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In Focus: Nursing Shortage: What Can We Do?
In Focus has spent the last month exploring the national nursing shortage crisis, looking at the problem from various viewpoints, and proposing some basic solutions. Let's look at the problem once again, and come to some conclusions about the crisis.

Some basic facts: the nursing workforce is shrinking, aging, and becoming more frustrated over work conditions and benefits. Add to this the increasing unionization of nurses, and their political awakening, and you have the prescription for a major workforce shortage in the near future. Some nurses are even recommending to interested young men and women to avoid the field altogether. This merely compounds the problems for nurses already in the field, since they're not getting as many new nurses as they need.

Management is frustrated, too. Having to deal with the demands of the corporate structure, as well as the needs of a changing workforce isn't easy. Some management groups have made this problem area worse by refusing to listen to or communicate with their nursing workforce. With neither side talking to each other, there's no way a solution can be discussed, let alone reached successfully.

There is hope, however. More and more people are becoming aware of the problem, and its scope, and healthcare professionals are speaking out. In an article entitled "Taking Care of Nurses, Before It's Too Late", in the October 5, 1999 issue of the New York Times Online, Sandeep Jauhar, M.D., notes that:

Good nurses also teach doctors. The nurses in specialized wards like the intensive care unit are some of the best-trained professionals in the hospital. When I was an intern, they taught me how to put in catheters and adjust ventilators. They told me which medicines to avoid. They taught me how and when to initiate discussions with families about end-of-life treatment. Nurses provide essential psychological and emotional support to patients, because they are the ones who spend the most time with them. And nurses are in the best position to judge minute-to-minute changes in a patient's medical condition. Rarely do I respond faster than when a nurse I trust tells me I must see a patient right away.

He also notes that some medical professionals, who decry the strike movement among the nurse workforce as unethical, are in a minority. He disagrees with their stance on strikes, and says:

I take a different view. It ought to go without saying that nurses, like any health-care professionals, provide better care when they are satisfied with their jobs and are not overworked. But these days, such conditions are not easy to find. Managed care and government cost-cutting measures have hit hospitals hard, and many have cut staffing to the bone. Some nurses in New York hospitals routinely take care of 8, 10 or more patients at a time, a monumental task given the monitoring and medication that sick patients require. (In 1968) Barbara Schutt, then editor of the American Journal of Nursing, wrote in an editorial in support of that decision: "Anyone who knows nurses knows that few will use the strike weapon easily, and that if they do, they will use it responsibly -- with adequate notice and plans to provide emergency care." This has indeed been the case. There is no record of any patient's dying as a direct result of a nurses' strike in the United States. Nurses are required to give a 10-day notice before a strike so hospitals can stop elective admissions and plan for emergency care.

When nurses struck for better benefits and working hours in 1984, in Minnesota, the strike organizers met with hospital administration before calling the strike, to work out emergency requirements, and nurses crossed the picket line with the support of their coworkers during the strike to assist in medical emergencies. So nurses on strike doesn't mean what many strikes mean, and patients are still the top consideration for all the health professionals, striking and non-striking alike. This is fairly unique among labor groups on strike, where crossing the line means abuse at the hands of those maintaining the strike. Nurses are working out their strikes differently.

Sandeep Jauhar, M.D notes that even though nurses deal with strikes in a creative and innovative, caring way, they "...often experience a conflict between the moral imperatives of their jobs and the practicalities of their lives. Many have families and financial concerns like anyone else. Most nurses I have spoken with at New York Hospital have a characteristically divided stance with regard to striking. They think it may be unethical, but may still be necessary."

One nurse said she believed that nurses' first priority must be to their patients. "But what are nurses supposed to do," she asked, "if hospitals don't let them be good nurses?" In the end, of course, the nurses decided not to strike. Just 90 minutes before the walkout was to begin, the union accepted a compromise giving nurses a say in deciding staffing levels and letting them work, for the most part, three days a week in 12-hour shifts. It was a welcome compromise, one that could probably not have been achieved without the threat of a strike. And it was a welcome lesson for other hospitals. In New Zealand, Italy and other countries, work stoppages by nurses have forced hospitals to increase personnel and decrease patient load. In Japan, nurses dressed in white took to the streets in the early 90's to demand more personnel and less night duty. Hospitals in the United States need to address nurses' concerns now, before strikes seriously undermine patient care.

In Focus agrees with Sandeep Jauhar, M.D. We need to address the problems now, and not wait until they grow to unmanageable dimensions. Nurses and management alike need to work together on finding solutions, and nurses need to continue to empower themselves politically. Healthcare professionals know they're going into a stressful, challenging field when they start schooling for it, but there's no reason to make the field even more stressful with an aging, decreasing workforce that's overworked and underpaid.

Is there a light at the end of the tunnel? Yes, and hopefully it's not the train! If management will give nurses more of a role in decision making, and if nurses will try to understand management's viewpoint, possibly by taking some management education courses themselves, then all the parties involved will benefit. If the nursing workforce problems are addressed in a timely, honest manner, then more people will be attracted to the field, and the nursing labor shortage will be averted. Unless we make some changes now, we'll be facing a serious, long-term crisis in the near future, even more so especially in the United States, where the population as a whole is aging. More elderly means more ill people, needing nursing care, and what happens if we don't have enough nurses to go around? Patients have a serious stake in this crisis, too, and they should be included on some level of the discussions between management and nursing.

The United States has always been a leader in the field of nursing, as well as being an innovator in the field of labor relations. There's no reason we can't continue this trend, specifically by encouraging nursing labor representatives, nurses themselves, patient representatives, other healthcare professionals, and management to work out their problems at the negotiation table, not on the picket line. Nurses have a lot to gain from working on this problem with management, and the future can be a much brighter-looking place if we all work together on finding solutions, not just identifying problems. Any healthcare professional can tell you the value of preventative medicine, and that's what the nursing field as a whole needs. Instead of being reactive, let's be proactive, and creative. We know what the problems are; let's focus on the solutions.

Discussion

June 2000 - In Focus: Nursing Shortage Previous Articles
June 26-30, 2000, Strike! Strike! Strike!
June 19-23, 2000, Supply and Demand, the RN Workforce of the Future
June 12-16, 2000, What Do the Numbers Say?
June 5-9, 2000, Nursing Shortage: Mirage or Menace?

Anne Marie Talbott - atalbott@healthbond.com

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