Tuesday, April 14, 2009

Where Are The Nurses?

It is no secret there has been and continues to be a nursing shortage in the US. This is ever so evident if you are in fact a nurse. We work many hours, and I would guess that most of those hours are spent with an increase in patient/nurse ratio. This causes the quality of care to decrease. I would say that many people in our country may not realize how important this is. As a nurse, and speaking generally, we try to not let it show that we are many times overworked. We do what has to be done to care for our patients, while not letting the stress show. Not letting the patient know how many other patients you are responsible for, while you are caring for them.
We work extra shifts out of guilt. Guilt of leaving our fellow nurses short staffed, as well as guilt for leaving the patients with an inadequate number of nurses. We leave our shifts feeling as though there was something missed, too many corners cut, and not really feeling like a nurse at all. We drive home in our cars thinking about how we didn't have time to listen, really listen to our patients as they try to tell their stories. We think about how we may have been a little short or standoff'ish with that one patient who pushed their call button one too many times for things that really could have waited. We think about who that particular patient may have just wanted the reassurance that someone would come if they called. We think about that person who was disoriented and climbing out of bed every 5 minutes, and how we didn't do the trial restraint release on our shift, because we didn't have the time to sit with them until they fell asleep and forgot that they were trying to get up and were unable to walk. (Don't even go there, if you are a nurse, you know - you know what I am talking about. And if you are not a nurse, don't judge this until you have walked in the shoes of a nurse.) You think about your charting, did you forget something, what about that shift note that you probably should have written but didn't because really, nothing significant happened, but the notes are important and you let that one go.

Studies are showing that the nursing shortage is predicted to just get worse. The Council on Physician and Nurse Supply released a statement in March 2008 that stated, based on a study done by the University of Pennsylvania, 30,000 additional nurses should graduate annually to meet the US healthcare needs. This was 30% more than the current number of graduates at the time of that study.
The problem with this number is that I found this study by AACN that showed 49,948 qualified applicants were turned away from baccalaureate and graduate nursing programs in 2008. Why were they turned away, if they were qualified, you ask? Because there was not enough faculty, clinical sites, classroom space, or clinical preceptors. This report also listed budget constraints. The report listed that almost 2/3 of the schools surveyed listed faculty shortages.

Another point of focus could also be the average age of the current RN. This study released in July 2006, by the Nursing Management Aging Workforce, showed 55% of the nurses reported intended to retire between 2011 and 2020.
Forty-four years old. That is the projected average age of RN's by 2012. Nurses in their 50's are expected to become almost 1/4 of the RN population. These nurses will be, by this time, seriously looking toward retirement. They will be burned out and/or looking toward management positions, because the patient care load is too much, the pace is too fast, the physical labor may be taking a toll on them.
In essence what I see happening? Put simply. . .
No faculty = less graduates = higher patient/nurse ratio = decrease in quality care
=increase in burnout = increase in nurse turnover rate
= decrease in continuity of care
= decrease in quality of care

Do you see a cycle here? It all goes back to quality care.

From what I saw as a nursing student 4 years ago, facaulty was not paid well. They were expected work an ungodly amount of hours. Not necessarily hours with students but hours in preparation, clinicals, classroom time, grading papers, tutoring, mentoring, encouraging students, meetings, etc. They do this for little pay. In the state that I live in, I just learned the average salary for an Assistant Professor was $51,000. I know RN's who are associate nurse RN's who are working in hospitals making more than that. Those assistant professors are still working full time hours and then taking work home to prepare for classes and clinicals. No wonder we don't have enough faculty!

A report initiated in March 2007 by the Agency for Healcare Research and Quality on Nursing Staffing and Quality of Patient Care found that the RN shortage along with increased workload, did in fact pose a potential threat to the quality of care. Increasing the RN staffing showed reductions in hospital related mortality and failure to rescure and also decreased the average length of stay. Patient care and safety showed compromise in hospitals with less than adequate staffing.

What can we do about this? Well, I found alot of information about how bad it is, but I didn't find alot of information about how we are going to make it better. What I found was information on the Nurse Education, Expansion, and Development Act (NEED Act). This Act if passed would amend Title VIII of the Public Health Service Act, authorizing caitation grants for nursing schools. This will result in the increase of faculty which results in the increase of students. This is called a capitation grant. This is not a new idea. Capitation grants have been helping to stabilize the nursing shortage for years. The Nurse Training Act of 1971, as well as the Nurse Traning Act of 1975 were brought about to increase enrollment thus help the shortages. From 1971 to 1978 the government provided capitation grants to nursing schools in support of education.

There are also many initiatives at a local level to help stabilize the nursing shortage. There are monies available in some states that will give extra financial assistance to nurses who are continuing their education in a master's program. There is also some states that have a loan forgiveness program for nurses who become faculty.
For me, it is nice to see there are initiatives being put into place. It was also disturbing that I found more research and studies done on the problem than I found on the solution.

What I know is that most of the nurses I know and work with are not doing this job because of the money. The money is good, I will not lie about that, and it does help. But most nurses just love the job. They love that they have the chance to make a difference in someone's life, that their life is changed on a daily basis by the patients they encounter. Many of the nurses I know, if given the opportunity and finances to quit their job, would not do it. I myself would not do it. Someone could give me $1million today. I would be estatic. I promise you that, but I would not quit my job. Nursing is a part of me. It makes up who I am. I would feel there was a piece of me missing if I did not have patients to care for. I would feel I have lost my purpose.

So, even though there is a shortage and many of us feel overworked. I keep my chin up, I show up for work when I am scheduled, I do my very best to have a good attitude and never let my patients know or feel that I might not have time to listen to their story. I have learned over the past several years, that some of those stories they feel they need to tell. The stories of their illness, misfortune, fears, and recovery have been meant just for me to hear. Some of those stories are imbedded in my mind and heart and help me daily be the compassionate nurse that my patients deserve.

Shortage or no shortage, I will always be a nurse and will always love what I do.

If you have considered being a nurse, take a minute to do some research. Ask a nurse you know if you can shadow them one day on their job. See what it is all about. Learn how rewarding this job can be and what a difference your patients can make in your life.

Help us end this shortage, and be able to provide the care each person deserves. You may be a patient some day and wish that your nurse had more time to spend with you. That is when you will get to see the other side of this story. That is when you will remember what you have read here. When you do, please remember to thank your nurse. They work hard to care for you. And even when the day is bad, and your nurse is running like a mad person, they really do care. That is just the nature of being a nurse.


1 comment:

  1. Wow! We need people with compassion and the heart of a servant to go teach and learn!