More Time to Care for the Ill Urged to Ease Nurse Shortage

The solution to the nation’s severe nursing shortage lies not only in increased salaries and opportunities, but in relieving nurses of non-nursing duties so that they can spend their time caring for patients, a federal commission said Monday.

Hospitals and other institutions “should preserve the time of the nurse for the direct care of patients” by providing enough staff to perform other functions, which often include clerical and administrative work, as well as such jobs as respiratory, occupational and physical therapy and tasks related to pharmacy, radiology and the medical laboratory, the panel said.

This burden--the result of the layoff of an estimated 100,000 non-nursing workers nationwide during the last five years--affects nurses’ “self-esteem as professionals and contributes to poor job satisfaction, high stress and high turnover rates,” the report said.

The 19-member commission was formed a year ago by the Department of Health and Human Services to study the nursing staff crunch. It concluded that a “significant and persistent” shortage is being experienced by hospitals, nursing homes and other health care settings because of “the increased demand for registered nurses due to changes in the health care system, while sources of supply have not been able to keep pace.”

The report said: “The country is demanding more nurses to supply increasingly technical, complex and cost-effective patient care while fewer potential entrants to the profession are viewing nursing as an attractive career alternative.”

Carolyne K. Davis, a registered nurse who served as chair of the commission, said that there has been an “unprecedented change” in the delivery, organization and financing of health care in the last decade. “These changes have had a profound effect on the practice of nursing and on the industry’s ability to retain and recruit nurses.”

She said that “more intense efforts” by nurses have prevented major negative effects from the shortage. But, she added: “Without intervention, eventually this shortage will adversely impact upon the quality of care and on our access to care.”

The commission urged the federal government to encourage health care delivery organizations to develop and use automated information systems and other new labor-saving technology to further free nurses for their chief responsibilities.

Salary Increases Urged

Saying that “lack of progressive financial recognition during a nursing career is widely cited as the primary reason for loss of nurses from the profession,” the panel proposed that salaries for nurses be increased. Moreover, the commission said, opportunities for pay advancement should be expanded throughout a nursing career “so that the percentage difference between entry-level and maximum pay is comparable to other professions.”

The average salaries for highly skilled nurse practitioners--97% of whom are women--are now just short of $27,000 a year. About 300,000 nursing positions are unfilled nationwide.

The group also recommended that facilities make it possible for nurses to become more involved in patient care decisions.

“All too often, structures and processes of health care delivery organizations diminish the professional practice decision-making role of the nurse and leave the nurse to carry out fragmented ‘tasks,’ ” the report said. “In job satisfaction surveys, the factors consistently reported as contributing to nurses’ discontent were the lack of participation in clinical decisions and the lack of autonomy and authority over nursing practice.”

The group further recommended that nursing education be improved, and that financial support for nursing education be expanded through more scholarships and increased use of so-called “service-payback loans,” where students agree to repay the loans by later working in areas lacking a sufficient number of nurses.

Such programs, the report said, “will create national visibility for nursing as a valued profession while supplying health care delivery organizations with well-qualified nurses.”