By Tim Graham
April 8, 2002
One year ago,
NurseWeek produced an attention-grabbing cover story
under the headline "Critical Condition" that heralded an
emerging worldwide shortage of registered nurses. The
article reported that some nurses and their employers
already were wrestling with the shortage and beginning
an urgent search for solutions in the hopes of averting
a potential catastrophe in health care.
The ink on those editions was barely
dry when NurseWeek announced it was joining the
American Organization of Nurse Executives to conduct a
landmark national research study of registered nurses in
the United States to learn their career intentions and
perceptions of their work environment. The goal was to
produce a research study that would provide objective
data about workforce trends and identify possible steps
that might be taken to address the shortage in the years
ahead.
The results of the scientific survey,
conducted for NurseWeek and the AONE Institute
for Patient Care Research and Education by Harris
Interactive, are now in. And what nurses told us is a
mixture of good and bad news. In a nutshell, here's what
more than 4,100 registered nurses across the country who
participated in the research study had to say:
America's nursing shortage has worsened during the past
year and is eroding the quality of patient care.
Despite their concerns about the shortage, most nurses
remain satisfied with their jobs and would recommend
their profession as a career choice.
Most nurses believe their employers share their
commitment to quality patient care, a finding that
provides renewed hope that together they can find and
work toward solutions, thereby safeguarding and
improving patient care.
The most distressing findings,
according to members of the NurseWeek/AONE
research advisory group that helped shape the survey and
analyze the responses, involve the apparently widening
scope of the nursing shortage and the resulting effect
on the delivery of patient care. Seven of 10 nurses
working in hospital settings said that during the past
year they had witnessed a negative impact on the quality
of patient care as a result of staffing problems.
"The results of this survey show that
nurses truly love their profession, but are finding it
increasingly difficult to provide the patient care they
feel is needed," said advisory team member Mary A.
Blegen, Ph.D., RN, FAAN, professor and interim associate
dean for research at the University of Colorado Health
Sciences Center School of Nursing.
Advisory team member Karen Donelan,
Sc.D., an international expert on health survey research
and a former faculty member at the Harvard School of
Public Health, said the survey's ultimate importance may
rest on its ability to serve as a catalyst for more
candid >> discussion about what is really happening in
nursing.
"The public, policy-makers and nurses
all are well aware there is a nursing shortage," Donelan
said. "We have conveniently avoided talking about the
impact of that shortage on patients. We have avoided
airing some rather difficult realities of how hard this
job really is. We want to lure new people into the
field, but we are afraid to be honest about what they
will face there."
"Nurses are worried about the impact
the shortage is having on the delivery of patient care,"
said advisory team leader Deloras Jones, MS, RN, a
renowned nursing and health care consultant and former
Kaiser Permanente executive. "We need to listen to
them."
The numbers suggest that the nursing
shortage has become more pervasive than it was a year
ago, when most available evidence indicated that, for
the most part, its effects were confined to certain
geographic areas-mostly inner cities and isolated rural
areas-and to some nursing practice specialties such as
critical care.
Peter Risher of Harris Interactive,
the project's senior research director, said the survey
indicates that virtually all registered nurses in the
United States believe there is a nursing shortage and
that the vast majority have witnessed its effects
firsthand.
"Most RNs also report that staffing
problems at the place where they work have gotten worse
in the past year and that these problems are having a
negative impact on the quality of patient care," Risher
wrote in an executive summary of the research report.
"Barring a reversal of current trends, the nursing
shortage that now exists can be expected to worsen as
RNs reduce their active participation in the nursing
workforce."
In the survey, 95 percent of working
RNs agreed that a nursing shortage exists and 88 percent
said that in their communities, the supply of registered
nurses working in patient care settings is less than the
demand.
A large majority of RNs who work in
hospitals believe that the nursing shortage-and staffing
problems that are a direct consequence of the
shortage-are having a negative effect on the quality of
patient care, Risher said.
Nearly three-fourths of the hospital
nurses said that, in the past year, they have witnessed
a negative impact on the quality of patient care as a
result of a greater number of patients per nurse and
higher turnover among experienced RNs.
Peter Buerhaus, Ph.D., RN, FAAN, a
member of the NurseWeek/AONE research advisory
board and one of the nation's foremost authorities on
nursing workforce trends, finds a silver lining in what
nurses have to say about how the shortage is damaging
patient care.
"The public understands there are
shortages, is concerned that they will hurt the
performance of the overall health system and worried
that shortages will harm the quality of care they
personally receive," said Buerhaus, the Valere Potter
professor of nursing and senior associate dean for
research at Vanderbilt University School of Nursing.
"In this survey, RNs tell us that they
believe harmful effects have resulted. Thus, this
information should be helpful to stimulate both public
and private sector policy-makers that it is time to make
addressing the causes and consequences of the current
nursing shortage a high priority on the domestic policy
agenda."
Another ray of hope can be found from
the substantial majority of nurses who said they are
satisfied with their jobs and would recommend the
nursing profession to young people as a career choice.
The results stand in stark contrast to some widely
publicized, often unscientific polls during the past
year that have portrayed nurses as so profoundly unhappy
with their profession that they wouldn't recommend it to
anyone.
"I am excited and thrilled by the
finding that, in the face of trends cited in the
results, most nurses would recommend nursing to others,"
said research advisory board member Karen Haase-Herrick,
MN, RN, executive director of the Seattle-based
Northwest Organization of Nurse Executives.
"And that younger nurses and those
with more education are more likely to recommend
nursing. This finding thrills and excites me because I
am passionate about the wonders of nursing as a
profession personally and the findings in this survey
convey a 'hopefulness' about nursing as a profession."
Risher agreed it's especially
significant that younger RNs and those with higher
levels of education are even more likely to recommend
nursing. So, too, he said, is the finding that, despite
some signs of strain in the working relationships
between nurses and management, RNs overwhelmingly agree
that patient care remains a priority at the
organizations where they work.
"Along with these positive views
toward nursing," Risher wrote in his executive summary,
"opportunities clearly exist to attract and retain more
RNs as working nurses. Many RNs who plan to leave their
present jobs in the next few years say they would
consider staying-and many others who have left nursing
altogether say they would consider returning-if certain
conditions were met.
"Among these conditions are better
compensation, an improved work environment, better hours
and more respect from management. Nurses with no
immediate plans to leave echo many of these same
sentiments."
Not surprisingly, based on dozens of
letters, e-mails and phone calls about the nursing
shortage to NurseWeek during the past year, money
ranks at or near the top list of concerns.
The response to our open invitation
for readers to share their thoughts about the shortage
generally falls into two categories. One group says it's
all about money and there's no need for scientific
surveys to find out anything more. The other group says
the reasons for the shortage are more complicated. While
acknowledging that money is important, this group says
other factors, including job stress and professional
status, may be even more critical.
In our scientific sampling, 79 percent
said improved wages and benefits would help a great deal
to solve the shortage. But even more, 83 percent, said
improved working environments would be helpful. Seventy
percent said higher status of nurses in the hospital
environment would help.
Among nurses who say they plan to
leave their present nursing position within the next
three years, 58 percent say improved compensation or
benefits would be "very likely" to cause them to
reconsider. Fifty percent say better staffing and 48
percent say more respect from management would very
likely cause them to reconsider.
But among survey participants who are
not working as paid nurses, less than one-third, or 29
percent, said more money would "very likely" cause them
to consider returning to work as a nurse. Almost half,
or 45 percent, said a less stressful work environment
would likely cause them to consider returning.
The results suggest that nursing
recruitment and retention promise to be challenging in
the years ahead.
Survey advisory team member Karen R.
Sechrist, Ph.D., RN, FAAN, said one of the most
significant findings is that 14 percent of the nurses
now employed intend to leave the profession within three
years, with more leaving for other professions than
those leaving for retirement.
Sechrist, project investigator for the
California Strategic Planning Committee for Nursing,
said the survey helps debunk a common perception in the
health care industry that the shortage might be
significantly reduced if nurses were to increase the
number of hours they work.
"The point that is obvious in the
survey and corroborates other findings is that more
nurses intend to decrease hours rather than increase
them," she said. "This finding is consistent with the
aging workforce and the stress of additional hours."
So what are employers to do if more
overtime isn't a practical or attractive option?
"The only area in which the shortage
might be impacted with the current workforce is to make
the working environment as positive as is possible to
retain nurses planning to leave the profession to work
in another field," Sechrist said. "There will always be
some loss to the profession for this reason, but it is
one of the few areas where employers can make a positive
difference."
But Risher said even that will not be
easy.
"Reducing stress in the work
environment-a leading cause of nurses leaving the
profession prior to retirement-will be particularly
difficult because this stress is a result as well as a
cause of the shortage," Risher concluded in his
executive summary. "Still, even as the shortage
continues, steps could be taken to reduce stress by
giving RNs more say in workplace decisions, more
opportunities for professional development, more
recognition and a physically safer and more
accommodating workplace."
Carol Bradley, regional vice president
and editor of NurseWeek's California edition,
said she would like to see survey serve as an important
tool for health care planners and policy-makers. "Nurses
have now told us what their world is really like, what
can be done to improve it and what they plan to do in
their careers in the future," Bradley said. "For both
nursing and health care to succeed, we must listen to
what they have said and act on it."
"Nurses believe that nursing is a good
profession," said Pamela Thompson, MSN, RN, executive
director of AONE. "We must all work to secure that
opinion for the future as well."
Contact Tim Graham
at
timg@nurseweek.com
Original source at
http://www.nurseweek.com/news/features/02-04/aone.asp
