Doris Young Associates'
Young Thoughts
Volume 8 Issue III
March 2008
IN THIS ISSUE
Nursing Shortage: How Will it End?
On The Lighter Side
Nursing Shortage: How Will it End?
Registered Nurses are the essential primary caregivers in health care facilities today. For millions of hospitalized people worldwide, nurses are the difference between life and death, independence and dependency, success and failure.
As nurses we have continuous thoughts rushing through our heads. If we're caring for an ER patient from an auto accident and our minds go to work asking: Is the patient breathing on her own?
Are we going to need to put a tube in her and should I begin to draw up the necessary medications to perform this procedure?
What are her current vital signs?
What is her respiratory rate, heart rate, blood pressure, and temperature now? Are they stable? Where can I start an IV line? Is the line running? What do these visual clues tell me about the status of the patient? How deep is the bleeding wound in her leg? Is his/her leg broken? Does the bruising around her abdomen indicate internal bleeding? When we consider where to work we have lots of choices. As nurses we choose the areas we work in based on what level of energy, excitement, teamwork and action we want. Whether we're in the trauma room or taking care of patients suffering from chronic illnesses, helping alleviate someone's pain from a broken bone, sitting and talking with someone who doesn’t feel safe to himself or to others around him, we desire to pour out comfort and compassion to those around us. We're the calming voice in the time of chaos and uncertainty. For a nurse each patient brings unique demands and knowledge requirements to assess and deliver what's needed. All this takes time and experience to acquire. It’s the expert nurse who notices that the patient usually put out a lot more fluid during dialysis and that his blood pressure normally runs high. It’s our gut feeling that something is wrong. We’re the ones that go to the attending physician overseeing the patient’s care to say, "Something is just not right with this patient.” As nurses we share our concerns and ask for a repeat echocardiogram, just to make sure before transferring our patient. And, astute physicians know to listen to the skilled instinctive nurse to find that in fact the patient's condition has deteriorated. So, it’s the nurses who’s intuition results in the patient being rushed to surgery within a few hours to save a life. Some days are harder than others for nurses and the greatest challenge is to come everyday ready to give our time, talents, and treasures gained over years of experience, caring, and love for those who face major struggles. Yet a lack of true support and value for nurses has contributed to a shortage that is one of our most urgent public health crises. The nursing shortage has claimed countless lives and threatens to overwhelm the world's health systems. It’s no overstatement to say that our future depends on superior attention to nursing. We need to change the everyday lives of nurses by focusing on what is important to them. Nurses want to be sought out for counsel. They spend all day with the patient and want to be asked their opinion and insight. If this doesn’t happen or if their perspective is discounted or, worse, ridiculed, as the nurse our heart is in pain. If in our home life we're not respected, asked for counsel, and not romanced, we're suffering often in silence. Nursing can be a great adventure of identifying maladies and guiding people to wholeness. And nurses want to feel like an integral part of this adventure and essential to the triumph of the exploration. If we feel we're treated as insignificant, our hearts are wounded. We're interested in the medical diagnosis as well as the nursing diagnosis. Too often the medical community and administration see nurses as a handmaiden’s role rather then integral to the successful outcome of her patient’s hospital stay and healing. No to mention the primary need people have when they come into the hospital. Nurse’s desire to make the world a better place by creating a calm, safe environment for patients to heal. If there's tension or conflict nurses tend to be distressed because they know the environment is vital for the restoration of health and can feel like failures if they can’t establish it. Our profession is in a dilemma.
Since 1960 the US has had episodes of nursing shortages that resolved fairly quickly until 1998 when it not only persists, but is expected to get a lot worse. Many contributing factors have been identified that increase the shortage including 80 million baby boomers retiring in the next decade. At the same time veteran nurses are leaving the profession they too may need nursing care as they age thereby adding to the demand. The shortage began after managed care ushered in an era of cost cutting in the early 1990s. Lesser skilled workers replaced nurses. In Massachusetts 27 percent of hospital nurses were laid off, the largest number in the country. Next, nursing became unappealing to women who began to have many other career choices. As nurses left the workforce, studies showed that patient care deteriorated. Some large scale nursing research studies found specifically if an optimal workload for a nurse of four patients increased to six the patients would be 14% more likely to die within 30 days of admission. If patient workload increased to 8 patients versus 4, the patient mortality rate rose to 31%. Studies have also shown that higher nurse staffing levels result in reduced numbers of urinary track infections, pneumonia, upper gastrointestinal bleeding and shock in medical patients as well as lower rates of "failure to rescue". Low registered nurse (RN) staffing levels and poor organizational climates have even been found to put nurses at greater risk of needle stick injuries. As hospitals started experiencing acute shortages of nurses, they responded by raising salaries and offering bonuses to nurses to enter the profession. Campaigns were launched to attract people into nursing. 185 thousand registered nurses entered the workforce by 2003. And in 2008, even with this huge entry of nurses the shortage is still here and is predicted to continue to grow as the nursing demand increases. According to the Department of Labor, nursing is the second fastest growing occupation in the US. And though nursing program applications are up, we can't train all those interested in becoming RNs. Due to the shortage of faculty 147,000 eligible applicants were turned away from US nursing schools in 2005. And 50 percent of nurse faculty is expected to retire within the next decade as well. Nurses often choose working in the hospital setting over teaching because the pay is so much better. An RN with a community college degree can make the same as an educator with a doctoral degree. Senior nurses and nurse administrators can earn into the six figures if they work in a hospital. Hospitals are recruiting both foreign trained as well as US trained nurses to come to work at the bedside. However, nursing shortage will continue and predictably get worse unless working conditions for nurses are addressed, including nurse-patient ratios, work schedule issues, unit-based decision making, and respect. In response to Canada’s growing nursing shortage, they’re sending a delegation to the Philippines to attract 300 nurses. And recruitment doesn’t solve the whole problem. 20 percent of nurses leave the hospital within their first year of work according to a recent study from The New York University School of Nursing. Some hospitals have improved conditions for new nurse graduates by providing longer orientation programs and other support like rapid response teams that deploy to help any nurse in a pinch. Hospitals are also seeing that higher wages to recruit and retain nurses is not enough. Nurses are now more frequently running the operations of the hospital. The amount of patients nurses must care for on a shift is being addressed in many hospitals. However, despite changes in some hospitals many nurses say conditions have gotten worse - they are caring for sicker patients and their job has become unrealistic. In more than a dozen states nurses are pushing to mandate nurse-to-patient ratios in hospitals. But despite all these efforts to address the growing shortage, the demand for nurses is expected to increase by 40 percent over the next decade while the supply steadily drops. Many young nurses entering the profession today are overwhelmed because there is so much to learn and do. Nursing schools don’t provide the clinical training and technical expertise unimagined even a few years ago that is needed for nurses today and hospitals must finish up the needed education and support. As a health care consumers we can help. When donating to a favorite University ask to have the donation directed to the nursing department. Ask local health care facilities in you area what their nurse-patient ratios are. Ask the nurse who is caring for you or your loved ones how many patients they have. If it's more then 6 ask administration why. Support health cares movements to focus on Holistic care and universal coverage. Ask questions. Know your medications. And finally, follow in the footsteps of Johnson & Johnson who were the first to sponsor the Leadership Empowerment Accelerated Development (LEAD) for health care program and donate to the LEAD Fund which provides leadership development to health care leaders who don't have adequate funding. For more information or to donate to the LEAD fund contact Doris Young PhD, RN. Doris Young, The Nurse Doctor, works with health care facilities to meet these challenges. She works with nurses and nursing leaders to develop extraordinary atmosphere where nurses thrive and provide the exceptional care that people deserve and ought to have. Doris supports health care leaders to create the environment that will eliminate nursing burnout, the nursing shortage, and improve the health of all. To reach Doris Young, author of “Save the First Dance for You, The Complete Nurses Guided to Serving Your Profession, Your Patients, and Yourself call 800 673-8005 or email at Doris@DorisYoungAssociates.com
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