Published Oct 9, 2001
The A-B-C's of the nursing crisis
By Roberta B. Abrams, RNC, MA, LCCE, for HealthLeaders.com, Oct. 8, 2001
As the exodus of nurses continues, only those who choose to ignore reality can believe the nursing crisis is anything but real.
Nursing is the largest healthcare occupation in the country, according to the June/July 2000 issue of Lifelines, an official publication of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). As of March 2000, there were 2.7 million nurses in the United States, and of those, Lifelines says:
81% are employed in nursing, with 58% working fulltime and 23% part time
19% are not employed in nursing
The average nurse is 45.2 years old. As s/he plans to retire from the workforce in the next 15-20 years (and many nurses say it will be sooner), there are predictions that the workforce will be 20% below need. Let's explore some symptoms of, and potential treatment for, the current nursing situation as we look at the A-B-C's of the nursing crisis from A Nurse's Viewpoint.
A is for Apathy
Apathy is a cardinal symptom of the nursing crisis. Certainly not all nurses are apathetic. But the number of apathetic nurses is growing, as is the extent of their apathy. Nurses are working hard - very hard. Many healthcare facilities lack sufficient nursing staff for the care that they should deliver. Nurses work short-staffed, they work mandatory overtime, and they work with imported agency staff who frequently lack appropriate orientation to the clinical site. They pour themselves into their work, and leave exhausted. They lack the time, the money, and the energy to participate in the "extras" - professional journals, conferences, and meetings - where nurses usually congregate to grow and renew themselves.
Too many healthcare organizations that formerly understood the benefits of having staff belong to professional nursing organizations have sacrificed the support of those memberships to specious economies. (Magnet hospitals, in contrast, typically support and encourage their staff to be professionally active.) Many nurses who continue to participate in professional activities do so by paying their own dues and shouldering the costs of participation in professional conferences. Some staff members are compelled to use vacation time to attend local, regional, and/or national nursing meetings.
Lacking support for participation, many staff members are unable to attend meetings of their nursing organizations. By not doing so, they lose the stimulation of exposure to newer, research-based practice phenomena. They lose the support achieved through networking with colleagues from disparate practice sites. They lose the ability to see themselves as part of a vibrant tapestry of professionals who share pride in and commitment to their profession. Most importantly, they lose the sense of professional awareness.
Nurses' apathy, in this sense, is not a pejorative phrase. It is a symptom of what's wrong with nursing and nurses. Apathetic nurses "do their jobs" - sometimes against overwhelming circumstances. Their apathy results from a perceived loss of control of their lives, from excessive stress, and from lack of ability to see means of ameliorating their situations.
B is for Boost
I strongly doubt that the apathetic nurses will find their way back to balance independently. The treatment for this pervasive disorder requires a Boost. Boosters come in many different guises. Some will come from the medical staff; caring physicians who elect to foster collaborative practice committees to improve interprofessional communications and enhance patient care.
We expect (hope?) to see boosters emanating from the ranks of healthcare administrators. With newfound insights (and some prompting from nursing leaders) they will recognize that helping nursing will be a keystone for ameliorating the healthcare delivery system. Restructuring the salary scale, providing scholarships and forgiveness for loans, and re-creating recognition systems such as clinical ladders will all have significant start-up costs, but those costs have a noteworthy return on investment. In time, the reduction in turnover, lack of need for agency staff, and improvements in patient outcomes will generate cost avoidances that more than offset the added expenses.
We expect to see boosters from the ranks of elementary and high school educators. For much too long, educators have done a poor job of boosting nursing. Too many of them lack an in-depth understanding of the scope and nature of nursing practice. Many of them dissuade their more gifted students from entering nursing. Sometimes aided by their apathetic nursing colleagues and/or mass media stereotypes, they focus mainly on the negative factors in the nursing culture. They fail to see that nursing needs the best and brightest and has many rewards for those who join the profession.
We require boosters from industry and commerce. There is no industry that would not benefit from a more prominent nursing presence in the workplace. Whether they staff a triage unit to initiate care for workplace injuries, monitor safety and uncover health risks in the job setting, assess workers' healthcare needs, or offer wellness care and education, nurses can and do make a positive contribution to business. In turn, resources from the business world can promote scholarships, and support nursing research related to corporate needs.
C is for Caring Colleagues
We need boosters from within nursing. These boosters, or Caring Colleagues, are the lynchpin that holds the nursing boosters together. Caring colleagues come from all aspects of nursing - from education, practice, and research. Caring colleagues are staff nurses, nursing educators, nursing administrators, and nurse practitioners. Caring colleagues come from associate degree programs, diploma programs, baccalaureate programs, and graduate nurse programs. The common thread that weaves through this tapestry of support for nursing is that these caring colleagues are professional nurses who have a commitment to enhance nursing's future.
Several groups of caring colleagues already exist. They are found in healthcare facilities, under a myriad of titles such as shared governance committees and clinical practice consortiums. Their work focuses around identification and treatment of barriers to sound nursing practice. Their mission focuses on retention and promotion of nursing staff. They have found a voice at the table of leaders in their organizations. They use that voice to enhance staffing and to facilitate improved practice conditions in their facilities.
Professional nursing organizations, such as AWHONN, the American Nursing Association (ANA), and Sigma Theta Tau, the international nursing honor society, are gathering nurses together to discuss enhancements to the nursing practice and improvements in areas such as the recruitment of student nurses.. They provide meetings where nurses can share opinions about nursing today. They sponsor forums where nursing leaders can share their expertise. They publish journals where nurses far and near can read about solutions to the problems of nursing.
Colleagues in Caring is a group of state and national leaders who have formed to assess the existing supply of nurses, explore projected needs for nurses and nursing, and to provide regional collaboratives for nursing workforce development. Its goal revolves around planning and implementing policies and actions to address the rapid changes occurring in nursing. Colleagues in Caring promotes collaboration and sharing of research, concepts, and successful (and unsuccessful) initiatives to improve both the workforce and the conditions under which they work.
We have a great number of people working on solutions to the plight of nursing. The solutions will not come from any one group. The solutions will require the collaboration of disparate groups of people who have the interest and who develop the ability to pool their resources - intellectual, fiscal, and technical - to provide a future for nursing.
Hi Karen. As the information from your post indicated, what will be key with the nursing shortage is boosting or keeping those of us who remain in the trenches motivated to stand up for nursing.
As far as grade school and secondary school educators are concerned, they have a problem promoting their own profession much less a profession who is undergoing similar challenges to theirs. It's going to take the action of mentors who are nurses to go into the schools and lead by example. Nurse mentors will have to gain the trust and respect of teachers to promote nursing.
May I add that D is for depression. It is a state that a large number of health care workers seem to be in these days. It is actually the real cause of the apathy Roberta describes. It is a contributing factor in the high turn over rates and a lot of the lateral violence we see.
Karen, I loved this article! Thank you! I kept shaking my head and saying "YES!...YES!".
I have become especially focused on the Caring Colleague part lately. The nurses who eat their young (or anybody else who's around) make an already difficult work place almost intolerable. We are trying to set up a mentorship program to help new grads feel more welcome because they aren't staying. We are also looking at ways to reward the nurses who are willing to be mentors. Any suggestions on what they would like? We have to start caring for eachother. There is one ward in our hospital that is so bad they have to trick people to come to work on it. They call in RNs and LPNs saying they will be on one ward then when they get there, they are sent to the b*tchy ward for the shift. People are becoming VERY upset at this and I wonder if any of you wise nurses have any suggestions for how to improve morale on an already cut-throat floor.
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