Physicians can ease nursing shortage

Physician Executive, Sept-Oct, 1991 by Leo M. Henikoff, Kathleen G. Andreoli

The nursing shortage continues to plague American hospitals and health care services, and no reliable solution appears on the horizon. The 5.8 percent increase in nursing school enrollments in 1989, the first increse in five years, will have a relatively small impact on the supply of nurses needed to meet the demands for nursing services this decade. Already, the critical shortage of nurses has resulted in a decline in the quantity and quality of health care to the public. Hospitals coast-to-coast are closing, limiting admissions, closing emergency departments, delaying scheduled surgeries, holding patients in the recovery room because of a lack of nurses in intensive care unites, and so on. Overworked nurses are "burning out" under the stress, compounding the problem.

The solution to the nursing shortage is clear. In the short run, the current supply or nurses must be used more efficiently and effectively without compromise to quality or cost. In the long run, recruitment efforts must be successful increasing the number of people who choose nursing as a career. The first solution has been addressed intensively and consistently in recent years by management journals nationwide. The second solution has been a priority for schools or nursing for decades. Responsive strategies, however, have been reruns of old steps without major innovation. The decline in people entering nursing has been painfully evident. A recruitment stragetegy that has not been explored to its fullest is the role of physicians in influencing career choices in nursing as supported by history, culture, and experience.

Physician Influence on Career

Choice in Nursing

The factors that influence a person to choose nursing as a career are multifold. Nevertheless, the public image of nursing has been noted as highly influential in this choice. The stereotypical public perception of nurses is that they serve as handmaidens to physicians in a work-intensive profession oflow esteem. This perception is also held by a substantial number of nurses. They believe the past paternalism and parochialism of medicine has conferred the feeling of powerlessness throughout the profession. Staien et al. point out that nurses see themselves as fighting for freedom and that the medical profession has been one of their main sources of oppression. [1] The Association of Academic Health Center describes the traditional hierarchical doctor-nurse relationship as exerting stifling, anti-intelectual effect on nurses that results in dissatisfaction with professional roles. The negative interprofessional relations contribute substantially to the nursing shortage. [2]

In a recent issue of the Chicago Tribune, [3] a nurse was quoted as saying "...nurses need more respect from the medical staff, should be allowed to do more professional nursing, and should have a say on how health care is delivered. Right now, nurses are at the bottom of the totem pole." This kind of publicity reinforces the public's low opinion of nursing.

Stein refers to the physician-nurse relationship as the "doctor-nurse" game. [4] Although this game was more popular in the past, it has left its mark on the public and on nurses. Briefly, the point of the game is that open disagreement between the players has to be avoided. Nurses convey their recommendations to doctors without appearing to make them. The physicians requesting recommendations do so without appearing to ask for them. According to the game, if the doctor interprets the subtle messages as challenges to his/her authority, the relationship breaks down, with the nurse losing the game.

Stein et al. also point out that it is not unusual for those in power to be oblivious to the fact that those under them may feel oppressed. [1] These doctors are comfortable with the hierarchical relationship. They see the nurse's role as primarily one of carrying out doctors' orders, and they are frustrated by nurses who want an equal relationship. In short, they want the status quo to continue because "it works."

The most recent example of negative publicity about the nursing profession by doctors was the AMA's proposal to develop "registered care technologists" (RCTs) to "replace the missing nurses" by the bedside. This movement reinforced the notion that physicians wanted to control patient care at the exclusion of nurses. Moreover, it was interpreted as devaluation of nursing, because it conveyed the message that nurses could be easily replaced by another health care worker with less training. Rather than working with nursing on a plan to bring more support services to the nursing staff and more people into nursing education, medicine was competing with nursing and, at the same time, abandoning it. Even though the AMA dropped its proposal in the face of intense opposition, this event contributed to the general public apathy about nursing as a career.

It comes as no surprise, then, that nowadays women would rather be doctors than nurses. In 1986, for the first time in history, woemn who intended to become doctors outnumbered women who intended to become nurses. [5] Because nursing is 97 percent women, the changing career aspirations of college women, encouraged and supported by society, have a critical impact on the supply of potential nurses. This negativism has infected the nursing profession as well. In a pool of 8,023 nurses, 60 percent have not encouraged other people to enter nursing, while 38 percent have. [6] Mothers who are nurses have directed their daughters away from the profession because it is so "demanding and thankless."