Who "Owns" the "nursing shortage?"

[Norbert Holz]

I remember talking with a DON at my first "job." She instructed me to solve a problem; first identify who owns the problem. They will be charged with it's ultimate solution/ resolution.

Here we are in 2002. The chicken little "The sky is falling," mantra of the day is that there are not and will not be enough nurses and other selected health"care" "workers" to provide the necessary "service" to those in need of it.

People clamor crisis with the best intentions of addressing the "problem." There are committees formed to address the "problem." Yet the "problem" remains; or does it?

Who owns the problem?

A working nurse who is short staffed not provided with enough of the avaliable nurses to safely "practice?" No, they do not own the problem. It affects them but they do not own it!

Educators clamor that there will not be enough educators to teach. A seprate issue, nurse educators; in a league all by themselves I mighn't add. They claim to have some ownership but in all praticality, they do not own the problem either. They are affected by it but do not own it!

Ownership of "the nursing shortage" belongs to those who hire nurses; solely and wholely! They do not do what is necessary to attract and retain nurses.

All of the good hearted educators and nursing organizations in the world can only make the actual solution of the problem a little easier for the "employers" of nurses. They can have an impact on the problem but not solve it!

As an individual nurse you can impact the"solution of the problem" by where you work and under what conditions you will work. You certainly will not solve the problem!

Trillions are spent on health care in the US alone! Where does the money go? Who hires nurses?

The problem is clearly owned by employers. They simply continually fail to do the right things to and for the employees.

The word is out! Nurses are treated poorly and paid poorly. Why should the owners be suprised there are no people willing to do what they ask? Why should people go through the experience of achieving a nursing education for the lack of reward offered by employers?

I've grown weary reading of the woes of employers and the entities working to address "the nursing shortage." They can not be working toward my best interest. They do not own the problem. They simply make it easier for employers to continue doing business as usual especially regarding poor treatment and pay of nurses.

Please tell me how I'm wrong and individual nurses can solve the problem. Please tell me how educators can solve the problem. Please show me anyone else who can solve the problem - if , in fact, - one exists.

Please don't let me keep believing that the only "solution to the nursing shortage" is held by employers. They have proven over time they are not willing to do what is necessary to solve the problem.

[brown rice]

why is there a nursing shortage? there seems to be no single answer, but a number of factors involved. Poor treatment among staff that drive nurses out, mangement only concerned with profits, lack of nurse educators, burn out, nurses just putting up with bad working conditions..

Would I be correct to say a large part of the problem comes down to money is more important then good health care in this country?

[flowerchild]

YES!!! You got it!!! Ir's all about the almighty dollar. It's such a shame that the consumer of today is more interested in money than they are their own health. Or are they? Do they really know? No, I don't think they do. And. I think that people/consumer will become more concerned about their health, especially as the baby boomers age. So, how much he11 will we have to raise to make the hospitals solve this problem? Cause you know as nurses we are ultimitly the only ones who will fight for the health and welfare of our patients. And eventually, everyone, will be a patient, so essentially we would be fighting for everyone.

I have a plan, an entire plan, on how to solve the problem. I think it is a workable plan that has a good chance of positive results. But, it would take cooperation and work on many nurses part. It does not have anything to do with unions or walkouts, or even rallies. It's just a plan that sits in my drawer in my desk. I have not implemented my plan b/c I'm scared that I will be ridiculed by my fellow nurses. I'm afraid that other nurses won't cooperate or help. It's such a good plan that I'm afraid to share it here, b/c it is mine, and I'm afraid someone will steal it. Fear never solved anything...and sooner or later....hopefully sooner, I'll implement this grand plan. Any words of encouragement would probably help.

[Brownms46]

Originally posted by nimbex

sorry, I work Icu, took a shift on step down, used to 2-3 patients in ICU... the step down takes 4-5, they were trying to give me six!!!!!!!

oohh ok..I get it now. I thought you were saying you get four pts in ICU! I have never even had three...and couldn't imagine getting 4..:)

[Norbert Holz]

Look at this another attempt to solve the "nursing shortage." It will not work!

Excellent article on nurse shortage in this month's "American Demographics" magazine. Note the reference to AFT Healthcare's nurse shortage survey of two years ago.

Wanted: One Million Nurses

The nursing profession is in need of critical care, as its ranks dwindle due to a combination of demographic trends, cultural shifts and image problems.

by Sandra Yin

American Demographics

Sunday, September 01, 2002

In 1991, Jennifer Mosier quit her job as a hairdresser and enrolled in nursing school. Later this year, the 37-year-old from Cleveland, Ohio, plans to quit her job as an acute care nurse and open up a beauty salon. Mosier says she turned to nursing 11 years ago to follow a childhood dream of "taking care of people." Today, fed up with what she calls unrealistic nurse-to-patient workloads, she's ready to give up the eight years and $20,000 of educational investment for work that's not as high-pressured. "I'm burnt out," she says. "I can't stand it. There are too many patients and not enough support."

Demographic trends, cultural shifts and image problems are eroding the ranks of the nursing profession. Despite a slight post-Sept. 11 rise, enrollment in nursing programs has been declining at an average rate of 4.2 percent a year since 1993, when it peaked at 270,000. As of 2000, enrollments were down 33 percent, to 181,000, according to the National League for Nursing. If the trend continues, nursing will face more staff vacancies by 2010 than any other professional category, according to projections from the Bureau of Labor Statistics (BLS). The agency pegs the number at a staggering 1 million job openings due to more demand and net replacement needs between 2000 and 2010. The dwindling interest in nursing comes at a critical juncture: A chunk of the country's 78 million Baby Boomers are poised to retire by 2010--creating a surge in demand for the health-care services associated with an older population at the very time that there will be fewer nurses in the work force. "We've got a real problem ahead," says Peter Buerhaus, professor of nursing and senior associate dean for research at Vanderbilt University. "The magnitude of these shortages would be big enough to severely hamper health care."

Formerly prized as one of only a handful of professions open to women, nursing has fallen out of favor with a new generation. Thanks to a wider range of career opportunities, young girls today seldom dream of growing up to be Florence Nightingale. According to the BLS, the median age in nursing in 2001 was 43, compared with 39 in 1989, the earliest age data available for RNs. The share of working RNs under age 35 dropped to 24 percent in 2001, from 37 percent in 1989, reports the BLS. The share of young registered nurses under age 25 sank to 3 percent in 2001, from 5 percent in 1989. Says Angela McBride, dean of Indiana University's School of Nursing: "Women used to become a grammar school teacher, a nurse or a nun." The women's movement helped expand the range of career options open to women; at the same time, the jobs women historically gravitated to were spurned in favor of the more lucrative, formerly male-dominated professions.

Forget attracting new candidates, nursing is having trouble holding on to its own due to irregular hours, heavy patient loads and stressful working conditions. A 2001 American Nurses Association study found that nearly 55 percent of the 7,300 nurses surveyed would not recommend the profession to others. Another 23 percent said they would actively discourage someone close to them from entering the field. In addition, nurses display among the lowest "engagement" levels of any category of workers, according to the Gallup Organization. Nearly 24 percent of the 22,000 nurses surveyed between 1999 and 2001 say they are "disengaged" from their work, defined as physically present but psychologically absent, compared with 16 percent of workers nationally who feel the same.

The number of those exiting the field is rising: The 135,696 RNs who were employed in non-nursing occupations in March 2000 represented a 15 percent increase over the 117,820 such nurses in 1996 and a 36 percent increase over the estimated 99,955 in 1992, according to the National Sample Survey of Nurses, conducted by the Health Resources and Services Administration. The exodus is likely to continue. One of every five nurses plans to leave the profession within the next five years, according to a survey of 700 current direct-care nurses and 207 former direct-care nurses, conducted for the Federation of Nurses and Health Professionals in 2001. And half of current nurses say that within the past two years, they have considered leaving the patient-care field for reasons other than retirement. What's more, the number of nursing school grads who sat for the national licensing exam for registered nurses has declined 29 percent since 1995, figures from the National Council of State Boards of Nursing reveal.

The No. 1 problem nurses cite is staffing. According to the Federation of Nurses and Health Professionals' survey, nurses say they are fed up with working conditions. In addition to working too many hours and performing thankless tasks, nurses also complain about conditions that may adversely affect patient care. For Mosier, the final straw came last March, when she worked as a temp nurse at an assisted living facility where the ratio of nurses to patients was an astounding 1 to 84. "I never thought it would be like this," she says.

Then there's Karla Monroe, 46, of Terre Haute, Ind. After 27 years of working nights, weekends and holidays, and being required to float to other departments (such as obstetrics, where she had no expertise), Monroe enrolled in a business school program in February 2001. After she gets her master's degree in management this year, she hopes to find administrative work at a university. "I like what I do. I'm good at what I do," she says. "But I don't like how I have to do it anymore."

Currently, hospitals are short an estimated 126,000 nurses, according to the American Hospital Association. The national vacancy rate for registered nurses ranged from 14.6 percent in critical care to 6.5 percent for nurse managers, according to a survey of 700 nurse executives commissioned in 2000 by the American Organization of Nurse Executives (AONE). The direct impact of the staffing shortage is substantial: 51 percent of those surveyed cited emergency department overcrowding, 69 percent reported higher costs to deliver care and 25 percent said beds had to be closed, AONE found.

To address the shortage, some hospitals are employing traveling nurses, offering sign-on bonuses, overhauling their recruiting approaches and recruiting out-of-state. The nursing profession may also benefit from casting a wider net to include a more diverse pool of workers: Compared with the national work force, which was 47 percent female and 83 percent white in 2000, the registered nurse population was 93 percent female and 87 percent white, according to the BLS. Blacks made up only 5 percent of the registered nurse population in 2000 and Hispanics only 2 percent, though each group constitutes 11 percent of the national work force, according to the National Sample Survey. Asians were 4 percent of the working registered nurse population and make up 5 percent of the work force.

It's therefore no surprise that marketing campaigns are underway to counter nurses' own bad PR about their profession and to influence the next generation's career choices. Johnson & Johnson launched a $20 million national television advertising campaign in February 2002 to stimulate interest in nursing. "By using images of more male and ethnically diverse nurses in our marketing materials, we hope to recruit from a broader group of people than nursing has historically attracted," says John McKeegan, spokesman for the New Brunswick, N.J.-based health-care products manufacturer. "If we can lure a more diverse group of people into nursing, we may well be on our way to addressing the shortage."

The Johnson & Johnson campaign created recruitment materials for distribution by school guidance counselors, a Web site that profiles a range of nursing specialties and scholarships for nursing students and prospective nursing faculty. A campaign has also recently been launched by the Nurses for a Healthier Tomorrow, a not-for-profit coalition of 37 nursing and health care organizations. The group's $1.5 million campaign of print and TV public service announcements aims to promote nursing as a career to Gen X and Gen Y. In May 2002, promos began to run in 436 movie theaters before such movies as Spiderman and Star Wars. The ads were expected to reach some 2.5 million people in 13 major markets. "It's a good way to reach young people who haven't considered nursing before, as well as older career changers," says Kathy Bennison, the coalition's manager of marketing.

Suggestions abound for ways to stem the nursing shortage; among them is the notion that the field may appeal to second-career seekers as well as to more diverse recruits, especially young men. Recruitment and retainment policies must appeal to different generations' particular needs and values, says Will Ruch, CEO and managing partner of Milwaukee-based marketing/recruitment consultancy Versant Solutions, which counts the Visiting Nurses Association among its clients. He says it's important to help nurses develop their talent, because once they stop learning on the job, they're apt to look elsewhere. Indeed, because the parents of Gen X and Gen Y lost jobs during recessions, these generations may be less likely to be loyal to companies and more interested in learning what they can get out of a job, says Bruce Tulgan, CEO of New Haven, Conn.-based RainmakerThinking, a workplace research and management training firm. He recommends recruiters make a point of framing messages in terms of what the workplace has to offer new hires.

Meanwhile, Susan Mitchell, author of American Generations (New Strategist Publications, 2000), suggests employers play up the job security in nursing. The stability of the profession would appeal to Gen X, she says, due to its experience with a rocky economy. A benefit that few realize the profession has to offer is competitive salaries, says Dani Eveloff, recruitment coordinator for the University of Nebraska Medical Center (UNMC) College of Nursing. Traditionally, nursing has been seen as a "calling" that many assume doesn't pay, Eveloff says. However, she adds that compensation varies considerably. While staff or general duty nurses averaged $42,133 in earnings in 2000, nurse practitioners averaged $60,534 and certified nurse anesthetists averaged $93,787. The UNMC's new brochures emphasize the potential for high salaries, including bonuses, loan repayment options and career flexibility. They also feature more male and minority students. The new brochures for UNMC's nursing school debuted in 2000; a year later, its applicant pool had increased by 29 percent and the number of minority applicants grew by 225 percent.

Health-care experts say it's never too early to start recruiting. The UNMC College of Nursing plants the seed for a nursing career by discussing the profession with preschool and elementary school children. The school has developed a coloring book that features males and minorities in varied nursing roles. Children in kindergarten and the first grade are invited to tour the medical center. For many, it's the first time they encounter nurses. Says Eveloff: "We start small."

While the forces eroding the ranks of nurses may not be easy to reverse, there are some small glimmers of hope. A majority of nursing schools report that applications are up after years of decline, according to the American Association of Colleges of Nursing. For example, Georgetown University's School of Nursing saw applications rise 10 percent over last year. And applications to Saint Louis University's School of Nursing increased by 53 percent over 2001, reversing a steady decline that began in the mid-1990s. Educators attribute the swell in applications to a shift in values post-Sept. 11, in which nursing and healing professions in general gained stature in the public eye. "Is this fleeting or will it last?" asks Margie Edel, director of the baccalaureate and master's programs at Saint Louis. "I'm hopeful."

[P_RN, ADN, RN]

Norbert, excellent post.

Bottom line is ALWAYS $$$

[sjoe]

And, as usual, nursing schools reap the $$$ by sucking in gullible youngsters who quit the field soon after their school loans are all paid off.

[tonicareer]

One of the problems is the cost of financing a degree in nursing. Most programs require full time attendence and students are not allowed to work during their training. Some of these programs require an overload of classes (schools are requiring more general ed. classes) in addition to more clinical hours than ever before. Programs that use to last 1 year are now 4 and many colleges want it to be a 5 year bsn. School tuition has risen greatly and the cost of textbooks and lab fees. Many private colleges are requiring an out of the U.S. field experience (costly). Community college costs are rising too and they only accept 10 to 50 students a year. Many people need to work while in school to pay for their education and can't in a nursing program (many schools require classes during the holidays. weekends and summer breaks. Many students are opting for other majors because of these restrictions. Nursing students have to pay extra lab fees, insurance costs, uniforms, transportation and parking fees at clinical sites. Medical textbooks are more expensive too. Student nurses are often used as a labor force (a free one) by the teaching hospital. Then when they graduate aren't offered a paying job. There are so many other reasons for the shortage of nurses. Hospitals and medical facilities don't want to loose profits. Insurance companies forbid adequate patient nurse ratios. I hate the fact that foreign nurses are be brought here to save the hospitals money. I'm sure these nurses won't be treated fairly and there will be lawsuits for discrimination. Nurses must educate the public, scream the real story to everyone you know. When people get sick and are in the hospital and start to die from not having enought nurses then we'll see lawsuits. Then the hospitals will have to do something. O, let's not forget the 16 hour days, 7 days a week and being required to work more or be fired. O and how about being sued because of being burdened by too many patients and someone not getting adequate care? Or how about Hospitals wanting Rns to wear a locater like their a prisoner or something? Let' s face it there are so many problems it's going to take 20 years to fix them.

[NancyRN]

What other profession is asked to help bring more young people in because 50 is "too old"? What a slap in the face to all the smart, experienced nurses whose backs and knees have been ruined by hospital nursing!

[JaneQ]

Show me a "profession" where your education / expertise is not appreciated, you work like a dog, you give of yourself emotionally, hardly ever see your family, and your check is 1/2 of what most "professionals" make?........I'll show you NURSING!

I took a course in nursing school, it was called the history of Nursing. I thought it would be a waste of my time. It was very educational. It profiled the business-side of running a hospital, while also comparing "nursing shortages". This problem has been around a long, long time.

Until the day comes when we are treated as a professional, and compensated for our knowledge, there will continue to be a cyclic pattern of shortages in nursing. The way I see it, it is getting worse.......

[sparrow]

I think ownership belongs to the public.

The public who valueS a baseball player or football player more than a nurse.

The public who are willing to pay big bucks to someone to play a GAME rather than the person who will wipe their bottoms when they can and take care of their most personal needs!

The public who want their pizza delivered so badly that the delivery boy makes $8.00/hr plus tips and the CNA who bathes them and takes care of their most personal needs only makes $6.00/hr.

The public who do NOT pay their medical or hospital bills and steal the sheets from the beds, telephones from the bed side, the very dishes their food is served on, pillows and dictaphones so that hospitals are forced to replace these items.

THE AMERICAN PUBLIC OWN THE PROBLEM, THAT'S WHO!

[mrdoc2005]

Well now it is almost 05. I am a student in my last year and I have been saying what Norbert is saying to anyone who will listen. I am a state officer in the National Student Nurse Assiociation. At the last big meeting in Nashville we heard how many nurses each state needed. I am sorry, but stats show that there are plenty of working age nurses. Only they are not working as nurses. They have other jobs that pay more and treat them better.

[Sheri257]

I am sorry, but stats show that there are plenty of working age nurses. Only they are not working as nurses. They have other jobs that pay more and treat them better.

Uh ... that's not necessarily the case. Don't get me wrong: there are a lot of licensed non-working nurses who probably quit because of lousy working conditions, but the situation is a little more complicated than that.

70 percent of those licensed non-working RNs are over age 50 and approaching retirement. And, retirements and deaths jumped by 150,000 in the last survey.

The fact is: The existing RN workfoce is aging and approaching retirement, while aging baby boomers are increasing the demand for RNs. Meanwhile, there's not enough new people coming into the profession either.

I agree that lousy working conditions are part of the problem. But there are many reasons for the shortage, working conditions only being one of them.