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December 2002 | January 2003 AWHONN Lifelines 479
i If you’re like me, you’re somewhat tired of
hearing about the nursing shortage. Yet, I keep
coming back to it, as I find it a pervasive sub-
ject and, frankly, of fascinating importance. It’s
hard to believe that we’ve had at least six prior
shortages starting as early as 1918. One would
think that by now we would be expert in han-
dling such difficulties, but we are not. Maybe
that is what keeps my interest level high.
The current situation is basically different
from the prior ones in that our supply of
potential nurses, primarily women, is inade-
quate. According to the Robert Wood Johnson
(RWJ) Foundation’s report on Health Care’s
Human Crisis: The American Nursing Shortage,
the current dilemma reflects competition from
other career opportunities for women who find
nursing to be less and less attractive, and “until
nurses gain a real place at the decision-making
table, we’ll continue to have a shortage of nurs-
es.” Other factors contributing to the shortage
include an aging nursing workforce, failure to
attract more men and minorities into nursing
and increased health care demands by the
aging baby boomers.
We can no longer afford wishful thinking.
We must look at situations as they actually
exist. For example, one of the most severe
shortages occurs in California which ranks
49th out of 50 states in nurse-to-population
ratios. There are 265,000 RNs in California
with 90 percent working. Some “experts” claim
that the other 10 percent should be recruited
back into the workforce and this would allevi-
ate the problem. Wrong! When investigated, we
find that older nurses and those who are physi-
cally incapacitated tend to maintain their
license even though they are incapable of
working, that nurses who move to other states
maintain their license, in case they return, and
that RNs who are well ensconced in other
fields keep their license, mostly for nostalgic
reasons. California does not have a 10 percent
pool of potential RNs; its workforce is working
pretty close to capacity. Other states may not
have as severe a shortage, but the U.S.
Department of Health and Human Services
reports that the country as a whole will have a
22 percent shortfall of nurses by 2015. We must
do something now.
NursingShortage
Barbara PetersonSinclair, MN, RNC,OGNP, FAAN, is anacademic specialist innursing programdevelopment atCalifornia StateUniversity Northridge.
Revisited
The
We can no longer
afford to have only 37
percent of nurses’
time in direct patient
care and a whopping
33 percent of their
time in documentation
In addition to inadequate numbers is the
fact that current policy initiatives are not
focusing on the challenges necessary to meet
nursing needs within overall health care deliv-
ery. The first challenge is to create a practice
setting that attracts and retains nurses. The sys-
tem must be redesigned to accommodate elim-
ination of waste and redundancy—we can no
longer afford to have only 37 percent of nurses’
time in direct patient care and a whopping 33
percent of their time in documentation.
Advanced technology must be utilized to its
fullest as a means to assist the provider. The
environment in which care is delivered by
nurses must be improved including physical
plant, scheduling and especially relationships
with other team members.
The second challenge involves a more
responsive educational system that functions as
a whole rather than separate entities. The sys-
tem must address the needs of those currently
in the profession and also appeal to a new gen-
eration of nurses. Of equal concern is the need
for service to accept its educational responsibil-
ities and assist in the development of creative
partnerships with education. A third challenge
involves moving nursing into a strategic level
in which nurses’ performance is recognized as
value added for health care outcomes, con-
sumer satisfaction and financial stability.
The RWJ report finds that sustainable solu-
tions to the nursing shortage will require col-
lective efforts by all concerned groups. With
goals of re-envisioning the nursing profession
and helping it to establish a full partnership with
the profession of medicine, the report suggests
the establishment of a national nursing work-
force measurement and data collection system;
creation of a clearinghouse of effective strate-
gies to advance cultural change within the
nursing profession; and the formation of a
National Forum to Advance Nursing, an inde-
pendent body that would draw together a wide
range of interested parties to work on chal-
lenges and recommendations. How exciting!
However, I believe that all of us must
assume some responsibility in this time of crit-
ical need. At the workforce level, we must share
opinions of situations that enhance or retard
nursing function, contribute ideas to improve
situations and willingly try new things. On the
overall nursing level, we must demand more
action, more money and more influence. We
cannot do this alone. Talk to your nursing
leaders; yes, but also talk to your physician and
health care system administrators, your
patients, your community and your legislators.
Let everyone know of the critical status of
nurses and, just in case, recruit one new nurs-
ing student.
480 AWHONN Lifelines Volume 6 Issue 6