My "Horoscope" for Nursing Shortages

My horoscope tells me that nurses are fortunate to do what they hoped and planned for, even if the circumstances need fixing and more RNs are needed on the job. It is good to be satisfied working full-time in a safe area and receive fair or better compensation. Despite the scourge of Covid, many nurses can be choosy about their employers and find jobs where the disease is mild. However, fair wages and pleasant working conditions are often ideals and unrealistic across the nation.  There are over 3.2 million nurses (13% men) in the U.S., but where and when are all the future nurses coming from¹?

The reasons why new nurses are not hired are possibly more important than the issues with nurses themselves. The causes of nurse shortages are well known and hardly new, except for the ongoing Covid pandemic crisis,  and it remains a valid reason for leaving nursing. Generalizations are difficult,  considering diverse years of experience, type of work or specialty, e.g., ER, the kind of facility, and the specific location. California, South Carolina, Nevada, and Texas have the greatest shortages while low populated states-- and Massachusetts have the highest percentage of nurses. Up to about 275,000 additional nurses will be needed in the next eight years, according to the U.S. Bureau of Labor Statistics and up to one million in the world². No one can say whether the nurse should work at a very stressful challenging job for high pay or an easy one for low pay. The old solutions have failed to work in the long run because the priority for increasing RNs in hospitals is not first or doubtful, and thus a fundamental change is needed. All big businesses demand and expect major profits, including not-for-profit enterprises and charities. No one wants to admit this in the mainstream media, though skeptical outsiders have said this for decades. Large nonprofit businesses, especially hospitals, universities and organizations may accrue millions in profits, though this is not its express purpose. When businesses say it is not about the money, it is about the money.

Clearly, physicians and nurses are the lifeblood of the hospital, and therefore executives should be working for the needs of the medical staff,  not the reverse. Marketing and finances are important, but obviously not the mission of hospital care. Certainly, this work is on a higher level (literally and figuratively) because they oversee the entire business enterprise that serves the whole medical facility, not individual patients’ well-being; even so, it’s questionable they deserve double the salaries of many nurses. Salary and wages reflect the value and importance of occupations in society, at least that is the perception.  This indicates that administrative labor is valued greater, or worth more than the labor of nurses--but their work is crucial day to day—not administrators! Large metropolitan healthcare is a lucrative business, in some ways like corporations with similar profit-making values. Executive-level departments resemble businesses across many sectors: human resources, advertising, and revenue enhancement, to name a few.  Nurses (and doctors) are generally categorized as human resources, a broad inaccurate term for all employees, including maintenance—euphemistically, environmental services. An article in The Nation stated that hospitals hire less nurses to save money rather than replace the vacant jobs, and because nursing assistants cost less and are more expendable-- despite that good nurses make a big difference, even when they are not saving lives³. One might well say to administrators-- don’t ask what nurses can do for you, but what you can do for nurses.

Executives advance significant increases in admissions and out-patient services, long-term planning, and other programs, and distance themselves from bedside patient care, the newest treatments and cures. Consider upper management executives with high six-figure salaries. They may not be fully aware of how nurse shortages affect bedside nurses and patients whose mortality or suffering rises as a result. CEOs know the data, but probably only a vague understanding of the different varieties of patient experiences.  Patient turnover is referred to as ‘heads in a bed’ (no pun intended) by upper management. Generally, the further up the rank, the management has less knowledge of actual customer/patient services and the immediate consequences. If hospital salaries are reallocated, marketing advertising staff and diversity officers might be cut where they are unnecessary. The salary of one upper management job could be transferred to hiring two beginning nurses. The positions of vice-presidents earning $200,000 could possibly be eliminated, and additional nurses hired. Also, unessential building projects that seem questionable, expensive, or that foresee a low likelihood of patient visits are dispensable.

The situation is somewhat similar to the dilemma in higher education. Adjunct faculty in nursing are paid rather lowly, compared to full-time professors, and administrators pay themselves nicely. They acquire all the respect and power while adjuncts receive little and are regarded as temporary, even after ten years-- expendable supplemental staff. Supply and demand theory explains only part of this because of the low priority for hiring faculty and with lower wages for online and campus courses. General Studies instructors in nursing programs are more plentiful, unlike professional nursing adjunct faculty but sometimes with lower student enrollments. Part-time teaching jobs do not make a living wage; basically, it is only supplemental income. My best guess is that the current shortage of nurses and faculty with unfair wages will continue, even in wealthy hospital systems and schools. The future graduations of students in nursing schools that surpass the 155,000 annual new nurses will not solve the long-term shortage. Economically, it is possible that the increase in new RN graduates is offset partly by nurses retiring, leaving their jobs, and the pressing need for nurses at present. Then there’s the balance between raising the wages of current nurses or hiring new ones for less, assuming that veteran nurses aren’t needed for some jobs. Some nursing schools must spend more on advertising, expanding their classroom space (or go online), and increase computer resources and books. As a former professor who taught nurses (and other professionals) for years, I have doubts about the lax educational quality of distance learning in medical professions and hope that coursework requirements are stronger and more stringent.

Working conditions might be improved and problems ameliorated, but unfortunately, when one problem is resolved, two more often arise. Ideally, the shortage would be helped if nurses possessed finer coping or tolerating skills, got department advocates or ombudsmen, and make the decisions about patient-nurse ratios. Overworked nurses experience burnout with more serious consequences than other essential human services. Shortages and burnout can lead to more errors and higher patient deaths⁴. Jobs have differing degrees, caused by chronic physical or mental exhaustion, low morale, physical violence, and workload. Yet some nurses do receive extra gratitude, but appreciation does not pay bills.  Employers instill the idea that everyone is dispensable and interchangeable with another or a computer. (One Chicago college board member said to my local union that they have money, but you’re still not getting a raise). We all think our wages should be increased, even if our pay is high or highest because we tend to value our work effort and achievement greater than others. Nurses who earn $120,000 a year may feel underpaid, as well as ones who earn half as much.

The nursing shortage does not affect all nurses, of course, and this problem will not worry those who are happy in their situation. When we can loosen the power and danger of the Covid pandemic, fewer nurses will quit, more will enter the profession and the "horrorscopes" will become great horoscopes. At least Libra nurses keep their balance and Aquarius is said to be the smartest.  (This is astrology, not my belief).            

References

^1,4Amid Shortages and Burnout, Could Adding More Men Ease the Nation's Nursing Woes?

²National Library of Medicine: Nursing Shortage

³There Is No ‘Nursing Shortage.’ There’s Just a Good Nursing Job Shortage.