I found was that since traveling tends to appeal to younger nurses, this population of nurses appeared to be more concentrated with recent graduates and nurses who were interested in either operating room, intensive care unit, or the emergency room. I have not heard specifically that contract nurses were either more or less safe than permanent nurses in hospitals. Tomorrow we will be talking to a traveling nurse and addressing that very issue.

CNN Moderator: Do you have any final thoughts to share?

Dr. Sanjay Gupta: The nursing shortage issue has captured the attention of everyone that is affected by the healthcare industry. From hospitals to the legislators and non-profit organizations, there are many that are trying to come together to find a solution to this agreed upon problem. We at CNN were delighted to be able to promote public awareness about this issue during this week, National Nurses Week.

CNN Moderator: Thank you for joining us today.

Dr. Sanjay Gupta: Thank you very much for coming. I look forward to being here often.

Dr. Sanjay Gupta joined the chat room via telephone from Atlanta, GA, and CNN provided a typist. This is an edited transcript of the chat that took place on Tuesday, May 08, 2001 at 1 p.m. EDT

To me it didn't really say anything that we didn't already know....kind of reminds me of the politician who got "caught" and just beats around the bush!!!

[Mijourney]

Hi essarge. I had originally planned to tape the series, but that fell through. I caught a couple of the short clips moderated by Dr. Gupta. I understand that he is CNN's medical expert, but it would have been nice to see a nurse moderate the series on the nursing shortage during nurses' week.

I suppose CNN thought that the shortage would have more legitimacy in the media if covered by a physician than a nurse. Perhaps they thought if a nurse moderated that series that it would have looked like whining from another special interest group?

I will tell you that the series has had some effectiveness in getting across the fact there's a shortage. My neighbors and patients have been telling me they have seen some of the series.

The problem is that these people still do not realize that they need to get actively involved in promoting support for nursing so that their needs can continue to be met. There's only so much I can do for my patients without allowing myself to get completely run down.