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Where Have All the Nurses Gone? The Impact of the Nursing Shortage on American Healthcare

AORN Journal, July, 2004 by Deb Miller

Faye Satterly 2004, 225 pp $21 paperback

This book provides an in-depth, behind-the-scenes look at a health care system under stress and the declining quality of medical treatment in the United States from a nurse's point of view. It should serve as a wake-up call for health care providers concerned about the quality of health care. The author, who has almost 20 years of nursing experience in a variety of roles, discusses some alarming statistics, such as how the amount of time a patient is allowed to spend in the hospital has decreased. Add to this decreasing insurance payments, new technology, the rising mean age of nurses, and declining enrollment in nursing schools, and it becomes apparent that the US health care system will never be the same again.

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One thing has not changed though, and that is the dedication and care nurses provide to patients and nurses' continuing desire to make a difference in patients' lives. Now, when it seems that inpatients are sicker and nurses are needed more than ever, there are fewer of them. Now, when the mean age of inpatients is older, there are fewer resources at nurses' disposal to assist in the care of those patients. During the next decade, Baby Boomers will increase the ranks of the aging population, and more health care providers, including nurses, will be needed.

The author breaks the chapters into concise and interesting bits of information. She follows a nurse through her day on a medical/surgical floor and describes the working relationship between nurses and physicians, concerns from a patient's perspective, how hospitals can recruit and retain nursing staff members, and who is responsible for the overall health of patients and the integration of this responsibility.

Some of the statistics the author presents in the introduction are alarming. For example, 90,000 medical errors occur in hospitals each year, many due to fluctuations in staffing levels. Nationwide, the hospital nurse vacancy rate is 13%--126,000 vacancies, the equivalent of a small city. There have been nursing shortages before; however, with the continual decrease in nursing school enrollments and the increase in a wider variety of opportunities for young people in other fields, the effect of the current shortage is far greater.

This book has several appendices. One contains contact information for national nursing organizations, specialty nursing organizations, and nursing support groups. Another contains information regarding advance directives and a children's book titled The Magic Stethoscope, which validates the author's belief that education about health care truly begins when children are school age. An appendix on fighting overweight and obesity is included as an adjunct to the principle that Americans need to take more responsibility for their health.

This fascinating yet disturbing account by a veteran nurse with extensive hands-on experience is a compelling call to action. The problems associated with the nursing shortage and the quality of care issues perceived in the health care system today must be addressed.

This book would be an excellent tool for a nursing class as adjunct reading material or for providers interested in broadening their knowledge base about needed reformation of the health care system and how to take a more proactive role in that reformation. It also could be used to stimulate discussion in nurse leadership groups in health care facilities.

This book is available from Prometheus Books, 59 John Glenn Dr, Amherst, NY 14228-2197.

DEB MILLER

RN, BS, CNOR

EXECUTIVE DIRECTOR, PERIOPERATIVE SERVICES

GALESBURG COTTAGE HOSPITAL

GALESBURG, ILL

Health Care Industry

Where Have All the Nurses Gone? The Impact of the Nursing Shortage on American Healthcare

AORN Journal, July, 2004 by Deb Miller

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