Missing the train

Connecticut Nursing News, Jun-Aug 1998 by Colby, Pat

It's like a locomotive, coming down the track and heading right for us. Last time, the train was traveling about 80 mph, this time I hear it's going a lot faster, maybe 110 mph. The train is called the Nursing Shortage and the next stop is here.

It's cyclical. About every seven years, a combination of events occurs that turns our nursing world into a nightmare. The current nursing shortage is defined by quantity and quality and the issues are complex. Today, there are 2.5 million RNs in the United States. Some 2.1 million RNs work in nursing; 60% are employed by hospitals. The U.S. Department of Labor's Bureau of Labor Statistics reports health occupations will increase by 2.7 million jobs over the 1994-2005 period, in large part because of the need to care for an aging population with a longer life expectancy. While all other jobs outside of health care will increase by only 13%, the health care industry will increase by 35%, of which nursing will be 25% of that total.

PREDICTIONS ....

Leah Curtin, D.Sc., MS, MA, RN, FAAN, and Editor-in-Chief of Nursing Management predicts by the year 2000 we will encounter the most severe nursing shortage to date. It makes good sense to listen to someone with that many initials after her name. But if you're still not a believer, look in the newspapers and journals, there is a definite increase in advertisements for RNs. Bonus and incentive programs are prevalent. Highly skilled ICU and OR registered nurses are always a hard find; hard-to-fill medical and surgical positions are the most telling sign of an emerging crisis.

THE GRAYING OF RNS . . .

We're getting older. The average age of an RN in the United States is 44.3 years and 91% of RNs are age 30 years or older. By the year 2000, it is projected that half of the nursing workforce will be over 45 years of age.

RESTRUCTURING. .

Downsizing and reengineering have driven some nurses to leave the profession and they're not coming back. Yet a recent ANA study found that more-not less-RNs in the nursing mix result in fewer incidents of pressure ulcers, pneumonia, urinary tract and postoperative infections. Cost cutting administrators need to be prepared for the consequences of their decisions. In addition, media coverage of nurses being terminated, downsized or replaced by "untrained" personnel creates a negative image of the profession and is believed to be a major factor to decreased enrollment ir. nurs-ing schools. It's difficult to convince students and parents to invest in an education with no security.

ENROLLMENT. . .

Enrollment of nursing students in entry level bachelor's level programs fell by 6.2% in 1996, the second decline in two years, according to the latest survey by the American Association of Colleges of Nursing. At the same time, master's level programs, which had climbed steadily in recent years, saw their first drop since 1988.

RESOURCES. .

Still, others contend that student enrollment is down not because of lack of interest but because of cuts in resources, especially the closing of certain nursing programs. Carole A. Anderson, PhD, RN, FAAN, and AACN President stated that applications remain high, showing that declining enrollment is not due to waning interest. Most Connecticut schools of nursing report "waiting lists" of qualified candidates. Yet three of this state's major schools of nursing recently closed their doors: Saint Francis, Saint Mary's and Ona M. Wilcox. So the reduction in resource theory seems to make sense, at least in this state. This year, more than any in recent memory, federal financial support for nursing and allied health education is in danger. In the Clinton Administration's fiscal year 1998 budget, the Nurse Education Act, the only direct federal support for schools of nursing, was cut from over $65 million to less than $10 million.

PROFESSIONAL DIVERSITY . . .

Nursing has remained a primarily white, female profession. Recruitment of minorities and men has remained untapped. Minorities are underrepresented in nursing-approximately 10%, as compared with 28% of the U.S. population. Of all employed registered nurses, only 5.4% are men.

SALARIES

A recent survey by RN magazine noted 56% of full time RNs working in acute care hospitals nationwide now make at least $40,000 a year. Another source, the Bureau of Health Profession Health Resources and Services Administration, quotes an average salary of $42,071 in 1996, an increase of 11% since 1992. However, raises for the past two years averaged a mere 4% increase. It is important to remember that the majority of nurses are older and their "average" salaries are greater simply due to longevity, not necessarily because entry level salaries are remarkable.

RECRUITMENT AND RETENTION . .

I don't have the answers. This shortage is too complex for any person or group to solve alone. However, I can share several suggestions that have recently surfaced in journal& Hospitals must be willing to supply the resources and training necessary to attract nurses. Forming partnerships with schools of nursing to increase hospital exposure is another idea. Through these clinical rotations, patient care managers can identify hot prospects and grab them before they hit the open market. Lack of experience is not necessarily a negative. Taking the opportunity to train and mold an inexperienced nurse and incorporating your mission and philosophy from day one can reap rewards for both the nurse and institution. And, as much as it will always be necessary to recruit a certain percentage of nurses, the key to survival is retention! Thomas Lee, a professor of human resource management and organizational behavior at the University of Washington in Seattle, defines that bottom line regarding retention, "You have some people who you believe are just so important. Figure out what's important to them."