By 2018, a projected 1.2 million direct care workers will be women age 55 and over.  In 2008, 22% of direct care workers were age 55+ compared to 18% for the overall female workforce.  The Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Resources, recently released data from a 2008 National Sample Survey of Registered Nurses (http://bhpr.hrsa.gov/healthworkforce/rnsurvey/).  Between 2004 and 2008, the number of licensed RNs in the U.S. grew by more than 5% to a new high of 3.1 million.  In 2008, 16.8% of nurses were Asian; African-American; American Indian/Alaska Native and/or Hispanic; an increase from 12.2% in 2004.  RNs are seen as having significant opportunity to influence the health care system’s adaptability to an increasing ethnically, racially and culturally diverse population.

By 2008, half of RNs had achieved a baccalaureate or higher degree in nursing or a nursing-related field compared to 27.5% in 1980.  RN salaries rose by 15.9% since 2004, which slightly outpaced inflation.  Average annual earnings for RNs in 2008 were $66,973.  Nearly 45% of RNs were more than 50 years of age in 2008, which is a dramatic increase from 33% in 2000 and 25% in 1980.

In a recent GALLUP study based on 1,504 telephone interviews with professionals that they have termed “opinion leaders” throughout the nation, a summarized report was submitted to the Robert Wood Johnson Foundation.  Views of nursing and nursing leadership among these opinion leaders were examined in this study.  GALLUP selected the opinion leaders based on certain criteria and included the following groups:

            University Faculty (n=276)

            Insurance (n=237)

            Corporate (n=232)

            Health Services (n=253)

            Government (n=253)

            Industry Thought Leaders (n=253)

The study sought their viewpoint about nursing leadership with emphasis on determining the role of nursing in the future, and potential barriers to leadership roles in health care today.  67% of the respondents have experience working in health care delivery with 78% working in acute/chronic care or public health.  70% of the respondents were male.

Cost and affordability of health care topped the ranking of issues across all six opinion leader segments.  Of concern is that as informed sources about health care, the survey indicated that opinion leaders do not consider doctors (54%) and nurses (42%) as having a great deal of influence on health reform in the next 5-10 years despite the fact that they are the closest providers of patient and preventative care.  Instead, the opinion leaders polled view government (75%) and health insurance executives (56%) as the groups most likely to exert a great deal of influence on health reform, compared to 37% for doctors and 14% for nurses.  Nurses, however, are consistently viewed as having tremendous influence on quality in the health care system.  At the recent ANA Constituent Assembly meeting, quality of patient care was acknowledged as a key issue where nursing could/should take a major leadership role.

The Executive Summary in the 2009 GALLUP Report indicates that “the major barriers to nurses having more influence and exerting more leadership include perceptions of their role as key decision makers compared to physicians (69% of the respondents said physicians are the key decision makers) and perceptions of their role as revenue generators (68% of respondents said doctors, not nurses generate revenue).”  Only 31% identify the media’s depiction of nursing as a barrier. Whether you agree or disagree with the view of those polled by GALLUP’s survey – the key point is that organizations such as GALLUP and Robert Wood Johnson Foundation consider them opinion leaders.  Needless to say nurses (especially those giving direct care) have vital opinions too!  A concerted effort to take on the mantle of the nurse as opinion “leader” would serve the patient, the system and the profession well.  ANA and GNA work hard to get the profession’s messaging out there and respected in the mainstream of ideas.

The opinion leaders interviewed for the 2009 GALLUP study offered two main recommendations for how the nursing profession can overcome barriers and achieve more influence in the reform of health care: “Foremost, nurses need to make their voices heard.  Opinion leaders view nursing as lacking a single, unified voice to focus on key issues in health policy, and view many nurses as lacking interest in taking on this role.  Second, opinion leaders feel society, and nurses themselves, should have higher expectations for what nurses can achieve, and that nurses should be held accountable for not only providing direct patient care, but also for health care leadership.”

While it is irritating when others impose their views (especially when they have been annointed by someone else as opinion leaders), one would hope that it results in encouraging a more concentrated effort by nurses to elevate the leadership of those who have first-hand knowledge about where improvements can be made (direct care nurses).

The Georgia Nurses Association (as the largest, oldest and most diverse nursing organization in the state) provides many opportunities for members to make sure their voices are heard, and to acquire the leadership skills and confidence that unifies that professional voice on key issues in health policy.  For example, at the end of April the Georgia Nurses Association will be providing its Chapter and Board leaders a public-speaking training session on how to be “an influencer.”