The nursing crisis: A long road

[NRSKarenRN, BSN, RN]

A Nurse's Viewpoint

The nursing crisis: A long road

By Roberta B. Abrams, RNC, MA, LCCE, for HealthLeaders.com, Nov. 5, 2001

http://www.healthleaders.com/news/feature1.php?contentid=29174

One of my mother's frequent New England Yankee aphorisms was: "It's a long road that has no turning." Nursing has been headed down a very long road into crisis for several years. However, the visionaries among us see signs of a turn up ahead. Let's look ahead, and try to see the turn from A Nurse's Viewpoint.

One recent, hopeful sign is a triad of bills before our federal legislators. House Bill 1436, and its companion, Senate Bill 706, have as their goals recruitment of new nurse candidates through public service announcements and other media campaigns. These bills would also enable nurses to perform outreach measures in primary and secondary schools. The legislation would further provide stipends for students from disadvantaged backgrounds, provide remedial assistance for students in basic English and mathematics courses, and assist with costs of transportation and childcare.

Senate Bill 721 shares with its companion bills features that include:

*Creation of career ladder grants for advanced nursing education

*Focus on gerontological and long-term care

*Partnerships involving schools of nursing and healthcare facilities to ameliorate care in areas with nursing shortages

*"Fast-Track Nursing Faculty Loan Programs" for public or nonprofit schools of nursing to provide forgiveness loans for faculty to obtain master's or doctoral degrees. Faculty achieving these awards would be required to commit to teach at the school for disparate periods of time.

Each of the three bills would create a National Nursing Corps Scholarship program to provide tax-exempt scholarships to students who agree to work in areas with nursing shortages after graduation. In addition, House Bill 1436 and its Senate companion would provide reimbursement to non-hospital providers (including extended care facilities, home care agencies, and hospices) for costs of providing clinical experiences for Fiscal Years 2002-2006.

It would seem prudent for all of us to study these bills and to encourage our elected officials to enact these and other measures to assist in provision of nurses for the future. The American Association of Colleges of Nursing provides a cogent, brief review of all of these bills, and endorses their passage.

These legislative initiatives are important. However, at best the relief that they promise is several years out. The crisis is real; the crisis is now, and the solutions proposed by the legislative initiatives will resolve only one part of the problem. Fortunately, there are several groups of nursing leaders who are joined together to assess the problems and to develop possible solutions.

Colleagues in Caring

Funded by The Robert Wood Johnson Foundation, Colleagues in Caring (CIC) focuses its efforts on helping states and regions to build systems of work force development with the ability and capacity to adapt to the rapidly changing factors in the our healthcare system. CIC's regional focus reflects its belief that care requirements are regional in nature. As demographics in a given region change, so will the supply and demand for healthcare and healthcare providers.

The stakeholders in the CIC collaboratives may differ by region, but basically consist of faculty from schools of nursing (all levels), nursing care employers (hospitals, home health agencies, nursing homes, etc.), professional associations, regulatory or accrediting groups, healthcare policy makers (relevant to nursing), and the gamut of healthcare consumers.

The first phase of the project focused on creating the regional collaboratives, collecting data, developing models for predicting nursing care needs, assessing the scope and nature of work to be done.

Colleagues in Caring is now in its second phase. Among other tasks, members are focusing on helping regions to develop "stable and satisfying practice environments that promote career advancement and lifelong learning and creating a permanent forum for exploring evidence-based policy measures regarding current and future nursing workforce requirement."

Tri-Council for Nursing

The Tri-Council for Nursing (a misnomer, since there are four nursing associations involved) is similarly focused on examining issues related to nursing education and practice. Its membership includes representatives of the American Association of Colleges of Nursing, the American Nurses Association, the American Organization of Nurse Executives, and the National League for Nursing. Group members convene to discourse about legislative issues, health,care quality, the nursing work environment, leadership in nursing, and the triad of education, practice and research.

In its policy statement, Strategies to Reverse the New Nursing Shortage, the Tri-Council has identified four areas of focus: education, the work environment, legislation and regulation, and technology, research and data collection.

Under its focus on education, the Tri-Council includes development of initiatives to "institute an education and practice system to promote more equitable compensation in the healthcare community based on a better understanding of the educational preparation required for different healthcare roles." It also stipulates the importance to employers to provide staff development and lifelong learning for continued nursing competence.

The work environment focus stresses the importance of retaining experienced nurses in direct patient care by measures including greater flexibility in the work environment, and appropriate salary and benefit programs. The Tri-Council also cites the value of nurses' autonomy over their practice, and "appropriate management [read "leadership"] structures within the healthcare system."

Legislative issues focus on advocacy for funding for nursing education and better identification of professional nursing services within disparate reimbursement systems.

In the section devoted to technology, research, and data collection, the Tri-Council supports the mission of the Colleagues in Caring with its emphasis on building predictive supply and demand models. The Tri-Council additionally advocates for the use of technological advances in nursing practice.

National Institute of Nursing Research

The National Institute of Nursing Research (NINR) is supporting efforts to demonstrate and document the value of nursing to the health of the public. In a June 2001 report from the American Association of Colleges of Nursing, four areas are cited in which professional nursing care has made a difference:

Nursing care reduces infant mortality. Currently the United States ranks 26th among nations in the number of babies per thousand who die before their first birthday. This abysmal statistic documents that 25 of the industrial nations of the world do better than we do in protecting our future. The NINR funded a fiveyear study involving low income Caucasian and African-American women at risk for low-birth weight infants. The study revolved about home visits, follow-up phone calls, and regular interactions by registered nurses during the prenatal period. The nurses taught their patients about the need for regular prenatal care and appropriate nutrition. The results were fewer at risk infants. The cost savings to the hospital were $277 per pregnancy. (We can only postulate about the emotional "savings" to the involved clients.)

Nursing care improves outcomes in diabetic adolescents. Diabetic adolescents have great difficulty in balancing exercise and diet to maintain appropriate blood sugar values. Lack of good control increases the occurrence of neuropathic and microvascular complications. Anyone who has worked with these adolescents knows the impact of peer pressure and their distaste for "being different." In this study, the nurses included coping skill development into the diabetic patients' regimen of care. The results included improved confidence by the teens in managing their lives, and improved adherence to prescribed care.

Nursing care improves outcomes in treatment of children with dehydration. According to the AACN study, about 200,000 children less than 5 years old are hospitalized each year for gastroenteritis-induced dehydration. The current cost of treating these children is approximated at $2 billion per year. Improved treatment, including use of short stay treatment centers and home care, reduced stress levels of the children and their families, and reduced the costs of care.

Nursing care facilitates elderly patients' transition from hospital to home. This study focused on the impact of appropriate patient and family discharge education. Most nurses are aware that assessing patients' post discharge needs, initiating appropriate referrals, providing for needed home equipment and medications, and preparing the patient and family with needed knowledge facilitates timely discharge and avoids unnecessary readmissions. In this study, there was a 65% decrease in days of hospitalization and a 48% decrease in the cost of re-hospitalization.

There you have it. Nursing is a powerful profession. The health of our public demands an appropriate supply of professional nurses. So what can you do? You can:

Write to support legislation which focuses on improvement of the supply of nurses and on conditions in the workplace

Read, learn about and support activities of the Colleagues in Caring and other professional groups

Join a professional nursing organization (those of you who are nurses). Find out what they are doing to facilitate improvements in nursing and encourage further efforts.

Assess your own nursing environment and get involved with others who are working to improve conditions there.

Start now.

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Roberta B. Abrams, a regular columnist for HealthLeaders.com, uses her education and experience to help further the evolution of healthcare delivery systems through her consulting group, RBA Consults, in Farmington Hills, Mich. She also is on the adjunct nursing faculty at Madonna University.

© 2001, HealthLeaders, Inc.

[oramar]

You can write Roberta anytime. She has responded to me on several occasions. I am going to respond to her and mention that under experienced nurses they should mention that nurses over 50 should be given extra support if they find themselves having trouble keeping up.

[Mijourney]

Hi oramar. How would you define extra support for a nurse over 50? How long do you think that extra support should be given? Do you feel that all nurses over 50 warrant extra support?

What I think needs to happen is that as we get older, we need to constantly retrain our minds to stay open and not to look for security in routines or habits especially when it comes to our jobs. We all know that change is a constant in our work, so we can ill afford to become stagnant in our way of thinking even though it makes us feel comfortable and competent. I'm learning this the hard way. I feel that this is one of the reasons why employers frequently choose younger workers over older, experienced workers.