nurse shortage and our ministry, The

Health Progress, Mar/Apr 2003 by Donley, Rosemary

SPECIAL SECTION

Catholic Health Care Needs an Action Plan Based on Church Traditions

The Catholic health care ministry is not exempt from the nursing crisis.

How can Catholic schools of nursing and the Catholic health establishment creatively approach the nursing shortage that is seriously affecting access to health care? Believing as I do that the shortage's resolution will require a fundamental transformation of nursing practice and education, I have organized this article around a model of change called "Four Requirements for Change." This planning framework, which is used by the Catholic Health Association (CHA):

* Analyzes pressure for change.

* Analyzes capacity for change

* Develops a clear, shared vision

* Presents a plan of action.1

THE CONTEXT

The contemporary nursing shortage has stimulated discussion of the issues that face the nursing profession. Various authors-using the language of recruitment and retention, supply and demand, feminism and workplace culture-have tried to explain the disenchantment of practicing nurses with their discipline and the lack of interest among young people in it.2 Other writers argue that nursing has failed to reinvent itself to appeal to a new generation of young people, that it must learn to present the profession in ways that will attract men or minorities. Such experts express the commonly held belief that, if it is to compete for talented people, nursing must create new images and better marketing plans. One writer goes so far as to argue that nursing's future is uncertain because it represents only one of many contemporary claims on the shrinking health care dollar.4

Whatever theory best explains the nursing profession's current status, there is ample evidence that it faces problems: declining enrollments in nursing schools, an aging workforce, the inability of health care organizations to fill vacant nursing positions, the reliance by those organizations on temporary staffing arrangements to provide care for very sick patients, and the early retirement of experienced nurses. These are not encouraging life signs.

Many analysts of the crisis fault nursing's business plan. Few economic incentives exist to encourage young people to seek baccalaureate or graduate education to prepare for nursing careers. Today, almost 40 years after the discipline's leaders endorsed baccalaureate education as the desired preparation for entry into the practice of nursing, no more than a third of nursing school graduates enter the workforce each year with a baccalaureate degree. A study recently conducted by the American Association of Colleges of Nursing revealed that fewer nurses with associate degrees are returning to school to earn baccalaureate degrees.

New graduates find that, when it comes to assigning titles, responsibilities, and salaries, employers rarely discriminate among graduates with baccalaureate degrees, associate degrees, or diplomas from a hospital nursing program-as long as all the graduates have passed the registered nurse licensing examination. The scope of responsibility for nursing practice is shaped not by educational preparation but rather by possession of the license. As time goes by, new graduates learn that experience is not valued in the marketplace either. In most professions, experience and tenure ensure better working conditions, more interesting assignments, higher salaries, and preferential treatment. In hospitals, however, shift rotation policies and mandatory overtime affect all staff members. When a floor must operate shorthanded, informal scheduling practices (which may at other times reflect seniority) are not honored.

Moreover, the clinical career ladders that do exist for nurses have only a limited number of rungs. Career-oriented staff nurses soon hit glass ceilings. Those who seek more control of the scope of their work and schedules leave nursing altogether, seek positions in other institutions, earn graduate degrees, or seek positions in management. The physical, intellectual, and emotional demands of nursing require energy and endurance. Most staff nurses retire at age 55 because there is no tradition in the work culture to make adjustments in work demands as nurses age.8 A nurse is a nurse is a nurse.

Workforce development is not valued in health care as it is in other industries. Writers on the topic have noted that, especially in hospitals, health care workplace and compensation policies are tailored to attract new graduates, not to retain experienced staff. Although hospitals do tend to emphasize the development of innovative recruitment policies during times of staff shortage, they usually shape their staff nursing roles, staffing patterns, and compensation packages around new graduates.

Since this practice does not make sense in the contemporary climate, it should be reexamined. Approximately 10 percent of the contemporary nurse force is under 30 years old.' The coming of managed care and the emergence of ambulatory and community-based delivery systems have changed irrevocably the practice of nursing and health care delivery. Inpatient acuity levels and the complexity of tertiary care delivery have increased. There are fewer new graduates, and, of course, those graduates are unprepared to assume immediate responsibility for patients in emergency rooms, intensive care units, operating rooms, neonatal nurseries, delivery rooms, and coronary care units. The high costs of recruitment, orientation, and turnover tend to support this observation.