Tenn: Peter Buerhaus-- Solutions for the Nursing Shortage

  1. VU researcher says pay, grants can help solve nurse shortage
    The Tennessean, June 2, 2002
    Staff Writer

    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.

    Tennessee's efforts

    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.''

    Multiple factors

    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.''
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  3. by   live4today
    What goes around always come back around. They crapped on us as nurses, now they're eating their own crap for doing so. When will they ever learn. :chuckle
  4. by   eltrip
    All I can say is DUH!!!!!
  5. by   oramar
    "older RN are well into their 50's & have been retiring because their bodies can't take it anymore" I used to have this vain hope that someone would see the light and try to accomidate people my age. I am starting to realize that the predjudice toward older nurses or nurses with health problems runs very deep. This guy notes the problem but does not even suggest changes that might keep old timers a few more years and temporarily ease the problem. I take that as a validation on his part of the way the system currently functions.
  6. by   teamrn
    Can't we help by offering a few solutions? I know we all feel crapped around for a long time (or many of us do); but if we entered nursimg for the right reasons, with the heart to care for patients and compassion to see beyond others faults, maybe we can begin brainstorming and offer a few potential solutions.

    I'm not so pollyannaish to feel that legislation and all the powers that be (CEOs, suits, politial action committees) will listen to all we say, but I really feel strongly that nursing needs to have a STRONG VOICE in its OWN future, or we'll be CRAPPED upon again, only this time in thee minds of American people, as well as everyone who is with us. (How many of you have considered the Million Nurse March in Washinton this summer?)

    May I suggest that millions of dollars that are spent on studies of non-essentials (not in any way related to health-care, defense or other essential goods and services) be 'tossed' in the direction of nursing? A sort of ad-campaign/media blitz to work on nursing's image and retore RESPECT. We learned to prioritize in nursing school; how 'bout REQUIRING that our legislators do the same?

    Also, the outcome of these 'studies' will be totaly irrelevant if over the years there are no nurses to care for patients; and friends, don't you feel we're approaching this scenario.?

    Fortunately, everyone in this democracy is entitled to his/her own opinion of what constitutes essential vs. nonessential goods and services, but we need to make some HARD choices in these hard times. I spend much less money supporting Hollywood's millions/billions/trillions and demand that they get involved. I also try to do my part by watching legislative TV and letting those representatives know when they stop 'representin'g me!

    We can also educate the public about safety of our health care system; apparently, the messages about crisises and shortages fall on deaf ears, but we can appeal to their deisres for SAFETY, and they in turn can realize that nurses were the ones who cared.
  7. by   Peeps Mcarthur
    Nursing is evolving before our eyes.

    The suits have managed to keep the value of a nurse hidden in the charges for the room. Like any other supply its value can only be measured if you in fact have it on hand. The supply's value becomes greater as its on-hand total drops unless it can be replaced by another type of suitable item.

    As we all know, a nurses training is comprehensive. As difficult as it is we know it's just the beginning of what a nurse will become. One year, two year and four year programs, all comprehensive for the job description yet still pretentiousely calling themselves "trained". It takes years of bedside nursing in order to function within the current enviroment that the cost-cutting suits have created. With experienced nurse leaving for many years now, the neglect is starting to show.

    The corporations have an interest in getting the most work out of the least number of workers as an old school corporate strategy. It's as if we were all in a timewarp to the Great Depression. Long ago when they got into the healthcare business there was a surplus of nurses trained under the previouse way of doing things. That method of revenue is becoming obselete as there are less and less nurses that can do the job of two or three with the same skill level or that are not willing. The suits created a new enviroment but left the previouse species of nurse to adapt to their harsh conditions. They thought nursing would just evolve somehow without any sort of development on thier part.

    Now it is obviouse that the nurse IS evolving. Unable to adapt and become just another supply on the ledger sheet, nurses are migrating away from the bedside. Strategies to lure them back are heavily weighted in favor of the corporations. As an example I would have to cite the most degrading one I know of, the "scholarship". I'll use the hospital in my area as an example. The hospital offers up to $3000 a year for tuition...but wait,there are just a few conditions to be met: You can't apply until after Nursing 101(highest tuition cost) You must work as a patient care tech$9/hr($2 less than the going rate).......................THE KICKER: You must complete 2 years of employment for each year of tuition or you must pay it back. A completely insincere effort.

    This program was most likely funded after a study like this one. I imagine the corporation can also write it off as loss somehow.

    I can't imagine what a living h$ll that 2 years of forced employment would be With no motivation to retain you since the total investment on thier part was practicly nill. The sacrifice for fixing the shortage again falling on the weary heads of the future workforce.

    Some of the other offers from suits has sounded just as empty to me such as hiring bonuses spread over three years that are half taxes going to the government and coming right back to the corporation as loss.

    I think corporations understand that they don't want unions sprouting up all over the place. After all, if nurses decide what they want, these programs their offering would be laughed off the table.

    What other vehicle is there for the usage of this data? The shortage is not going to be fixed by the suits but simple supply and demand. The only way to control the supply of nurses and therefore the value, Is to be able to cut off the supply on demand, decide who will get the supply under what conditions. That would point to unions. It's the only thing I see working.

    As one study after another has shown, they need more nurses. Thier strategy has used up the reserve and the future is coming.
    Those that control the supply will thrive.
  8. by   -jt
    <That would point to unions. It's the only thing I see working.
    As one study after another has shown, they need more nurses. Thier strategy has used up the reserve and the future is coming.>

    I agree. Interestingly enough, there are now executive groups, JCAHO, & the AHA talking about nursing union contracts & looking to see what it is exactly that we are obtaining for ourselves that they can also give to their employees - before their employees get the idea to unionize. Any improvements in a non-union facility are based on what unionized nurses have already fought for, won, & obtained in written guarantee. Lots of nurses say they "dont believe in the U word", but they can be glad that there those of us around who do - because what unionized nurses accomplish from state to state is the only way things are going to get better for any of them.


    Also very interesting was a nursing managment study that surprisingly found that pts have better outcomes in unionized hospitals than in non-union hospitals:

    news release:
    JONA says Nurses Unions Decrease Pt. Mortality rate
    Journal of Nursing Administration -

    Patients with heart trouble would be wise to seek care at a hospital with a nurses union according to a recent study of the impact of nurses unions and the mortality rate for patients with acute myocardial infarction (AMI, the medical terminology for heart attack).

    The study, which was published in the March issue of JONA (Journal of Nursing Administration), studied hospitals in California and found that hospitals with a nurse's union had a "significantly predicted lower risk-adjusted AMI mortality."

    The study's authors, Jean Ann Seago, PhD, RN and Michael Ash, PhD, concluded that "this study demonstrates that there is a positive relationship between patient outcomes and RN unions."

    "Thirty-five percent of hospitals in California have RN unions. The significant finding in this study is that hospitals in California with RN unions have 5.7% lower mortality rates for AMI after accounting for patient age, gender, type of MI, chronic diseases and several organizational characteristics. This result includes controls for number of beds, AMI-related discharges, cardiac services, staff hours and wages.

    In discussing how unions impact the quality of patient care, the authors stated, "unions may impact the quality of care by negotiating increased staffing levels...that improve patient outcomes. Alternatively, unions may affect the organization nursing staff or the way nursing care is delivered
    in a fashion that facilitates RN-MD communication. This is the 'voice' function of unions...Yet another possible mechanism by which unions can improve care is by raising wages, thereby decreasing turnover, which may improve patient care."

    The authors conclude, "perhaps having an RN union promotes stability in staff, autonomy, collaboration with MDs and practice decisions that have been described as having a positive influence on the work environment and on the patient outcomes." >>>>>>>
    Journal of Nursing Administration
  9. by   Peeps Mcarthur
    Excellent!....Thanks JT.
    It really brings my hopes up to know that it's being looked at as a viable alternative.

    And that I'm not just a kook with a keyboard!:wink2:
  10. by   teamrn
    JT: For most years of my 20+years of nursing practice, I've felt that I DON'T need a union to represent me as the professional I already am. I'm still operating with that plan in mind. I've been represented and not represented, and quite frankly, the representation was, if anything, weak.

    However, I read your post, realizing that I've been on 'hiatus' for 18 months; maybe I'll 'sing a different tune' when I return to the field! I still consider myself a nurse, and have been trying to keep up w/ the latest We'll see.
  11. by   -jt
    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