Tuesday, October 28, 2008

New Nurses, Primary Care, and the Calculus of a Multifaceted Shortage

(Note: This is my twelfth---and final---post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

It seems that everywhere I turn, someone is telling me that, a) they just applied to nursing school, b) someone they know just applied, or c) they or someone they know was just accepted/rejected from nursing school.

New nurses---and those who wish to be nurses---are entering a profession in transition, a profession that is losing its older members more quickly than its educational institutions can churn out novices ready to enter the fray.

Today I was interviewed on a radio program in Gainseville, Florida about a recently published book of non-fiction writing by nurses in which I was a featured contributor. The show's hosts seemed sincerely perplexed when I explained that older nurses are retiring faster than they can be replaced, and that nursing schools simply cannot offer faculty salaries that can compete with what nurses are paid in clinical positions. Thus, thousands of qualified applicants for nursing school programs are turned away each year since there are not enough professors to educate them.

As a consequence, far too many eager and highly qualified applicants are rejected from nursing schools around the country---and in fact, around the world, as well---and where do they turn? Do they re-apply the following year? Do they look for another school to which they might have a chance of acceptance? Or do they give up their quest to join the nursing profession and simply move in another career direction entirely?

At a time when aging Baby Boomers are living longer with chronic illnesses and are increasingly in need of quality nursing and medical care, it's time for our government and other influential entities to step up to the plate. The government itself must realize that the calculus of the nursing shortage must change, and this continuous hemorrhage of nurses from the profession without a consistent transfusion of new nurses must be short-circuited.

I will grant that we are in difficult economic times. I will also admit that the U.S. healthcare system is dysfunctional at best, and broken at worst. It is also plainly apparent to me that a growing lack of sufficient nurses to provide care in numerous facilities across the country is a recipe for a public health disaster of enormous proportions.

Meanwhile, if an Obama administration gains control of the White House, a push for near-universal healthcare coverage for all Americans will most likely be an important agenda item in the first year of such as administration. This is a laudable goal that may or may not be achieved. However, it must be acknowledged that the process of bringing more citizens into the healthcare system must be met by a similar process of encouraging more healthcare providers to take part in delivering that care.

The nursing shortage is real, and it is effecting how healthcare is provided around the country. Similarly, there is a very real shortage of primary care physicians, with more physicians opting for specialties in which the demands and low pay of primary care are eschewed.

Now, it is easy to see that if more citizens are insured (a goal that should absolutely be pursued despite the current economic climate), then we must simultaneously ensure that a sufficient number of physicians and nurses are available to provide the quality care that would consequently be delivered.

We must create incentives to lure physicians back into primary care, perhaps by reaching out to medical students and residents with a campaign to describe the value and rewards of primary care. Financial incentives such as loan repayment programs could also be enacted for new doctors who enter the field of primary care or family medicine, whether they work with vulnerable populations or not.

In terms of the provision of primary care, an expansion of Masters-level Nurse Practitioner programs and Doctoral nursing programs (especially for the new Doctor of Nursing Practice designation), could go a long way toward assuaging the nationwide shortage of primary care physicians, especially if interest-free loan programs and other incentives are created and fully funded.

We also must urgently expand the capacity of nursing schools by subsidizing nursing professors' salaries, expanding programs, and enacting a massive campaign of grants, scholarships and interest-free loans to make nursing school more readily affordable for a broad spectrum of prospective students.

Yes, these programs would indeed be expensive, and a great deal of money would need to be designated for such a sizable undertaking. Yet we must examine the relative costs of our inaction, and the crisis of untreated chronic illness and substandard medical care that will be the result of such a failure to act.

As the population ages and people live longer with more complicated constellations of chronic illness and multiple comorbidities, the provision of medical care will necessitate an enormous number of nurses as well as a solid base of primary care providers for patients across the lifespan. Nursing education must be funded and supported, nursing faculty must be recruited and well-compensated, and primary care providers must be given viable reasons for remaining in an area of medicine that has fallen from favor.

We cannot afford to ignore the multifaceted issues which are throwing the American healthcare system into crisis, and rest assured that any money invested now in improving the delivery of care will pay astronomical dividends in terms of prevention, improved healthcare maintenance, and increased cost-effectiveness. It is in our best interest to act, and we can only hope that political will and popular support will be enough to set these wheels in motion.
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