Nursing Notes

October 26, 2010

Brother, Can You Spare an RN?

Filed under: Nursing — Shirley @ 8:02 pm
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A friend recently sent me this article in an email.  I read it and I have to say I was appalled by the thought of this type of teaching for new nurses.  Nursing is all about touch and connection as well as knowledge.  What this type of training might turn out are simply nursing technicians–those capable of doing the tasks but without the underlying understanding and without the judgement factored in.  Please let me know what you think after reading this article.  Maybe I am just too old fashioned, but I want a nurse who knows all about me and what is best for me at that moment, not a nurse who is proficient in the tasks but hasn’t a clue how to deal with anything else.

This article is from, which in and of itself is kind of creepy.


There aren’t enough nurses to go around, and there’s no cure in sight.

Ellen Perlman | May 2004


Coming soon to the state of Colorado–if the Colorado Department of Labor and Employment has its way–is a computer simulator that will train nurses on virtual patients programmed to have emergent symptoms of a variety of conditions and diseases. With a shortage of clinical training sites and qualified nursing instructors throughout Colorado, the virtual teacher is one way the state plans to pitch in to help get more nurses trained.

Colorado is not the only jurisdiction that needs to take action to ease a nursing shortage. At the present time, at least 30 states are grappling with a shortage of registered nurses and that number is expected to grow to 44 states by 2020. The lack of nurses is felt in all sectors: private hospitals, nursing homes and doctor offices as well as facilities run by states and localities–clinics, public hospitals and the like.

While there are limits to how much an individual government can do to boost a profession’s ranks, several states and localities are trying to figure out how to solve the nursing riddle in their jurisdiction. And it is a complex riddle because the shortage problem is two-fold. There is a dearth of nursing teachers to teach the next generation of nurses, thereby cutting down on the number of people who, even if they want to become a nurse, can find an open slot in a nursing program. Beyond that, there are not enough young people being drawn to the profession to replace retiring nurses and meet escalating needs.

The current nursing shortage didn’t materialize overnight. It’s been happening, off and on, since the 1960s. Each time a crisis has arisen, it has taken a year or two to resolve it. The current shortage, however, breaks with the past: It began in 1998, and there’s no end in sight.

Lifestyle and demographics are part of the reason. In the early ’60s, nursing was one of the few careers open to women. Opportunities are, obviously, greater now, and the supply of students has gone down. As the nurse workforce ages, no baby boom of high schoolers is rising up to replace the old order. The employment growth in various age cohorts tells an alarming story. From 1994 to 2002, the number of employed nurses 50 years old or older grew by 60 percent; for those younger than 35, growth was inverse: -17 percent.

Given those numbers, it is not surprising that many nurses are likely to retire within the next 15 years. Unfortunately, those retirements will come just as the need for their services increases. “Demand,” as Peter Buerhaus, associate dean at Vanderbilt University School of Nursing, points out, “is going to accelerate with the wave of boomers turning 65.”

Throw state budget problems into the mix and the picture darkens further. Many state schools and community colleges that offer programs to train nurses have been devastated by funding cuts, and early retirement packages to reduce the workforce attracted a healthy share of nursing teachers. “We’re almost at a public health crisis on this issue,” says G. Rumay Alexander, a director at the School of Nursing, University of North Carolina at Chapel Hill. “Many of the schools don’t have the capacity to handle the numbers applying.”


Last fall, schools of nursing turned down at least 15,000 applicants. A big piece of the problem is the lack of nursing instructors. “The faculty shortage is the choke point right now,” says Jo Ann Webb, senior director of federal relations and policy for the American Organization of Nurse Executives. Clearly, without a sufficient number of nursing instructors, there’s no way to educate enough nurses to ease the shortage.

Low pay relative to nursing positions makes it difficult for schools to attract and keep teachers. “Why would I want to teach when I could be a nurse practitioner and make a heck of a lot more money,” asks Peggy Welch, a state representative from Indiana and a registered nurse in oncology. “We’re all scratching our heads over this. We know there’s a shortage. How do we address that?”

Colorado is trying. It is tapping public and private funds to develop an e-learning portal aimed at expanding classroom space and the availability of instructors. Simulation software will allow nursing students to take part of their clinical instruction in a virtual situation. Once in place, the portal could provide other curricula so students could complete some coursework over the Internet.

The state submitted a proposal for $250,000 in grant money from the U.S. Department of Labor and expects a public-private partnership to fund the rest of the $1.3 million to $2.2 million needed to design and launch a system and develop training modules. “We’ve all known the problem is there,” says Tom Looft, director of workforce development programs for Colorado’s labor and employment department. “It’s just gotten to the point where it’s become very critical.”


If the teaching shortage were solved, that would still leave states with the problem of attracting people to the nursing profession, and particularly to areas of health care where the shortages are most acute. In fiscal year 2001, when state budgets were flush, many legislatures passed measures creating nursing scholarships or loan- forgiveness programs for nursing students who agreed to serve in health professions that faced nursing shortages. The next year, as budgets shrank, legislatures focused on setting up nursing workforce commissions and data centers to analyze statistics on the nursing situation.

Some big states have persevered in efforts to bring more people into the profession. New York passed a health care reform act in 2002 that provides $1.8 billion over a three-and-a-half-year period for health care workforce recruitment, training and retention in hospitals, nursing homes and home health care settings. That same year, California announced a $60 million, three-year nurse workforce initiative to recruit, train and retain nurses for employment in hospitals and other health facilities. About $36 million of that money had been allocated by the time Governor Gray Davis was recalled.

Still, there are problems. There is a waiting list of one to two years to get into nursing schools. “The California pipeline for nurses is not big enough,” says Joanne Spetz, assistant professor at the University of California at San Francisco. “And it’s a leaky pipeline.” Anywhere from 10 percent to 50 percent of nursing students don’t complete their schooling. An average of 20 percent to 35 percent of students either don’t graduate or don’t pass the board exam.

Other states are rounding up public and private organizations to attract and train nurses. In Georgia a $4.5 million initiative pairs the state university and health care providers in an effort to turn out 500 new nurses, pharmacists and medical technologists within two years. The state pays $2 million for instruction and expenses. Health care providers contribute money and also donate equipment, staff time and lab space.

Agencies in neighboring Florida have teamed up with private partners to provide eligible nurses with affordable home mortgages, including up to 100 percent financing. The partners also offer low-interest student loans to those who work full time in health care after graduating from Florida colleges and universities.

The Colorado Department of Labor and Employment teamed up with representatives from federal and state agencies, community colleges and private health care groups to develop scholarships for nursing students. Small projects around the state have community colleges working with workforce investment boards and hospitals to increase capacity for nursing students in select community colleges and to speed up the training track.

Some legislators are studying working conditions to see how they can be improved to attract more people to nursing. In particular, they have looked at minimum nurse-to-patient ratios so nurses aren’t overburdened. California passed a law, sponsored by the California Nurses Association, that calls for clearly defined nurse-to-patient ratios. There must be, for instance, at least one nurse for every four patients in the emergency room and one for every six on medical- surgical wards.

Hospitals are not happy with the law, particularly since it doesn’t provide money to pay nurses or to train them. “Hospitals,” says Jan Emerson, spokeswoman for the California Healthcare Association, “are in a bind.”

Some hospitals have been trying to staff up by hiring nurses through traveler agencies–companies that get nurses from out of state. But Emerson says that’s just stealing nurses who are needed in other states, and it doubles a hospital’s nursing costs. “You can’t pass a law mandating new nurses when the nurses don’t exist. That requirement is posing serious problems.”

Emerson says the association has been doing a weekly survey of 450 acute-care hospitals and the responses from nine out of 10 of them is that they cannot comply with the state law. Their options, they say, are to break the law and continue to provide care or comply and shut down beds, make people wait longer in the emergency room and delay surgeries.

Meanwhile, hospitals have taken steps to increase the base of nurses available. Sutter Health, a not-for-profit community-based hospital system, is underwriting a program that enables Sacramento Community College to hire more faculty members and expand space to admit more nursing students. “It’s wonderful that hospitals are stepping up to the plate and partnering, but it’s not the solution,” says Emerson. “We need a statewide policy solution.”

The problems caused by a nursing shortage are repeated all over the country. The annual need for nurses is at least three times above and beyond normal levels of enrollment, says Vanderbilt’s Buerhaus. If schools don’t produce the required number of nurses, “the alternative is watching health care facilities turn off their lights. Access will go down, quality will go down. States will have to deal with the issue in a different way.”

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  1. “We’re all scratching our heads over this. We know there’s a shortage. How do we address that?”
    Well one thing is for certain. The current nursing shortage will never be addressed by scratching your head.
    Collaboration among stakeholders and getting at the root causes so that systemic solutions can be identified might be a starting place.

    From what I read in this article there are a lot of agencies “throwing money” at the problem without identifying the root causes of the nursing shortage so that long term solutions can be implemented for future labor needs. This is not a problem that will go away overnight. It did not appear overnight either. I have been in the nursing profession for over 30 years and there has always been a nursing shortage.

    It takes up to 4 years of education to prepare a nurse and 6 years to prepare a nurse with a masters degree. Without long term solutions in place you are spinning your wheels.

    “Anywhere from 10 percent to 50 percent of nursing students don’t complete their schooling. An average of 20 percent to 35 percent of students either don’t graduate or don’t pass the board exam.”

    You see here is a great example of root causes.
    Why are students being accepted into programs that they cannot complete? Are nursing programs held to standards of quality? Are they regulated in any way?
    or can they just accept anybody who pays tuition?

    Why are programs preparing nurses who cannot pass the exam? Are their identified competencies for entry to practice and are nursing programs required to show that they can prepare students to meet those?
    Is nursing curriculum planned to prepare graduates to meet specific entry level competencies and who regulates that accountability? Are nursing programs held accountable for the quality of their programs?

    What is wrong with better pay and working conditions for university and college faculty? Get some labor unions in there for job security and better wages.
    By all means create strategies for nurses to have better access to higher education so there are more qualified nurse educators but first there has to be a job that is desireable and will attract them.

    And whose ideas was it to legislate nurse patient ratios? – WOW how can you possibly determine that when there are so many patient and nurse variables that should be considered in making assignments.

    Why can’t the nursing staff make that decision on a day to day basis based on the needs of the unit and skills of the staff within the established facility policy and past practice? Those are exactly the kind of decisions that professional nurses should be qualified to make if they are supported by a quality practice environment.

    Canada also has a nursing shortage predicted for the long term. However, nurses in Canada are unionized and have more regional consistency for salary and benefits across the country than in the US. This tends to stabilize the work force and nurses are less likely to move from job to job looking for something better.
    There is also a shortage of nursing faculty in Canada. But at least the salary and benefits of university faculty are protected by unionization in most cases and many faculty are attracted to education because the working conditions are better that front line nursing.

    “…I want a nurse who knows all about me and what is best for me at that moment, not a nurse who is proficient in the tasks but hasn’t a clue how to deal with anything else.”
    And I want a nurse who will keep me safe when I am weak and vulnerable and unable to advocate for myself.
    Simulation has been used for decades in the airline industry to train pilots. do you feel safe when you are in a plane?
    Granted they do not have the face to face contact with passengers like nurses do, but simulation has been shown to develop proficiency.
    Developing all the skills that nurses need will require a combination of education strategies and that should include simulation, but it should not exclude face to face interaction.

    There are many difference between Canada and the US including our systems of health care and nursing education but the the nursing shortage is one thing both countries have in common and it will not go away by using the trial and error method of problem solving.
    It won’t go away by head scratching either.

    Comment by Beverky — October 30, 2010 @ 5:29 pm | Reply

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    Comment by scholarships for mothers — November 17, 2010 @ 8:02 am | Reply

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