Saturday, October 25, 2008

The Nursing Shortage, PBS-Style

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

Well, it finally happened. The nursing shortage received some well-deserved coverage that, in many ways, actually did the subject justice. Now with David Brancaccio, a weekly half-hour television show of investigative journalism on PBS (previously hosted and made famous by Bill Moyers), focused its attention on the nursing shortage in America, and I can only hope that the message delivered is heard by the people who most need to hear it.

With a shortage of as many as one million nurses projected by the year 2020, calls to address this crisis within the troubled American healthcare system are becoming louder and louder.

As described in the course of the program which aired this evening on PBS, nurses are the engine that keep the healthcare system humming. While doctors may sometimes receive the lions' share of the praise for life-saving surgical techniques and heroic medical measures, it is round-the-clock nursing care that can often mean the difference between life and death. And as outlined during Mr. Brancaccio's investigative story, a number of studies have demonstrated quite clearly that when the number of patients cared for by nurses increases, mortality also increases. And by most measures, successful outcomes most often directly correspond to the quality of nursing care received.

As the population ages and lives longer with more chronic illness, the need for nurses in hospitals, health centers, nursing homes, and in home care will continue to increase exponentially. (It was pointed out during the broadcast that approximately 75 cents of every healthcare dollar is spent on chronic illness.) And with nurses working harder as salaries remain essentially stagnant in the face of increasing workloads and a sagging economy, attrition from the profession should be of paramount concern.

Speaking of attrition, approximately 25% of new nurses reportedly leave the profession each year, and one can only imagine that falling from the frying pan of nursing school into the fire of full-time nursing may be one of the many factors that push new graduates right out of the profession before they have even had the chance to settle in.

As 25% of new nurses leave the profession, the average age of the American nurse continues to increase, with retirements from active duty occurring on a daily basis. Meanwhile, 70% of nursing schools turn away thousands of qualified applicants due to a shortage of nursing faculty which, if left unchecked, will continue to cripple any efforts to assuage a shortage that only seems to expand with each year that passes.

When it comes to retaining new nurses who have recently entered the field, some facilities (as shown during the broadcast), utilize a year-long residency or internship structure so that new graduates actually receive the guidance and mentorship needed to make it in the real world, post-nursing school. Similar to the medical residency that newly-minted doctors receive, a nursing residency or internship allows a new nurse sufficient time to receive the focused training that he or she will need in order to deliver high quality and safe care. Thus prepared for full-time nursing, the new graduate is thus less likely to burn out, and more likely to succeed in his or her work and be satisfied with a newly chosen profession that desperately needs to retain its newest recruits.

If you would like to watch the Now broadcast in streaming video on your computer, you can click here. To watch a four-minute interview with a University of Pennsylvania School of Nursing professor regarding continuity of care from the hospital to the home, click here. To find what hospitals in your state have received the American Nurses Association "stamp of approval", click here. And to follow a week in the life of a new graduate working on a New York City burn unit, follow this link.

My one criticism of the program is that, like all media covering nursing and the shortage, only hospital-based nursing was addressed. There was no mention of home care, community health, public health, or school nursing, areas which are also struggling mightily with the effects of the shortage. This focus on hospital nursing---however important hospital care certainly is---only serves to underscore the public's (and the media's) misconceptions about nursing. Our society seems to ubiquitously see nurses solely as workers in the hospital, overlooking the fact that nurses provide crucial care to myriad populations of citizens well beyond the walls of the nation's hospitals.

Such media attention on the crisis of the national---and global---nursing shortage is truly needed, and it is only by educating the public (and our elected officials) about the crucial need for nurses that change and growth might occur. While Barack Obama and John McCain both have, to some extent, made gestures vis-a-vis the shortage of nurses in America today, a new administration in Washington will have many pressing issues to address as power is assumed in January of 2009, and fixes to the healthcare system will certainly take time.

No matter how the enonomic climate evolves, people will still get sick and need nursing care and medical care. No matter how many banks fail, hospital doors will still be open, visiting nurse agencies will visit patients at home, and surgeries and emergencies will continue to occur. Even as the global economy reels from the latest financial implosion, qualified applicants will be turned away from nursing schools and shortages of nursing faculty (due to relatively low salaries and other factors) will plague the halls of academia.

A new administration will need to have the political will to take some bold strides vis-a-vis the American healthcare system. The delivery of care as it pertains to chronic illness will need to be addressed. Nursing faculty---the key to educating new nurses in preparation for the workforce---will need to receive improved compensation for their important work as educators of future nurses. Nursing students from a broad socioeconomic spectrum will need scholarships and grants to offset the costs of a community college or university education. And healthcare facilities will need funds to give new graduates the time and attention they need for mentorship and preparation for autonmous practice.

The list above is by no means exhaustive, and the program aired on PBS is also by no means the final word on a shortage that currently is without a forseeable end. Creativity, forethought, vision, and a savvy understanding of both the economy and the vicissitudes of the healthcare industry are all necessary in order for current healthcare problems to be sufficiently addressed and remedied. Many of us are cynical that any meaningful change is close at hand, but we can only hope that our pleading, explanations and supplications do not, in the end, fall on the deaf ears of bureaucrats who just cannot see the healthcare forest for the trees.
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