Do We Need More Nurses - from the Toronto Star - March 10, 09

  1. opinion | opinion | 'do we really need all these nurses?'
    'do we really need all these nurses?'

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    mar 10, 2009 04:30 am
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    sioban nelson

    if there's one thing nurses know, it's that tough economic times tend to mean cuts to the profession. this has been the pattern over the decades, where nursing from toronto to manchester to so paulo has all too frequently been the health-care service sector that takes the hardest and deepest cuts when the economy takes a nose dive.
    there is an obvious reason for this. nursing salaries account for a major percentage of health-service budgets. as ceos and cfos are driven to reduce spending and create efficiencies, the first question that comes to mind is usually: "do we really need all these nurses?"
    this is at one level a legitimate question. the drive to answer it has spawned an entire science that measures workload and efficiency, examines the relationship between the number and skill level of nurses on patient outcomes, and analyzes the relationship between staffing profile turnover and burnout.
    the lawrence s. bloomberg faculty of nursing, through its nursing research unit and faculty research, has made this faculty one of the top sites in the world for health-services research in nursing and health care.
    but the question "do we really need all these nurses?" is not only an empirical one that good research can answer. it is also a rhetorical question that reflects a worrying attitude toward nursing that has bedevilled the profession for more than a century.
    even today, when we finally have the data to show that quality nursing staff is strongly correlated with patient outcomes (including mortality), the question continues to be raised. the tradition of seeing nursing as a resource to be built up in good times and trimmed back in lean times dates back to the very beginning of professional nursing.
    for most of the 20th century, nursing-student labour fuelled the engines of the modern hospital. hospitals hummed with industrious nurses washing patients, bed-making and establishing military order and cleanliness. behind the scenes, student nurses rolled bandages, mended surgical gloves, sterilized and packaged all the sterile materials and packs, sorted laundry items, stocked and restocked drugs and supplies, cooked special diet meals in ward kitchens, distributed all meals and fed all patients. nurses managed the wards, their patients, the operating room, the hospital budgets and overall operations.
    there was clinical work, too. early transfusions involved six nurses managing the two patients, careful handling of the delicate glass equipment and ensuring constant flow to prevent clotting. hypodermic injections involved oil-lamp heating of solutions, and nurses did a great deal of dispensing work in the everyday course of caring for their patients. pre-antibiotic era nursing meant lengthy and complex irrigations of wounds and douchings.
    when students graduated from their programs and completed their staff nurse year, they made their way into the few senior roles that existed within the hospital sector or moved into the community, public health and home-nursing sector, where experienced nurses held their own.
    back in the hospitals, the priority often was volume rather than quality. young girls were worked hard and long with poor remuneration and little respect for their contribution to patient care. high burnout rates, workplace injuries and poor health status have been the norm for hospital-based nurses around the world for far too long.
    it also has led to the idea that nurses are in a sense a disposable resource, replaceable and interchangeable like front-line soldiers in early 20th century warfare. despite clear advances in nursing's position in many parts of the world, including canada, with each turn of the economic screw, nurses feel the vulnerability of the sector.
    every time we cut nurses, we hit a pipeline. it is not today's nurses we affect but the next 10 years' worth of nurses. in five years' time, with normal attrition and the retirement of the boomers, there will inevitably be more panicked calls for nurses - but where will they be?
    every time nursing jobs are cut, smart young high-school students watch and learn. they choose other careers. meanwhile, health-service providers cut services and shed nurses. overwhelmed services can't cope with the demands of students. they cut places. so when the pendulum swings it is impossible to increase the number of nursing student seats.
    meanwhile, entrepreneurial governments and private providers scour the world for nurses, causing more inequity and suffering in their wake as they contract large numbers of nurses from countries that can ill afford to lose them.
    what are the implications for health care with today's economic crisis? the rise in chronic illness along with the aging rn workforce make this a critical moment for the future of our health-care system. if we cut off nurses now, we will feel it for the next decade and beyond -and it will be bad.
    do we really need all these nurses? we do.
    we need new graduates developing their skills and knowledge in a safe and supportive environment so they do not burn out and leave. we need advanced practice nurses bringing creative and cost-effective solutions to complex system problems. we need nurse practitioners to provide access to the great number of people the system currently fails and to keep costs down. we need them to prevent illness, manage chronic disease and to keep people well and safe in the community. we need them to track us through the highly dangerous space of the acute in-patient sector and ensure that we avoid life-threatening complications, are well-informed and educated about our treatment and its consequences, and go home in the best position possible to undertake self-management of chronic conditions.
    to cut nurses is to cut the system's capacity to do this now and into the future. it is in everyone's interest to make sure our decision-makers understand this and are held accountable for the consequences of their actions. as members of the profession and members of the public, it is our job to ensure this.
    sioban nelson is dean of the lawrence s. bloomberg faculty of nursing, university of toronto.
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  3. by   FireStarterRN
    Fascinating article, thanks! Wonderful little nursing history lesson as well.
  4. by   Belfegor
    [font="comic sans ms"]below is the letter a surgeon for london,ontario, sent to the journal
    in response to the article "do we need all these nurses?"

    interestingly, many comments following the article, did think that nurses are "overpaid" and compare nurses to car workers....
    "nurses, like autoworkers, have priced themselves out of jobs."
    submitted by gardiner westbound at 2:16 pm tuesday, march 10 2009

    "what we need is patient care

    the current nursing job description has produced a system that is rapidly increasing in cost and not providing services patients need. the lack of services could be a result of a lack of service providers, or the wrong specification of the workers involved. right now the nursing profession defines both the educational requirements "bachelor of science degree in nursing or equivalent" and the scope of practice. unfortunately, the result is that nurses are overqualified for most of the work they do. overqualified means overpaid. right now the scope of practice definition is controlled by the nursing profession. that has to change. the medical system exists to treat patients, not to provide jobs to nurses."
    submitted by brentb at 12:49 pm tuesday, march 10 2009

    my personal favorite is this comment: "start another lottery, make drugs legal and tax them, same with prostitution. somehow get the money and hire more nurses, we need them. ontarians are getting older, geriatric units are needed now, and nurses are needed to fill those positions. let's not play with healthcare, it is too important. how about a major casino in toronto? hire more nurses!!!"

    letter to the editor
    nurses crucial to health care, surgeon says

    mar 13, 2009 04:30 am
    re: 'do we really need all these nurses?' march 10

    i applaud sioban nelson's article. i have been a surgeon now for almost 10 years, during which time i have seen the knife cut into health-care resources many times. ms nelson is correct: nurses are often the sacrifice made to correct budget shortfalls. what a tragic shame. what a gross misunderstanding of the vital role of nurses in health care.

    without nurses, health care grinds to a standstill and patient care cannot take place. nurses are as critical to modern health management as physicians are.

    a simple case in point: i received notice recently that several of my operating days were to be cancelled by the hospital. patients who were suffering for months from their diseases were now to be suffering even longer. why the cancellations? not enough operating room nursing staff. and imagine ... this is before nurses are laid off.

    just consider what the situation will be like after layoffs occur.

    we don't need fewer nurses; we need more. the nurses we do have are highly trained professional health-care workers. they deserve more respect. and, as ms nelson points out, with decreases in nursing enrolment and increases in retirement, they are actually non-renewable resources. if budget managers think that public health can be maintained without nursing staff, they are sadly mistaken.

    dr. brian rotenberg, london, ont.
  5. by   AtomicWoman
    Thanks for the article! You know, I wonder if there were a pandemic or other medical emergency, would all of those carping commenters consider nurses "overpaid" or "overqualified"? Who do they think would be on the front lines of any emergency?
  6. by   judybsn
    Interesting summary of nursing history. I've always felt that the nursing profession shot itself in the foot by closing hospital based nursing schools and making the 4 year degree the standard. In those 3 year hospital schools students were very well trained and were able to be fulling functioning RNs the day they graduated. Anyone who wanted to teach or do Admin. went back to University for a few years. It was a much more efficient system and provided the hospital with a wonderful work force of students. Sure wish we could go back, but that will never happen, I know.