Stress, physically exhausting, unsafe, demanding: Gone Public

[Cascadians]

Oh my, the word is starting to get out to the public with mainstream articles.

This brushes the surface and may be a shock to all those folks who think of nursing as a quaint pastime of giving backrubs amongst the capped sisterhood.

The overwhelming high pressure and abuse from management isn't mentioned, but this is educational for a beginning public newspaper article:

[ Fair Use: For Educational / Research / Discussion Purposes Only ]

http://www.oregonlive.com/news/oregonian/index.ssf?/xml/story.ssf/html_standard.xsl?/base/news/101058093619514171.xml

01/09/02, by Wendy Y. Lawton

Nurses open office to lift ailing profession

Deborah Burton is a chameleon.

The 47-year-old nurse has treated intensive care patients, helped run rural health departments and supervised an Army hospital in Italy. She's earned three nursing degrees and teaches at the University of Portland. She has served as a union officer, hospital administrator, regulator and researcher. Burton is also a political operative who briefed Hillary Clinton and lunched with Barbara Bush.

Her next act: Point person for the state's nursing shortage.

As interim executive director of the Oregon Center for Nursing, which opened last week, Burton must get nurses, executives, educators and politicians to work together to fill an estimated 3,600 nursing positions in Oregon by 2010.

The Boring resident sat down in her still-bare office Tuesday to talk about the shortage, solutions and the nurses strike at Oregon Health & Science University.

Why should the public care about the nursing shortage?

Because the public is aging. And if there aren't enough nurses around when they reach old age, they're going to be in sorry shape. Quality of life is directly tied to access to health services -- and nurses by far are the largest component of the health care infrastructure. In other words, if you care about quality of life, you gotta have nurses.

Nursing shortages routinely crop up. Is this one any different?

This one is completely different, because in the past there was a simple imbalance between supply and demand. We didn't have enough nurses. So all we did is throw in a little money and some incentives, like nursing school tuition support, and we recalibrated quickly.

This shortage is a demographic shortage. The average age of nurses is 47, and we don't have anywhere near the number of young students choosing nursing as a career to replace those of us who are aging -- let alone meet the enormous increase in demand for nurses in the future.

So we don't have the numbers, even if we had the incentives. And even if everyone could have a free scholarship for nursing, we don't have enough people to teach. The average age of nursing faculty in Oregon is 50. So we need to prepare more faculty as well.

What is the most important step Oregon must take to combat the shortage?

Publicize it. Let the public know their health is in jeopardy. Let them know we have to do something about it. Period. But there's a second thing. We have to fix the pipeline. We need to make sure we can produce as many nurses as possible.

Why aren't more people going into nursing? And why aren't they staying?

First of all, 96 percent of nurses have been women, historically. There are tremendous other opportunities for bright, capable women now, which there weren't in the past. Before it was teaching, librarianship and nursing. So it's a good thing that there are other opportunities.

But there isn't an accurate and positive public image of nursing. The work is challenging. It's intellectual. It's autonomous. You can do just about anything, go just about anywhere. And you can change what you want to do over the life of your career. But we need to publicize that.

Now why aren't nurses staying? There's too much stress. It's too physically exhausting. There's fear of unsafe outcomes simply because the demands are too high. So it's a little of everything. But most of all, we need to go back to the relationship between the nurse and patient. The reason this profession exists is to support people through health and illness. If you don't have enough time to do what is needed, patient outcomes won't be what you want. And the work won't be satisfying.

One of your tasks is to convince hospitals, nursing homes and other places nurses work to adopt high quality standards for nursing care. How will this help?

There's now enough research to say that if you implement certain standards, the outcomes for your patients and the outcomes for reducing turnover and improving satisfaction are validated.

When you orient a nurse well, give her a job that satisfies her, and keep her working for 40 years, it's cheap, really, to improve staffing and assignments. If you overstress nurses and your turnover rates go higher, eventually the economics are going to hit you between the eyes. We have to get out of emotionality, and we have to talk about what it really costs when a nurse leaves. And how much it costs to have to pay temporary agencies to fill staffing holes.

Fixing the shortage will be very expensive. At the same time, you can't force solutions on nursing schools or hospitals. So how realistic are the center's goals?

The center's goals hopefully reflect the values and philosophy of the state of Oregon. Quality of life is everything here. If you think of the fact that 40 percent of people over the age of 85 need some kind of nursing care just to stay independent and functional, you can quickly figure out that the future of Oregon in 10 to 20 years will be directly related to access to health services.

Are the shortage and the OHSU strike related?

Yes. First of all, they're related because the noncompensation issues being raised by the nurses are the same reasons that cause nurses everywhere to leave the bedside. Also, one way or another, public opinion about nurses on strike will affect perceptions about the profession itself. It's too soon to tell if it will go in a positive way or a negative way.

How do you think it will affect public opinion?

You know what? I don't know. Just talking with regular folks who have nothing to do with nursing, it seems polarized. Either people want to walk the picket line with nurses or they're appalled and think nurses should never go on strike. I don't hear a lot in between.

The strike points up a lot of frustration in health care. How will you get front-line nurses and health care executives to work together to solve staffing problems?

It will take common ground. And not waiting until frustration gets so high that everyone gets too polarized. Trying to get people together might sound naive, but it's the right thing to do.

( You can reach Wendy Y. Lawton at 503-294-5019 or by e-mail at [email protected] )

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[oramar]

I expect that there are those including myself who could take issue with some of the stuff.

[Jenny P]

Oramar, what part don't you agree with? I read recently that the average age of nurse educators is 52. Back in '99, the average age of Minnesota nurses was 47 and a paper put out by MNA titled "Conern for Care: Will Care be There?" asked who will care for patients when we will be the ones needing the care.

I feel we need the publics' awareness and support to help nurses overcome some of the problems in nursing. Granted, we (nurses) are part of the cause of the problem: we have put up with understaffing and kept our mouths shut when we should have spoken out about poor and unsafe staffing; we have b#*@+ed and whined amongst ourselves instead of speaking out as one when administration and the current health care climate have forced us to work in unsafe conditions. We have accepted salaries that are now inappropriate for the skills, education, responsibilities, and liability of the job we are doing.

We have ignored the fact that patient acuity has probably at least tripled in the past 10 years (I remember a manager asking me several years ago "whatever happened to the 'bread and butter' hearts?" She was referring to the fairly healthy 60-70 y/o male who came in and had OHS without complications and was discharged without any problems 10 days later; he was a money maker for the hospital!). With this increased acuity, we have been expected to "work smarter, not harder" with no increase in staff and usually a decrease in licensed personnel and an increase in CNAs if anything.

We have sat back and let this happen to us because we had our heads in the sand; not looking beyond our own little worlds and workplaces. We have deemed ourselves to be "too busy" with our own lives to be involved with the larger picture of what was happening in nursing and health care. Now, some of us are starting to wake up and be aware of the entire health care mess we are in.

Health care in general and nursing in particular, have to be fixed. This is an interesting idea, one possible solution to part of a major problem in health care. I think we should encourage new ideas; and watch where this particular idea is going and maybe step out and try to reshape the whole profession.

[hoolahan, ASN, RN]

I for one volunteer to teach nursing school when the instructors are retired if 1) the gov't pays for the mandatory MSN or 2) They begin to accept BSN's to teach. Why can't a BSN, or an ADN for that matter, with a strong clinical background teach nursing students. Don't we teach new nurses at the bedside?

Otherwise, I do feel it was a pretty well written article and interview, "for a start."

[oramar]

The thought that came to my mind when I read it is "Where is the CPR". When you find a person without pulse or respiration you need to start CPR. Health care is in cardia arrest. Check ABCs, give a couple of breaths and start chest compressions. All these measures needed to start yesterday.

[Jenny P]

I know, Oramar, we SHOULD have started yesterday; but at the same time, because of us crusty old (or are we just stubborn?) nurses, nursing ISN'T dead yet! I still love it and am passionate about the work I do. Many are still trying to revive and change it; maybe this is a new type of therapy that will work. Of course, we have to do some research-based trials; probably double blind studies, to see what works best.

I just don't want to be the double blind nurse!

[NRSKarenRN, BSN, RN]

State Boards of Nursing are the ones to set the rules re Nursing Eduators educational background. In PA you can be a lecturer with a BSN and have so many years to get MSN (which your employer will help you pay for, these days)!

Oramar and Jenny, I'm in stitches...Nursing + CPR, "double blind " nurse.

[pebbles, BSN, RN]

I think it's nice to see something in the media that even mentions the deeper issues of why nurses are so frazzled. Often, all I see mentioned are wages and rates of overtime, and it is so much more complex than that. I agree that more public education needs to be done about the profession of nursing - who we are, what we do, what this job is about, and what roadblocks are in the way that prevent us from giving the best care possible.

I work on an acute surgery ward, and this winter I have been told too many times "yes this patient is critically ill, and he needs to be in an icu, but we have no icu beds, so we're going to see how long we can manage him down here". Can we say "unsafe"??? But our media focus on how many patients are waiting in the ER waiting room or have to be on stretchers in the ER hallway... I'm frustrated that the public does not get to hear the real story of what goes on in nursing and why we are fed up to the point of calling strikes and quitting in droves. The public is sick of hearing the phrase "nursing shortage", they are tuning out - and in my experience, many lay people don't even believe that there really is a shortage.

Public education is the key to fixing many of our woes, and the way to reach the public is through the media. Even if every point isn't exactly in agreement with what each of us as nurses experience in our lives - getting people to talk about the REAL issues is an excellent first step.

[hadit]

I agree we have to talk to the public and get them to listen and understand how this affects them personally. That is hard to do....my sister-in-law told me she didn't think she wanted to know when I was talking about nursing end of conversation. Your right about the ER attention....Denver area just changed the rules to when a facility can divert. Public education has to come from the nurse's mouth....to the consumer. So write a letter to the editor if you haven't and mail your elected officals or better yet call them. When I hear someone complaining about the nursing care they recieved I suggest they write the administration. I explain that nurses are working very short staffed compared to 12 years ago and the patients are sicker also.

Originally posted by pebbles

......But our media focus on how many patients are waiting in the ER waiting room or have to be on stretchers in the ER hallway... I'm frustrated that the public does not get to hear the real story of what goes on in nursing and why we are fed up to the point of calling strikes and quitting in droves. The public is sick of hearing the phrase "nursing shortage", they are tuning out - and in my experience.....

Public education is the key to fixing many of our woes, and the way to reach the public is through the media. Even if every point isn't exactly in agreement with what each of us as nurses experience in our lives - getting people to talk about the REAL issues is an excellent first step.

[P_RN, ADN, RN]

Guys write your legislators RIGHT NOW!

Cut and paste if needed but do it. Write the editor, call the radio and tv stations. You wouldn't believe all the correspondence I have gotten since I talked w/ media.

Pebbles I think you have put into words what I have been trying to say. Exactly!!

P