Healthy solutions: The nursing shortage--a reflection of underlying values

The Healthy Solutions column was created in the spirit of the AARN initiative on Healthy Workplaces, Healthy Nurses. Do you know about a project or idea that has improved patient care or helped to create a healthier environment for your nursing colleagues? Send your contributions to Healthy Solutions, Alberta RN (780) 452-3276 (fax), 11620-168 Street, Edmonton, AB, T5M 4A6 (mail), or aarn@nurses.ab.ca (e-mail).

Widgets on a line

In talking with a senior official about the stated mission and values of a major Alberta health region, I asked why the values expressed - such as efficiency, appropriateness and effectiveness - did not include concepts such as compassion. I suggested that people who work in health care, people such as nurses, may be more encouraged and "at home" if their values are expressed by the organizations for which they work.

The official said that including a statement such as "we will serve patients and clients in a spirit of caring compassion" was not possible because compassion is not measurable. This approach belies the fact that we have relegated our understanding of health care to the business context where things must be measurable, deliverable, and definable.

The environment of modern health care is focused on cure over care and technology over touch. Cost pressures in recent years have tended to promote a view of health care service as a commodity that can be defined and delineated like a widget on an assembly line.

Such an approach may be at the heart of the nursing shortage because it negates the very essence of nursing care. That is, nursing care is, at its core, about more than a service offered in any marketplace. Reducing it to the status of a good among many may itself be a reason why we are struggling to secure its supply in sufficient quantities.

The Heart of Nursing

In Ronald Reagan's autobiography, he speaks of his experience arriving at the hospital shortly after being shot in an assassination attempt. By some stroke of luck, a group of the best physicians in the Washington area were having a conference in the facility and many of them assembled in the emergency room to tend to the president.

Yet, the former president's recollection of the event is centred not on this skilled technical expertise, but rather on an emergency nurse who held his hand and the profound sense of hope he had due to this simple act of kindness. In the midst of some of the best technology and medical teams available in the world, it was the simple compassionate act of a nurse holding his hand that sustained him through the ordeal. And it is this type of compassionate act that epitomizes the nursing profession.

People encounter the health system at times of profound struggle with disease, pain and suffering. Beyond the technically proficient delivery of the tools and technology of the health system, they seek a connection with someone who genuinely cares for them. We want compassionate care when we enter the health system and desire a system that fosters this style of caring.

In long term care settings, we hear from residents that they are far more concerned about being cared for in a respectful and dignified manner than whether the technical aspects of their personal care are always right. There is a profound sense that their humanity is preserved and fostered by having someone else care for them, which supercedes their need for basic personal care.

Caring is used to describe those rare, precious moments of unique encounter when the participants recognize their common base of humanity.1 Caring, thus, is both central and crucial to the healing experience. It is at the heart of nursing, but it is not confined to nursing. In fostering a culture of caring in hospitals, we enrich the lives of nurses and, perhaps through this enrichment, attract people to this type of vocation.

Yet we are moving from seeing the experience in the light of care to seeing it as an economic enterprise. Serving in this environment without genuine caring dehumanizes both nurses and residents. Again, the suggestion is that this dehumanization may have a key place in the human resource challenges that we face in our health system today.

Strategic Withdrawal

Our society may indeed not be short of men and women who have skills to serve as nurses. Chris Ceci more aptly suggests that nurses have made a "strategic withdrawal" from the workplace because it no longer meets with their values or responds to their concerns.2 That is, it may also be that nursing itself has moved away from its core of caring.

A System that Fosters Caring

It is important to recognize that nursing is caring - caring is the heart of nursing and care can be a powerful means for healing. As we continue to respond to the challenges presented by the nursing shortage, it is important to consider how the modern health care industry fails to foster or recognize fundamental values at the core of nursing. As we change our thinking and foster caring in our system, though it is not measurable, we will promote environments and experiences that attract and retain those who devote their lives to such worthy ideals.