Nursing shortage solutions explored
Published: Saturday, January 31, 2004 at 6:01 a.m.
Last Modified: Friday, January 30, 2004 at 10:39 p.m.
Although it may have dropped out of the headlines, the nationwide shortage of nurses has not gone away. And where nurses are overworked, spread too thin and burned out on their jobs, hospital patients pay the price.
Those are two of the premises health-care leaders from around the country agreed on in a two-day conference on nursing leadership, "The Critical Link: Nursing and the Future of Health Care," held at the University of Florida College of Nursing Thursday and Friday.
These leaders in the field also agreed that any "fix" of the current health-care system also would demand changes in the education, recruitment and retention of nurses.
Linda H. Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, set the table for two days of discussion with her research findings on the connection between nurse staffing and patient outcomes.
In a 2002 study published in the Journal of the American Medical Association, Aiken reported that when hospital nurses are forced to care for eight patients instead of four, their patients are 31 percent more likely to die within a month, and that hospitals that place nurses in these short-staffed settings are twice as likely to cause nursing burnout. Many of the nurses who suffer job burnout leave the profession within a year, Aiken's study showed.
Across the country, she said, the consequences of nursing shortages can add up to 20,000 deaths a year.
Aiken, who received her bachelor's and master's degrees in nursing from the University of Florida, also urged more formal education for nurses.
"As a nurse's education increases, patient mortality decreases," she said. "The best hospitals have a 1:4 ratio of nurses to patients and 60 percent of the nurses have a (bachelor of science in nursing)."
Every nurse is important, she concluded, but in the future, hospitals might be able to operate with fewer nurses if they were better educated.
Aiken's arguments were echoed by UF College of Nursing Dean Kathleen Long, who also serves as president of the American Association of Colleges of Nursing.
The association reports that by the year 2020, 44 states and the District of Columbia are expected to have shortages of registered nurses. Nationally, more than one million new and replacement nurses will be needed by 2010. The Florida Hospital Association estimates there are already 9,000 vacant nursing positions in the state.
Long said the secret to adequate nursing care is not just in the number of nurses, but in the right mix of different educational levels in the right environment.
"The United States has one of the least well-educated nursing workforces in the developed world," she told an audience of some 500 current and retired nurses and nursing educators. "The majority of American nurses have (two-year) associate degrees, while only 43 percent hold a (bachelor of science in nursing) or higher."
Long said the American Association of Colleges of Nursing is fielding a four-year study of the role of nursing education in improving patient care.
One proposal is the development of a new position in nursing, that of a clinical nurse leader, which Long described as "a better-educated nurse generalist" who would have either further experience after receiving a bachelor's degree or have completed a post-bachelor's degree residency program. Administrators at Shands at UF and the Veterans Affairs Medical Center have been considering the feasibility of a clinical nurse leader pilot project here, according to the dean.
As part of a panel discussion on how to "fix" the nursing problem, Dr. Bruce Vladek of Mount Sinai School of Medicine said the underlying issue is that the health-care delivery system in the United States is broken. The role of nursing must be central to any redesign of that system, he said.
"As long as our health-care system treats staff nurses as disposable commodities, we are going to have shortages," Vladek said. "If we are going to fix the problems of nursing, it cannot be done only through the nurses themselves."
Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations, said there was an urgent need to diversify the nursing workforce, not only in terms of racial and ethnic makeup, but also in terms of recruiting more men to the field.
O'Leary also pointed out that in nursing, there are different levels of education without differing layers of compensation. He called for internships, if not residencies, for nurses, and financial support for continuing education for nurses already in the field.
"The Nurse Reinvestment Act (which would have provided such support) was signed with great fanfare in 2002," O'Leary pointed out, but has been funded only minimally since.
In summing up the conference, nursing dean Long said, "The world has changed in the past two decades and what has prepared us for nursing practice has changed with it. Education does matter and we must not be satisfied with being the least well-educated health care providers."
In continuing to work to resolve the issue of nursing shortages, O'Leary advised, "Be tenacious until you win. Don't let anyone forget that this problem is still here."
Diane Chun can be reached at (352) 374-5041 or firstname.lastname@example.org.
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