Are you proud to be a nurse? I am proud to be
a nurse. Even though, in a recent ANA Survey asking nurses if they would
recommend nursing as a profession to friends or family, fifty-five
percent stated they would not recommend nursing. This is alarming and
really warrants taking a look at nursing’s respectability, work
environment and voice.
At the ANA Convention in June, 2002 President
Mary Foley introduced “Nursing’s Agenda for the Future”. I would like to
share parts of this address/document as well as incorporate Georgia’s
statistics and efforts in both Georgia and the nation to work toward the
visions outlined in the “Nursing’s Agenda for the Future”.
Even though Nurses may have reservations with
recommending nursing as a profession, Americans continue to hold nurses
in high regard according to national Gallup polls. The number of nurses
is 2.7 million and ranks as the nation’s largest health care profession,
and their professional commitment runs deep. Nursing offers diverse
career paths for both men and women.
Studies conducted by the Department of Health
and Human Services have consistently shown that high quality Nursing
care reduces the rate of complications and lengths of stay in hospitals.
At the present time, there is a growing
disparity between the supply and demand of nurses. This disparity is
leading to the severe nursing shortage and health care crisis. There are
many factors related to the shortage including 1)changing demographics,
over the last 10 years there has been a 26% populations increase in
Georgia;2) decreasing resources including budget cuts, Georgia had to
cut 80 million from the budget during the legislative session and all
state agencies have had 3 – 5 % cuts recently; 3) increased demands ,
the population is aging ; 4) declining social value on nursing as a
career, have resulted in other opportunities for more rewarding
professions. This nursing shortage is classified as more severe and
presents a real threat to the nation’s health.
The Health Resources and Service Administration
Bureau of Health Profession’s, National Center for Health Workforce
Analysis is the primary federal agency responsible for providing
information on supply and demand for health professionals. The National
supply and demands were as follows: in 2000, the National supply of FTE
registered nurses was estimated at 1.89 million while the demand was
estimated at 2 million, a shortage of 110,000 or 6 percent. The
shortage is expected to grow slowly until 2010, by which time it will
have reached 12 percent. By 2015 the shortage will have quadrupled to 20
percent. If not addressed and if current trends continue, the shortage
is projected to grow to 29% by 2020.
The shortage is not evenly distributed across
all states, thirty states have been identified as having shortages.
Georgia is one of the 30 states. According to this national data,
Georgia had a 7% shortage in 2000, will have a 15% shortage in 2005; a
23% shortage in 2010; a 32 % shortage in 2015, and 40% shortage in
2020.
Other factors affecting the supply of RN’s
sheds light on what has caused the nursing shortage. These factors
include the declining number of nursing school graduates, the aging
workforce, declines in relative earnings, and the emergence of
alternative job opportunities.
There was a decline in RN graduates in the
1990’s resulting in a 26% fewer graduates in 2000 than in 1995.
The number of new licenses in nursing is
projected to be 17% lower in 2020 than in 2002, while the loss from the
RN license pool due to death and retirement is projected to be 128%
higher. According to a AHEC Survey of Georgia’s 58,713 RN’s, 32% FTE
RN’s presently in the workforce plans to retire within 10 years; 40% in
15 years and 69% in 20 years. We also have a shortage of nursing faculty
as well as an aging nursing faculty. Presently in Georgia there are 34
vacant faculty positions which is projected to increase to 71 in 4 – 5
years. Shortage of faculty directly affects the number of students that
can be admitted to nursing schools.
The impact of supply problems in the RN
workforce is seen in recent studies: they stated that there is a “Strong
and consistent relationship (has been found) between nurse staffing
variables and patient outcomes in pneumonia, length of stay, upper GI
bleeding, shock, and failure to rescue. Better outcomes were associated
with higher levels of nurse staffing. In JACHO, Health Care at the
Crossroads, “Nurse staffing levels have been a factor in 24% of 1609
sentinel events that have been reported…as of March 2002”.
Even though the health care system is dependent
on nurses, their contributions receive little recognition in many
arenas. Is there are charge for nursing care on the patients bill? No
this is included in the daily room charge or some other way.
When the nurse accompanies the physician to the
patients room, the physician states, I am Dr. so and so. The nurse is
silent with out voice or recognition even though the patient knows that
while in the hospital particularly they are there to receive nursing
care. Suzanne Gordon , a journalist” in her book “From Silence to
Voice” wrote” nursing may be the oldest art, but in the contemporary
world, it is also one of the most invisible”. We must work to give
nursing a voice and make it visible.
ANA Foundation awarded a grant of $100,000 to
fund a call to the Nursing Profession summit. Nursing leaders began to
identify the scope of the work required to attain nurses desired future
state. The focus was on what nursing would look like in 2010.
The future vision as identified by this group
is “ Nursing is the pivotal health care profession, highly valued for
its specialized knowledge, skill, and caring in improving the health
status of the public and ensuring safe, effective, quality care. The
profession mirrors the diverse population it serves and provides
leadership to create positive changes in health policy and delivery
systems. Individuals choose nursing as a career, and remain in the
profession, because of the opportunities for personal and professional
growth, supportive work environments and compensation commensurate with
roles and responsibilities.”
Ten domains and desired visions for the future
as areas of concern demanding action were identified: The following are
visions for the future in the 10 domains.
1) Leadership and Planning: The nursing
profession exhibits leadership through unified and systemic planning
focused on the desired future of the profession. The leadership is
data/evidenced based and is implemented in a collaborative manner.
2) Delivery Systems: Nurses will unite
to create integrated models of health care that are nurse led or co-led
Models are created through education, research, practice, and public
policy partnerships that improve the health of the nation.
3) Legislation/Regulation/Policy: Nurses
are policy-makers at the local, state, national, and international
levels. Nurses develop evidenced-based health policy (legislation,
regulation) in collaboration with consumers to ensure access to health
care services and safe competent nursing care.
4) Professional Nursing/Nursing culture:
Nurses are viewed to be critical strategic health care assets valued by
the public, policy –makers, employers and health care colleagues as
equal partners in health care. Nurses embrace their professional
responsibility and accountability, including: collaborating, mentoring,
promoting diversity and adhering to standards and ethical codes of
professional practice.
5) Recruitment/retention: Nursing is
comprised of a diverse body of individuals committed to promoting and
sustaining the profession through addressing diversity, image,
education, funding, practice models and environments, and professional
developments.
6) Economic Value: Nurses are recognized
as providers of quality, cost-effective health care and are compensated
for their value and supported through public policy. The RN salaries
have not kept up with inflation since 1991.
7) Work environment: Environments promote
safety, health, appropriate staffing, shared decision-making,
collaboration, mentoring and professional growth. Workplace environments
are experiencing staffing shortages, voluntary and mandatory overtime
and workplace violence among other issues.
8) Public relations/communication: Nursing is recognized as an
influential, highly rewarded profession valued for its unique knowledge
and expertise. It is widely known that nurses make a difference in
peoples lives.
9) Education: Nursing education
is valued by the public because it prepares nurse for discrete scopes of
practice and roles through programs that are assessable, affordable and
flexible. Adequate numbers and qualified faculty.
10) Diversity: Nursing reflects the
population it serves. Our profession derives strength from its ethnic,
cultural, social, economic and gender diversity, thereby enhancing its
capacity to respond to the health care needs of a diverse nation. I’ll
speak to the status of some of these issues.
Diversity is spoken to in most reports and
research. Nursing is not very diverse. Nursing is 94% female and women
may work less than men due to family responsibilities. The nursing
workforce is composed of the following: 81.5% of RN’s are white,
compared to 62.% of the population; under 15% of RN’s are African
American compared to 29% of the population.
The Nursing Summit sponsored by ANA is a
beginning for nursing leaders to look at the shortage and plan for the
future. Other Federal, National and local efforts include:
