SON: Connections - Fall 2004

Headlines | Briefly | From the Deans Desk

A Question of Care: Three Health Care Leaders Reflect on the Nursing Shortage
By Lia Unrau

Leo Greenawalt President and chief executive officer, Washington State Hospital Association Joan Shaver Dean and professor, College of Nursing, University of Illinois at Chicago Nancy Woods Dean and professor, School of Nursing, University of Washington

The nursing profession is at a critical crossroads. The country faces a severe nursing shortage, right at a time when aging baby boomers need more care. Nursing faculty are aging too, and more than half nationally are set to retire in the next 10-15 years, with few younger nurse-professors ready to step in to replace them. Today's specialized nursing care demands nurses be better educated and prepared for a range of work settings. With this in mind, Connections asked a few top nursing and health care leaders to reflect on the nursing shortage and nurses' role today.

How is the nursing shortage affecting your organization?

LG : There have been significant efforts by Washington hospitals to implement programs aimed at retaining the existing work force as well as those who are just entering the work force. The Washington State Hospital Association (WSHA) and the Northwest Organization of Nurse Executives have joined together to survey members in an effort to quantify the extent of these efforts. Survey data done by WSHA in 2001 and 2002 showed a downward trend in vacancies and turnover.

Other efforts include an expanded re -introduction of nurse residency programs, recruitment of new graduates to work in specialty units, and re-thinking the staffing methodologies used today in terms of their impact on safety and quality outcomes. Some Washington facilities have participated in foreign nurse recruitment campaigns. From 2000 to 2002, there was an increase in the use of traveler and temporary staffing agencies. Washington hospitals are working in collaboration with educational institutions to increase the number of slots for nursing education programs. WSHA supported the start-up of the Health Work Force Institute to focus on capacity issues and manage WSHA's health care work force agenda.

JS: Competition to attract faculty is high and it is more difficult to find "star" and potential "star" faculty. Therefore, recruitment of faculty is a growing challenge. We are viewing our needs so as to recruit into more general scholarship areas, complementing what we have already and not into highly specific areas. We are mindful of creating scholarship teams and having to create "special" positions with leadership roles that go beyond the usual faculty roles, for instance, center directors and special projects coordinators.

NW: The current nursing shortage challenges us as an academic institution just as it challenges clinical services. We have a much smaller pipeline of future academic nurses-those who have earned doctorates and are prepared to offer clinical education and conduct cutting-edge research. Our recruitment efforts must be much more aggressive as we see the shrinking number of faculty applicants who are prepared for the complexity of our academic programs and research. We have not experienced a decline in our enrollments, instead an increase in the number of applications from students. Our frustration is in not being able to accept more students into our programs due to our limited and declining state resources for teaching. We have been able to maintain our class sizes by creating clinical teaching partnerships with area hospitals. Through the partnerships, hospitals provide a master's-prepared experienced nurse to help teach our students in their clinical settings.

We have experienced nursing shortages before. What makes this one different?

LG: This is a demographic shortage as well as a supply and demand shortage. There has been a shift in the types of RNs needed due to increased demand external to acute care facilities. We have an aging work force. Nurse faculty are aging, thus creating a need to replace the retiring faculty so we can continue to educate RNs. The population is aging, thus creating the need for more health care services and new types of settings, such as continuing care retirement communities. We are preparing RNs across the country primarily at the associate degree level. However, there is an even greater need for professionals to work in provider settings with the competencies that come with education at the BSN and higher level. We also have a work force that doesn't represent the diversity of the communities we serve. If we are to address the quality of care in our increasingly diverse communities, we need a more diverse work force that reflects those communities.

NW: This nursing shortage is unique because it is destined to deepen as the population ages. With more older people in the United States, the need for nursing care escalates. With the aging of those in the profession, the number of available nurses will decrease. We have not kept pace with the future need for nurses as the support for higher education has declined. And we cannot replace the experienced nurse of today by producing a large number of nurses quickly. Instead we need to educate nurses better for the pressing challenges of our health care system and the complexity of today 's health care problems.

From your perspective, what steps do the health care community and/or the public policy makers need to take to address the nursing shortage?

LG : Fully fund the Nurse Reinvestment Act, provide adequate funding for nursing education at the state level, and create public/private partnerships to provide scholarships and grants to enable students from diverse backgrounds to enter and complete nursing education programs. Provide adequate funding to educate the nursing faculty needed for the future, adequate reimbursement across provider settings to pay for the unique and critical services RNs provide, and continue the focus on retaining our existing workforce.

Even with all of the above, we will continue to have a shortage of health care workers unless we start redefining the models of care delivery by first looking at the changing needs of patients and populations.

JS: Advocate for and provide incentive for the redesign of health care so that fewer care providers can meet the challenges of keeping older people healthy and managing in the face of chronic illness. Broaden the driving forces behind health care planning and delivery to encompass health promotion and disease prevention, population based health, and integrated health care services for mental and physical disease and illness-and not function with as much predominance of the biomedical model, mainly crisis physical care.

NW: We need the best thinking of our profession, consumers of health care, and policy-makers to create a multipoint strategy. At minimum we need to intensify our support for higher education, support efforts to prepare nurses who are better educated and more capable of facing the complexity of health care problems, and encourage a diverse population of potential students to pursue nursing as a career. We need to explore alternative ways to deliver services, using nursing professionals in positions in which they can have maximum impact on health care. We need to clarify the fiscal policy about health care-a national health plan. How do you define the role of nurse in today's health care system?

LG: The nurse is the integrator and coordinator of care delivery, working with many other disciplines to ensure, first and foremost, that care is delivered in a way that focuses on safety and quality. The nurse today remains a strong advocate for the patient/ population/ consumer. The public has responded by ranking nurses as one of the most trusted professionals. Today's nurse is also a continuous learner who must blend science and art into the realm of their work.

JS: The roles are plural-the main coordinator and manager of health restoration care in hospitals and the deliverer of primary (health preservation and promotion for individuals) and public health (same for groups) care in the community (private practice, interdisciplinary group practice, neighborhood health centers, clinics, schools, corporations, etc.).

NW: Nursing is knowledge work- why would you hire a nurse? Because of what she or he knows, because of how she or he thinks, the ability to make critical judgment calls that often have life-saving consequences.

What do nurses need in order to be prepared to meet the needs of the public?

LG: Nurses need a solid education in physical and social sciences and an understanding of how to access information because it is no longer possible, with rapidly expanding knowledge bases, to learn a finite body of knowledge. They need solid communication skills; empathy; basic management skills such as organizing work and delegating tasks of care; the ability to critically synthesize a broad array of information in order to integrate the care delivered based on the person's needs; fundamental leadership skills; an understanding of the financing of our health care system; and an understanding of the history of nursing and health care in this country.

JS: They need systems quality focus, strong behavioral, information and technological science-driven education and a caring motivation.

NW: The growing diversity of the U.S. population and migratory patterns have escalated the need for deep education in sociocultural aspects of health care. More of us need to be bilingual or multilingual and culturally competent to practice with many different ethnic groups of patients. Nursing's emphasis is on the whole person, not just body parts. Our students need to understand the biobehavioral, body-mind connections.

They need to be educated to provide skilled nursing care to the aging population, and to address health disparities among the poor and those with poor access to care. Also, nurses need supports in the workplace for complex decision-making, such as computer generated decision aids and artificial intelligence.

What kind of leadership skills do new nurses need?

LG: The skills to engage and mobilize a multidisciplinary team that remains focused on the needs of the patient/population/consumer. Transformational, not transactional, skills that engage patients, populations and families as well as other professionals in achieving desired outcomes of care.

JS: Interdisciplinary communications, strong collaborative problem-solving, vision/scenario-building and persuasion skills for enacting change.

NW: Critical thinking, communication and assessment skills, and nursing technology and resource management.

What advice would you give to the next generation of nurses?

LG: Remember that the core of what you do must be driven by the needs of the patients/populations/ consumers. It is no longer acceptable for those of us in the health care professions to "tell" them what is needed.

Understand the history of where we have been in health care. Help us define new frameworks with which to provide care. Develop a lifelong love for what you do. Health care has ups and downs-your passion will sustain you during the down times.

JS: Keep an open mind, think and learn constantly, neutralize the negative voices and take seriously your role in shaping the future of nursing and health care. Be brave (a risk-taker) since most new things and ways are not a "risk" if there is no "fear of failure"-they are merely a trial.

NW: Follow your passion. In looking at your future, there will be specialty areas of nursing practice yet to be identified and often these will emerge on the boundaries of disciplines. Watch for these. Align yourself with initiatives you can really believe in and feel passionate about. No matter what you choose to invest in, it will be hard work. The thing that will sustain you will be your passion-pursue it without reservation.

What do you want the public to know and understand about nursing?

LG: The work of nurses is core to safety and quality in health care. The public continues to trust nurses because they are intelligent, they care, and they maintain a focus on the patient. Education and practice prepare nurses to work in a wide assortment of direct and indirect care. Nursing is a profession rich with a diversity of opportunities. It is no accident that nurses also make successful lawyers, legislators, CEOs, entrepreneurs and inventors.

JS: Nurses are experts and our main role is to help people who are sick to resume, or are well to continue or maximize, living their life as optimally as possible. We do this by guiding and supporting self-care through phases of health/illness. We make a huge difference to the health status of people in ways that remain quite invisible because of societal overemphasis of high-technology health care. Nurses practice virtually in every sector where health care is delivered. Nursing is a robust, versatile profession that allows one to keep re-inventing oneself career wise throughout a lifetime.

Return to Headlines
Headlines | Briefly | From the Deans Desk