A Crisis in Care: So Much Need, So Few Nurses

The American public has grown accustomed to living with a health-care system that suffers one acute crisis after another. During the 1960s there were not enough doctors. Now we have too many doctors. Growing health care costs continue to escalate and there is inadequate financing of care for the poor. In the midst of this, trauma centers and hospitals are closing and prepaid health-care programs have gone bankrupt. It may be difficult, therefore, to convince anyone that one of the best-kept secrets in the industry is a critical shortage of nurses that threatens to make the situation worse. The result will be the closure of patient care units in hospitals and the reduction or elimination of visiting and community nursing services.

Several national commissions have located the nursing crisis at the educational level, at the time young people think about choosing a career. The current shortage will only become worse unless we can reverse the declining interest among young people in nursing. The solution requires, in addition to money, improving the work environment.

Right now, more than 80% of the nation’s 2 million nurses are already working, although some are part-time employees. In 1972 there were 50 nurses per 100 patients, whereas in 1986 there were 91 nurses per 100 patients. In today’s hospitals, patients are sicker and the treatments more sophisticated. The nearly 1-1 nurse-patient relationship is not a factor of more bed-baths or taking more vital signs. Providing care has become a far more complex service; there is increased demand for nurses with advanced educational preparation, to monitor and respond to the life-support technology critically ill patients require. Modern medical care requires a nurse well-grounded in both the biological and social sciences, a professional able to attend the needs of patients and their families.

With the expanded nature of the work-load and the limitations faced by nurses in the workplace, it is no surprise that bright, caring young women so often look elsewhere. Their career-options are now much broader than nursing or teaching; they are encouraged to become doctors, lawyers or business executives. These choices offer larger opportunities for more income, prestige and control over their work environments.

Today, hospitals are spending enormous sums to recruit nurses--from abroad or from each other. Wages have increased as a function of demand, but clinical nurses reach the top of their salary range in five to seven years. To gain more income and prestige--or to feel more responsible for the care provided--they are likely to move into management and away from the bedside.

Some health-care practitioners--the American Medical Assn. in particular--would relieve the nursing shortage by adding a new person with a limited job description: “registered care technologist”--a high school graduate trained to perform non-nursing tasks. Yet in the process of routine bedside nursing tasks, professional nurses are able to make some of their most critical clinical observations, the early warning signs of physiological deterioration. Let those who would solve the problem with new job titles work exclusively with barely trained people--at least for a while. Such people might be more easy to “control,” but God help the patients.

The nursing shortage will not be solved--or susceptible to solution--until hospital administrators and physicians accept this contemporary fact: The environment they helped to create for nurses, one that may have worked for them 30 years ago, does not provide the quality of working life that young women and men want and that able young adults deserve.

After 32 years in nursing, I begin to ask myself, “What if we ‘owned’ the nursing units? What if we were involved in decision-making about the care of patients and the organization of our work? What if we set the standards for care and decided which institutions provide the quality of care that met our professional expectations?” In some instances, we make those decisions out of necessity right now, because there are not enough of us. But few of us are involved as professional partners in the day-to-day decisions about our environment.

The California Nurses Assn. has worked diligently with nursing-related organizations throughout the state to improve our stature and implement strategies to deal with the shortage. Our efforts include setting more rigorous standards for professional practice, but we cannot solve the crisis by ourselves. We also need support from the public, hospitals and physicians to improve the structure of the workplace so that nursing practice meets our needs, as well as those of patients, attending physicians and hospital management.

As long as the media-portrayed image of “handmaidens” or “bimbos” persists, being a nurse has a limited future, with limited opportunities to participate in thedecisions affecting one’s sense of self-worth.

Stop and ask yourself: Would you want your daughter or son to become a nurse? On the other hand, the next time you are unfortunate enough to be in a hospital bed, who would you like to answer your call light? After your discharge from the hospital, who would you like to help you, your family and friends deal with the self-care activities related to recovery? In a concerned, good world, there will be a competent nurse available, with the appropriate educational preparation to provide a quality of care that will make a difference.