"The Many Sides of a Nursing Shortage"

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    April 23, 2002, by Ryan Alessi

    The many sides of a nursing shortage

    Amid the beeps and blips of medical machines, Kara Coullard calmly takes a needle and injects it into her elderly patient's vein. The fluid is supposed to rush through the woman's bloodstream to trace how swiftly her struggling heart is pumping.

    The patient just had her chest opened for double-bypass surgery. A team of doctors had delivered her to Coullard in the George Washington University Hospital's intensive-care unit only a few hours before.

    It was just the second heart patient Coullard had worked on, even though she has been in the intensive-care unit since she graduated from nursing school two years ago.

    "I was very nervous," Coullard said, glancing over at the monitor of numbers and zigzagging vital signs. "I said, 'Oh no, I don't know if I can take it.' The doctors said, 'Oh, we'll be right there to get you started. You'll do fine.' "

    Then they left the woman's life in Coullard's hands.

    It's routine that once a procedure is finished, doctors rush off to the next. Their time is spread thin. It's the nurses who hold patients' hands, keep an eye on all those vital signs and rush to bedsides for special needs.

    But the nation's aging nursing corps has faced its own needs in the last decade. Hospitals have been bound more closely to their bottom lines, largely because of managed-care organizations. And nursing schools haven't been churning out enough new nurses to replenish the work force.

    As a result, some health officials fear that the decline in nurses over the last few years is only the beginning of what could be a 20-year shortage.

    "We've had shortages before," says Rep. Lois Capps, a California Democrat who is a registered nurse. "But we could see the signs a few years ago that it was not a quick downturn - not part of a cycle. And it's becoming critical for many hospitals across the country."

    Last summer, the American Hospital Association estimated that U.S. hospitals have a combined 126,000 nursing vacancies. Three out of every four open positions at a hospital is in nursing.

    In addition, the average age of nurses has risen steadily over the last 15 years to more than 43 years old, meaning a higher percentage of nurses will begin retiring over the next decade. At the same time, the U.S. Department of Labor predicted in November that demand for nurses will rise 21 percent between 1998 and 2008, in large part because of the aging population's need for health care.

    To stem the nationwide shortage, the government, a few schools and some health-care companies have begun campaigns to drum up more interest for the profession and offer incentives for people of all backgrounds to don scrubs.

    Capps, who was a school nurse for 20 years before coming to Washington, is pushing Congress to pass her bill, which would provide federal funds to pay for nursing scholarships, training of more nursing instructors, public service announcements for the profession and programs in schools to nudge young students toward nursing.

    Different versions of the bill, which was introduced last April, have passed in the House and Senate. Now a team of legislators is wrangling over which parts will become law. Among the biggest questions: whether to provide money for nursing faculty development, whether to pay other stipends for nursing students and whether to fund residencies for specialized nurses.

    Corporate giant Johnson & Johnson sponsored television ads featuring nurses from around the country collectively explaining why they do what they do. The ads began airing in February. The company also hosts a Web site, www.discovernursing.com, which includes a database of grants and scholarships for prospective nursing students, as well as a listing of nursing programs across the country.

    "That's a start," said company spokesman John McKeegan. "But the shortage of nursing (instructors) is just as severe."

    It is one of many threads that has been unraveling from the tapestry of America's nursing corps.

    Because nursing classes must be kept small - one instructor per 15 students at most - schools must hire more faculty members before admitting more students. As a result, many nursing programs have waiting lists one or two years deep.

    On the other end of the spectrum, some nursing schools can't find enough students. Overall, the American Association of Colleges of Nursing reports enrollment in entry-level nursing programs dropped from 127,683 in 1995 to 106,557 last year.

    Sue Dachenhaus, an administrator at San Marcos High School in Santa Barbara, Calif., knew nurses were in high demand. All she had to do was go down the street to Santa Barbara Cottage Hospital to see that.

    In May 2000, she and other teachers from San Marcos trekked to Bakersfield to visit a health academy for high school students, which sits across the street from a Kaiser Permanente facility. "We decided we could do something like that in our school," Dachenhaus said.

    Last fall, 10th- through 12th-graders became the first San Marcos students to parti
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  3. by   -jt

    Ive corresponded with the writer & he is doing more reports on this issue. Anyone want to give him your side of the story?

    <<Last summer, the American Hospital Association estimated that U.S. hospitals have a combined 126,000 nursing vacancies. Three out of every four open positions at a hospital is in nursing.>>

    Yes and a Congressional Research Report released to Congress by the GAO last May along with data obtained by the HRSA indicates that there are approximately 500,000 licensed, experienced nurses in this country who are not working in nursing right now. Many have said the reason is the working conditions - short staffing to save a buck, dangerous and unmanageable patient loads, forced overtime, poor compensation, inadequate benefits, lack of respect, and hazardous workplaces (lack of lifting equipment, lack of assistive personnel, lack of protections from workplace violence).

    Many have also said that if these working conditions were improved, they would consider returning to the bedside jobs. Simple arithmetic tells us that if there are only 126,000 open nursing positions in the nations hospitals, but there are 500,000 non-working nurses, we do not yet have a shortage in numbers of nurses. In fact, we currently have enough non-working nurses to fill every one of those open positions and then some, while new students are being recruited and educated in the profession for the future. The AHA's claim that "there are no nurses" is a fallacy.

    What we are seeing right now is not a shortage of experienced nurses - it's a REFUSAL of these nurses to work in the conditions the hospital administrators perpetuate.

    Nurses have been saying loud and clear all across the country exactly what it is they need to have before they will work in hospitals again (as listed above), so it would behoove the AHA to pay attention, start investing in their nursing staffs and make their facilities places where nurses will want to work.

    Correcting the problems that nurses say are keeping them away from these jobs would help alleviate some of the current bedside RN "shortage", but instead, healthcare administrators and the AHA fight tooth and nail against making these improvements, and are lobbying hard in our legislatures to see that laws forcing them to do so never come to be. Where is the logic?

    The fact is that nurses are out there right now and the present "shortage" of bedside nurses could end tomorrow if just a fraction of them came back to work.... and many would if the hospitals priority was patient care and quality nursing instead of profits-before-patients.

    So the question remains - what is the AHA doing to make the hospital nursing job more attractive to entice some of that large, potentially available pool of experienced nurses back to the bedside? Answer - "not enough".

    Last edit by -jt on May 1, '02
  4. by   MichelleRN1102
    You go, -jt!

    I've been doing research on the nursing shortage for a few years (started back when it was "predictions of a nursing shortage") and my results were motivating factors in my returning to school to get my degree after practicing as an LPN for five years.

    Driven by outrage that none of the local hospitals would even grant me an interview for a staff position since getting my RN license in November, I've become considerably politically motivated and proactive and my current research has led me to the same conclusions you mention in your post.

    I've written several legislators, nursing and hospital organizations and have created and maintain a website focused on gaining political support to legislatively CHANGE the way the hospitals collectively operate and treat their "valued" nursing staff. However, the only replies I have received have been "form letters" composed by someone totally removed and completely unaware of the immediacy of the situation.

    In any event, I couldn't agree with you more on the issues. Current research also indicates that the "shortage" is expected to worsen before it gets better, so we still have a few more years to have our voices heard! And, hopefully, they will listen...

  5. by   -jt
    Thanks. I recently wrote to our elected officials too. Only one replied personally ( one of my state assemblymen) and sent me a bound copy of a new report on the RN shortage that was done by a state legislative task force - headed by one of our Assemblywomen who is an RN - and convened specifically to assess the problem and possible solutions because of active lobbying by our nurses. The legislators wanted a clearer understanding of the issue because nurses and our state nurses association were saying one thing & the employers and AHA were saying a completely different thing.

    I was very impressed by the work the task force did - holding town hall forums all over the state with nurses, educators, and administrators - hearing all sides and then writing an official legislative report that hit the nail right on the head.

    I dont have a link to the report but I can tell you this - they get it. They definitely heard the nurses & have put forth OUR solutions as recommendations to the state for what needs to be done to solve the problem. They made repeated mention of working conditions as a cause & focused a lot on that when listing the necessary legislative course of action to curb the current shortage. Congress should be so responsive.
    Last edit by -jt on May 1, '02
  6. by   aimeee
    This article appeared in our Sunday paper:


    and this letter to the editor followed a couple days later:

  7. by   -jt
    <<Rita Brandt, a nurse recruiter at Lakeland Hospital in St. Joseph, said schools and hospitals have been working to eliminate the negative stigma nursing has gained over the last decade...."It's not the occupation of honor that it used to be," Brandt said. "When you (used to) say your mother's a nurse, people would say 'Oh, wow.' Now they would say 'What, is she crazy?' ">>

    It is an occupation of honor but nobody wants to kill themselves doing it. Thats why people think we're crazy - because they know now the conditions we are being made to deal with in our workplaces & the honor is just not worth it. The negative stigma comes in part because they see how their nurse mothers are being abused at work. Who would not be crazy to go into that field knowing what our kids know about the job? Another reason for the negative stigma is because nurses, their unsafe working conditions, poor compensations, and lack of respect from their employers has been in the news the last few years. Do they suggest we shut up about it all so we dont scare unsuspecting young people away? The bottom line is when they fix the problems we are talking about need fixing, a lot of this negative stigma will disappear.

    <<"We really dropped the ball 15 years ago when we were doing OK," said Brandt. "We stopped recruiting in the schools and we stopped promoting nursing as a career because we were doing OK. "We shouldn't have done that, and we know that now.">>

    so NOW they know it. But 10 yrs ago when we were telling them that they were manufacturing a shortage of crisis proportions and we were out there protesting it, they ignored us and saw only the $$$$$$$ that they were saving by getting rid of us. Does this person not remember mass "downsizing" (lay-offs) along with the lack of recruiting & hiring? They forced RNs to find out that there was still a good life after the bedside. This 10 yr debacle should be a whole chapter in business management how-not-to text books.

    <<"The problem now is the question of whether graduates are going to have that same type of longevity that our current nurses have had.">>

    not if they have the same working conditions we have now.

    <<As we were told years ago by a LRHS manager (still employed there), "Nurses are like pizzas; when I want some, I'll order them.">>

    And as we were told at more than one contract negotiations and by our managers over the years "nurses are a dime a dozen"....
  8. by   oramar
    "nurses are like pizzas" "nurses are a dime a dozen" I heard statements like this over the years myself. Like -jt says the people who made them are still sitting at their desk, picking up their paychecks and running up those big pensions. Why are they not being punished or penalized? Because they came in way in the black that is why, because of the bottom line. Personally I want to see them dragged through the streets behind wild horses. The jokes on me though, me and many like me who are no longer in the business.
  9. by   fedupnurse
    I work ICU. I work nights. I am the one who has to look ata patient and know something is wrong. Hopefully I will have time to look and thoroughly assess each of my patients. When I do find something wrong and try to get the attending to address the issue after 11pm, I get screamed at, cursed at and hung up on. I always call them back! But still. The public perception of nurses are that we are still the handmaiden of doctors. We are not given credit by anyone other than other nurses for the vast amount of knowledge we must possess and the vast amount of abuse, verbal and physical, we must endure on a daily basis. Hospital exec created this shortage and are doing a very poor job addressing it. Give us the respect we have earned and deserve, equipment that we need when we need it, a decent pension plan so we have something to show for innumerable years of back breaking work and pay us what we are worth. I don't know about all of you out there but we are responsible for human lives!!! That is only worth anywhere from 14 to 30 bucks an hour????? That is obscene! We should make what hospital suits make!!!! Then there would be no shortage!
  10. by   boobaby42
    The nursing shortage is a big problem everywhere. Do any of ya'll remember checking your patient's q15 min. after surgery? Taking v/s, assessing the patient frequently until stable. Then, pt assessments at least q2h? I never stopped, but that was the only way to properly care for your patients.

    This spring, my nephew had surgery. I was so disappointed in the nursing care he received. After returning to his room from recovery, he was visited by a nurse once for a report from the recovery room nurse, then 3 times in 6 hours. One of those visits was requested by me for pain medicine. The doctor told us he had prescribed Tylenol with Codeine q4-6 hrs prn pain. The nurse, pulled from another floor, came in with plain Tylenol. When questioned, she said that it was what the doc had ordered. I know the protocol and I know she was wrong. I felt sorry for everybody. Anyway, my nephew was still in pain and we requested more medicine. This time, she brought in the correct medicine. Dang it, it's not fair for a patient to suffer because of this type of negligence or whatever you want to call it. This example is nothing compared to some, I'm sure. You are better off just going home with instructions from the doctor.
  11. by   Furball
    Plain tylenol for immediate post op pain control!!?? I'm sorry but that "nurse" must've been a nitwit.
  12. by   PhantomRN
    I doubt she was a "nitwit"...I hate to see lateral abuse of ourselves.
    It is more than likely she was running around like crazy, checked the med sheet and read tylenol, but in her rush did not see the codeine part. If she had a free second I am sure she would have questioned why a fresh post-op only had tylenol ordered.
  13. by   PhantomRN
    Another thing they failed to mention in the article is that yes maybe a new grad will start out at 35-37000 a yr, but she will only be making 40-45,000 in 10 yrs. NO progression.
  14. by   -jt
    <The nurse, pulled from another floor,....... Dang it, it's not fair for a patient to suffer because of this type of negligence or whatever you want to call it.>

    Exactly the reason that nurses are protesting the reliance on this kind of short-staffing-to-save-a buck nursing care delivery. Working in an unfamiliar environment & with an unmanageable pt load sets us up for mistakes. Thats why nurses are protesting this all over the country. The flawed system and administrators who perpetuate it are more at fault than the nurse who is forced to work in it. Recently a court decision absolved the nurses of blame for a case of poor pt care & held the hospital responsible for its short staffing practices which led to the incident. The hospital was sued - the nurses were cleared.

    Before jumping to call the nurse a nitwit or claiming she was negligent, Id ask how many pts she had, what was her experience level, was she ever even oriented to the unit she was floated to, to the type of pts it cares for, to its paperwork and routine, how many hours she was working, and what was the staffing & acuity of the unit like that day? The answers may show that, like in this recent court case, it was the hospital that was negligent - to both the pts & the nurses - leaving them at risk for mistakes to happen.
    Last edit by -jt on May 12, '02