It Starts with You: It's up to nurses to act now to strengthen the RN workforce and help create a better future for the profession

Alabama Nurse,  Sep-Nov 2003  by Buerhaus, Peter

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In the past 18 months, concern over the hospital shortage of registered nurses and the future supply of RNs has grown to the point where these worries have captured the attention of the media, health policy-makers and Congress. National news media have carried numerous stories about the problems facing hospital-employed RNs. In addition, special task forces and workforce commissions have been established by virtually every national nursing and non-nursing health professional organization, and by more than a dozen states, labor unions and the Joint Commission on Accreditation of Healthcare Organizations.

Furthermore, many states have introduced legislation aimed at resolving nurse shortages. Congress has introduced four separate bills to increase enrollment in nursing education programs and improve the image of nursing, federal health agencies have made millions of dollars available for research on the nurse workforce, and the secretary of Health and Human Services recently announced that 82 colleges, universities and other organizations will receive $27.4 million in grants and contracts to increase the number of RNs and the quality of nursing services.

Clearly, the problems affecting hospital RNs are no longer on the agenda of nursing profession alone, but occupy a position high on the social policy agenda.

Still, it is unwise to rely solely on others to solve nursing's problems. I believe nurses must be actively engaged in helping create a better workplace and a better nursing profession. A look to the future shows that we will face many important challenges above and beyond those connected to the present RN shortage.

2010 and beyond

A recent study on the aging of the RN workforce found that the average age of employed RNs increased more than twice as fast as all other occupations in the U.S.workforce in the past 15 years.

Today, more than 60 percent of working RNs are older than 40. By 2010, more than 40 percent of the RN workforce will be older than 50. Between 2010 and 2020, many RNs will begin to retire and the largest group of RNs remaining in the workforce will be between ages 50 and 60. In that same period, many of the nation's 80 million baby boomers will turn 65 and enroll in the Medicare program.

Thus, both the demand for health care and the demand for RNs will rise significantly at the same time that the number of RNs in the workforce will be declining. The gap between demand and supply is expected to be so large that future shortages could cripple the health care system.

While Congress, the states and other public policy-makers are trying to develop and pass measures to avert this long-term scenario, much can be done now to improve and strengthen today's workforce. Each of us needs to become involved in our own way; we can't wait for someone else to make the first move.

Community survey

Do you know the knowledge and perceptions that people in your community hold about the nursing profession? Without first knowing how people perceive nursing, it is difficult to know what to do to make positive changes. You can address this by persuading your colleagues to form a journal club and read up on the image of nursing, learn how public opinion is shaped and become informed about efforts underway throughout the country to bolster the image of nursing.

Next, find out if a faculty member in a nearby school of nursing has experience in survey research and would help develop a community survey. (The local newspaper might also have an interest in helping.)

The next step is to determine the number of people to be surveyed, if there are any groups you particularly want included (for example, high school-aged boys or minorities), the procedures to get the survey to people in the community and how people will return completed surveys.

While working on these activities, you can develop the questions to be included in the survey. Conduct a short pilot test of 15 to 20 people to identify the questions that are confusing and make modifications where needed.

The results will provide information about how people in your community view nursing, stigmas about nurses that lead to an unfavorable image and how informed citizens are about the profession. In turn, this information can be used to guide the development of strategies to change negative perceptions and provide facts and positive images that promote nursing.

Change your community

Nurses should write letters to the editor and develop opinion pieces for the local newspaper explaining the results of the survey, describing the work of nurses and how nurses make contributions to patients and people throughout the community (not just in the hospital), the issues in health care that have brought so much change to nursing and what people can expect will occur in the future.

The letters and opinion pieces should provide objective and factual information and avoid an accusatory or negative tone. Ideally, physicians and health care executives should write letters that complement those written by nurses. As this campaign to provide information to the community via the newspaper develops, don't be surprised if a reporter from the newspaper, local talk radio show or television station becomes interested and wants to produce a story. If they don't come to you, go to reporters with your story.