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My take on the current nursing shortage.

Nurses are acutely aware of the nursing shortage, but I'm not sure the general public is. Having been a nurse for four decades myself as well as being interested in history I have a perspective on the current shortage that you might find interesting. First, there is most definitely a shortage of professional nurses in the United States and health care is suffering because of it. The problem and therefore the solution is not however a straightforward one. Let me explain.

Everyone has heard of Florence Nightingale as an historical nursing leader, which she was. The contribution she made during Britain's war in Crimea was astounding by any standard. She was able to legitimize the role for nurses by drawing attention to the high death rate among the wounded solders from infections. She was well educated and had a knack for statistics that provided the numbers to support the magnitude of the problem and the obvious solution. She counted the number of soldiers with diarrhea and plotted their cots in relation to the open latrine. She kept track of deaths, she introduced tea (which required boiled water), she trained women of high social status and most importantly she wrote. She wrote notes, she wrote letters, and she kept pages of figures to substantiate her claims. She was the first nurse researcher. She revolutionized care of soldiers and elevated the standard of nursing as a profession suitable for nice young ladies. She created a demand.

World War II further contributed to the demand for nurses. The 1940s found nurses in demand in industry, public schools, public health settings, and private duty in addition to hospitals. Hospitals started nursing schools to provide a ready source of labor and therefore were able to meet their needs by increasing enrollment. The war shifted the demand to meet military obligations and since 99% of the civilian nurses were women who were not subject to draft, the shortage of skilled nurses for the war efforts was acute. Women were needed to volunteer for the military to provide the nurses required. By 1944 nurses were given military rank as officers, which had long-term impact on several facets of the profession. Nurses as officers in the military provided for upward mobility for women, but maybe just as importantly, nurses were eligible for the GI bill that meant they could afford go to universities for higher degrees, and indeed many did. Nurses, who would have previously retired from work when they married, were more likely to continue working after the war. It seemed that Rosie the Riveter didn't want to go back home after the soldiers returned.

The war directed public attention to the virtues of being a nurse also, which was great for recruiting. War demanded nurses quickly so nursing education programs were able to accelerate the previous three years' program to two and a half with the Army Cadet program in addition to providing funding for them.

Since 1945 other wars influenced the profession by attracting more men increasing their numbers to 7.5%. Simultaneously technological advances have made remarkable improvements on civilian health care which in turn have resulted in longer healthier lives, lives that rely heavily on the health care industry. Researchers like Linda Aiken have been able to provide strong evidence that good nursing care makes a difference in the outcomes to hospitalized patients. The number of patients the nurse cares for and the nurses' educational preparation also figure prominently into outcomes. Other current research studies examine the influence of ability to make decisions in relation to the number of hours on shift and working conditions as they influence retention.

This dependence brings the good and the bad news for the nursing profession. The good news is that society needs and wants professional well educated nurses! The bad news is there are too few nurses to meet the demand for the present for at least 20 years. Nature abhors a vacuum I always tell my students. That means either someone else will assume responsibilities or society will learn to get along without nurses. I'd like to see a solution that does not eliminate nurses.

Many creative solutions have been offered such as retraining retired nurses and nurses who left the profession to sell real estate and enticing them back to work. Importing nurses from the developing world where salaries are deplorable and work in the US is desirable to the foreign nurses and attractive to US hospitals. Fast track nursing education has also been proposed as a way to attract second career students who could progress through the program more quickly. Other ways to provide a program includes distance education using computers and the internet to study from home which is ideal for nurses continuing their educations at the graduate level which means they can stay on the job while attending school. Using simulation labs provide a quicker, safer way for students to master decision making in a sheltered environment.

The average age of nurse educators is 58 years. What does that tell you about recruiting large numbers, accelerating their study and including distance education models? Hurrying students through a program in shorter times can help with numbers in the short term, but quality graduates requires quality educators with advanced degrees and that takes time.

To summarize my original point then, there are more people desiring and needing nursing care and evidence to show that aspects of nursing care impact outcomes in hospital care yet, numbers are dwindling among the ranks. Therefore, we could conclude that a multi-faceted front is required. Increased recruiting, increasing scholarships, more creative ways to use the few educators, better working conditions to retain working nurses, using computers and technology to our advantage, and a close look at using nurses to do what they do best while sub-contracting those duties where a professional education is not needed. In other words, giving up some traditional duties and redefining the 'essence' of nursing without eliminating quality. This might mean creating new cadres of care providers.

There was an article published in the American Journal of Nursing in 1944 explaining what the public could do to relieve the nursing shortage. One suggestion that sticks in my mind warned the public not to make additional demands on nurses' time such as caring for patient's flowers and visitor requests. That is a pretty good suggestion and has merit for today. Nurses don't fuss with patient's flowers any more, but are involved with duties that could be carried out by others such as visitors and non-licensed personnel. The danger comes when hospitals must rely on non-licensed personnel because professional nurses aren't available.

My suggestions for the public include these:

1. Take an advocate to the hospital with you to help provide your care.

2. Don't make irrational demands on nurses, but expect high quality safe care.

3. Encourage young men and women to be nurses in service or education.

4. Encourage nurses who have left nursing to return even part-time.

5. Consider sponsoring a student in nursing by buying their books.
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Title Annotation:ONA News
Author:Acheson, Evelyn L.
Publication:Oklahoma Nurse
Geographic Code:1USA
Date:Jun 1, 2007
Words:1175
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