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A Colleague Looks at the Nursing Shortage
A COLLEAGUE LOOKS AT THE NURSING SHORTAGE Philip Cooper, M.D. This is not the time to change radically or to experiment with nursing education! The shortage of registered nurses is critical. As a surgeon, I have observed the gradual deterioration of nursing care as it relates to surgical patients. The scrub and circulating nurses in the operating rooms are to a great extent being replaced by nursing aides. Such replacement has gone beyond acceptable limits. Also, postoperative patients requiring close supervision and monitoring must remain in recovery or intensive care units if they are to receive qualified nursing attention and care, for ward and floor staffing with r e g istered nurses is now inadequate to handle such patients. In many hospitals, one registered nurse is responsible for two to three wards or floors, and most nursing activities in those areas are delegated to assistants or aides. A great deal has been written about the nursing shortage and many reasons have been advanced to explain why it exists, and why it is progressively getting worse. I would like to touch upon one aspect of the problem, the attitude of some nursing organizations toward hospital diploma schools. They feel that such schools do not offer the student an academic program, a scholarly environment, and the prestige that are available at universities. They also feel that the acquisition of an undergraduate degree should be a requirement for becoming a professional nurse. The closing of many hospital diploma schools, and the uncertain future of the rePhilip Cooper, M.D., is chief of surgical services for the Veterans Administration Hospital, Bronx, N. Y. He is also professor of clinical surgery at Albert Einstein College of Medicine in the Bronx.
November 1967
maining schools have contributed significantly to the nursing shortage. Also, students at these schools fear that they will find it difficult to advance in position and salary unless they acquire an academic degree at a later date. The students and graduates of these schools should be assured that they will not be penalized when it comes to salary increases, professional standing or seniority, after years of dedicated service, knowledge gained from experience and from properly directed studies, because they lack baccalaureate degrees. What many educators fail to recognize is the fact that hospital diploma schools can offer excellent programs for students interested in bedside nursing, and that such schools enjoy the same academic atmosphere as institutions of learning. Deficiencies in the schools could be corrected by affiliations with universities, or by utilizing instructors from universities. Those nursing educators who are now opposed to such schools should work to improve them and to elevate their standards where necessary, rather than to encourage their closing, Fortunately, some of these schools, such as the Faulkner Hospital Nursing School in Boston, have their own recruitment programs, and will increase the number of their students. One unfortunate result of the drive to establish the university based school as the only acceptable type of nursing school, has been the graduation from some of these schools of nurses seriously lacking in clinical experience. This is particularly true with the Associate Degree or the two-year collegiate programs. In one such program the nurse at graduation has had only 30 hours of clinical work, most of it on an observation basis.
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Nurses graduating from such a program cannot be adequately prepared to take on the full responsibility of the nurse in the care of a patient. There would be little objection to the use of university based nursing schools exclusively, and to the degree requirement as long as the student in university based programs is offered adequate clinical experience at a hospital. This arrangement, also, should not interfere with the recruitment of enough students to fill the needs of hospitals and other institutions for graduate nurses. The shortage of nurses has resulted in the delegation of many nursing duties to relatively unqualified personnel. “Practical” nurses, aides, technicians and others are being assigned to more and more duties, and are being given increased responsibility. No one would dispute the fact that many of the duties previously assigned to nurses can reasonably be delegated, under supervision, to others. However, there remain many other duties and responsibilities that the graduate nurse alone, can and should assume. The nursing field should have no serious
problem in recruiting students. The nurse interested only in the bedside care of patients can gain much satisfaction from her work. She may not be interested in going into specialized nursing work, nor in acquiring a baccalaureate degree. Others interested in supervisory work, in teaching, or in specialized fields such as psychiatric, operating room, intensive care, or rehabilitation nursing etc., in general, would seek university work, and in some fields, postgraduate work. I do hope that nursing organizations, acknowledging that the nursing shortage has reached a critical stage, and that patient care is being seriously jeopardized, will appreciate the need for compromise at this time, and adopt a realistic approach to the problem. That approach should include the recognition of the teaching potential of the existing hospital diploma schools and the possible establishment of additional hospital diploma schools at this time. When the nursing situation has improved, and the critical shortage of nurses no longer exists, a reassessment of all teaching activities in the education of the nurses, could then be carefully done.
ANA NEWSTwice a year at the ANA convention, the Mary Mahoney Award is awarded to those who have opened opportunities in nursing for members of minority groups. Th e panel of judges to select the recipient of the 1%8 award has now been named. Nominations must be received by December 1, 1967, through your state nurses’ association. T he person chosen will he either a n outstanding individual or group having made a significant contribution to the advancement of equal opportunities for minority groups in nursing. T he award was named for Mary Eliza Mahoney, the first Negro nursc in the IT.S., an outstanding student, nurse, and citizen, who worked to improve the status of the Negro nurse in professional life. Miss Mahoney graduated from the New England Hospital for Women and Children in 1879 and spent forty years as a nursing practitioner. Th e National Association of Colored Graduate Nurses established the award and since tlie NACG was dissolved in 1952, after tlie ANA assumed activities relating to discriminating practices, the ANA has continued presentation of the award. T he judges for 1%8 are: Dr. Kenneth B. Clark, department of psychology, City College of New York; Mrs. Arthur J. Goldberg, wife of t h e U. S. Ambassador to t h e IJ. N.; Rev. Theodore M. Hesburgh, President of th e University of Notre Dame; Luis Munoz Marin, former governor of Puerto Rico; and James F. Oates, Jr., Chairman of the Board, Equitable Life Assurance Society of the U. S.
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AORN Jourranl
November 1967
maining schools have contributed significantly to the nursing shortage. Also, students at these schools fear that they will find it difficult to advance in position and salary unless they acquire an academic degree at a later date. The students and graduates of these schools should be assured that they will not be penalized when it comes to salary increases, professional standing or seniority, after years of dedicated service, knowledge gained from experience and from properly directed studies, because they lack baccalaureate degrees. What many educators fail to recognize is the fact that hospital diploma schools can offer excellent programs for students interested in bedside nursing, and that such schools enjoy the same academic atmosphere as institutions of learning. Deficiencies in the schools could be corrected by affiliations with universities, or by utilizing instructors from universities. Those nursing educators who are now opposed to such schools should work to improve them and to elevate their standards where necessary, rather than to encourage their closing, Fortunately, some of these schools, such as the Faulkner Hospital Nursing School in Boston, have their own recruitment programs, and will increase the number of their students. One unfortunate result of the drive to establish the university based school as the only acceptable type of nursing school, has been the graduation from some of these schools of nurses seriously lacking in clinical experience. This is particularly true with the Associate Degree or the two-year collegiate programs. In one such program the nurse at graduation has had only 30 hours of clinical work, most of it on an observation basis.
61
Nurses graduating from such a program cannot be adequately prepared to take on the full responsibility of the nurse in the care of a patient. There would be little objection to the use of university based nursing schools exclusively, and to the degree requirement as long as the student in university based programs is offered adequate clinical experience at a hospital. This arrangement, also, should not interfere with the recruitment of enough students to fill the needs of hospitals and other institutions for graduate nurses. The shortage of nurses has resulted in the delegation of many nursing duties to relatively unqualified personnel. “Practical” nurses, aides, technicians and others are being assigned to more and more duties, and are being given increased responsibility. No one would dispute the fact that many of the duties previously assigned to nurses can reasonably be delegated, under supervision, to others. However, there remain many other duties and responsibilities that the graduate nurse alone, can and should assume. The nursing field should have no serious
problem in recruiting students. The nurse interested only in the bedside care of patients can gain much satisfaction from her work. She may not be interested in going into specialized nursing work, nor in acquiring a baccalaureate degree. Others interested in supervisory work, in teaching, or in specialized fields such as psychiatric, operating room, intensive care, or rehabilitation nursing etc., in general, would seek university work, and in some fields, postgraduate work. I do hope that nursing organizations, acknowledging that the nursing shortage has reached a critical stage, and that patient care is being seriously jeopardized, will appreciate the need for compromise at this time, and adopt a realistic approach to the problem. That approach should include the recognition of the teaching potential of the existing hospital diploma schools and the possible establishment of additional hospital diploma schools at this time. When the nursing situation has improved, and the critical shortage of nurses no longer exists, a reassessment of all teaching activities in the education of the nurses, could then be carefully done.
ANA NEWSTwice a year at the ANA convention, the Mary Mahoney Award is awarded to those who have opened opportunities in nursing for members of minority groups. Th e panel of judges to select the recipient of the 1%8 award has now been named. Nominations must be received by December 1, 1967, through your state nurses’ association. T he person chosen will he either a n outstanding individual or group having made a significant contribution to the advancement of equal opportunities for minority groups in nursing. T he award was named for Mary Eliza Mahoney, the first Negro nursc in the IT.S., an outstanding student, nurse, and citizen, who worked to improve the status of the Negro nurse in professional life. Miss Mahoney graduated from the New England Hospital for Women and Children in 1879 and spent forty years as a nursing practitioner. Th e National Association of Colored Graduate Nurses established the award and since tlie NACG was dissolved in 1952, after tlie ANA assumed activities relating to discriminating practices, the ANA has continued presentation of the award. T he judges for 1%8 are: Dr. Kenneth B. Clark, department of psychology, City College of New York; Mrs. Arthur J. Goldberg, wife of t h e U. S. Ambassador to t h e IJ. N.; Rev. Theodore M. Hesburgh, President of th e University of Notre Dame; Luis Munoz Marin, former governor of Puerto Rico; and James F. Oates, Jr., Chairman of the Board, Equitable Life Assurance Society of the U. S.
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AORN Jourranl