- Email: [email protected]
Could the nurse be an endangered species?
EDITORIAL TCould
the Nurse Be an Endangered Species? Judith Stoner Halpern, RN, MS, CEN
uring the last half of the twentieth century, scientists from around the world noticed that many plant and animal species had been lost to extinction. It was difficult to accept the realization that living creatures were unable to go on surviving against all odds. The environmental and scientific communities joined efforts and took drastic preventative action to stay the loss of additional species. In 1973, the United States Congress enacted the Endangered Species Act (ESA), which had 3 important aspects: follow the numbers, monitor and strengthen the habitat, and, when planning interventions, think globally.1 The ESA mandated federal agencies and encouraged states to work together by offering financial assistance and a sys-
D
Less than one half of the total estimated number of nurses are employed in hospitals. tem of incentives. If meaningful interventions were not implemented, an endangered species would show “red flags” by progressing from threatened to endangered and finally becoming extinct. Admittedly, using the analogy that professional nursing can be considered a living thing is asking for a stretch of the imagination. However, analogies are used to make a point: to show similarities and to learn from the experience of a nonrelated entity. If we use the ESA template to assess nursing, we discover the following: 1. Follow the numbers: According to the 2000 National Sample Survey of Registered Nurses in the United States,2 there were approxiInt J Trauma Nurs 2001;7:40-2. Copyright © 2001 by the Emergency Nurses Association. 1075-4210/2001/$35.00 + 0 65/1/115595 doi:10.1067/mtn.2001.115595 40 INTERNATIONAL JOURNAL OF TRAUMA NURSING/Editorial
mately 2.7 million persons with an active registered nurse license in the country. Unfortunately, their average age increased (in 1980, 52.9% of RNs were under the age of 40 years; in 2000, 31.7% were under the age of 40 years) and their total number represents a net gain of little more than 130,000 nurses since 1996. The number of persons employ- ed in nursing has dropped by 1% since 1996. There has been a notable decrease in nursing school enrollments, especially of young college graduates selecting nursing as their first career option. Less than one half of the total estimated number of nurses are employed in hospitals. 2. Monitor and strengthen the habitat: Both acute– care and long–care facilities have traditionally served as the major habitat for nurses. Health care institutions are a hub of multidisciplinary professionals, services, and technology and provide a natural setting for providing nursing care and learning about a variety of human needs and disorders. Educational opportunities are lost as hospitals decrease the numbers of professionals who can teach and consult and simultaneously reduce patient contact through shorter length of stay. A flawed educational system threatens the ability of a profession to regenerate. It is a catch-22 situation for trauma care; hospitals need educated, experienced nurses who need hospitals to gain clinical knowledge and skills. 3. When planning interventions, think globally: We no longer think of one nation’s problems as an isolated entity. Increased global trade, communication, and travel have made us all subject to each other’s issues. Therefore, it may not be surprising to learn that there is a worldwide nursing shortage. (See Trauma News Today, p 78, VOLUME 7, NUMBER 2
for specifics from the World Health Organization [WHO].) The WHO has warned that unless the world’s public health community recognizes and deals with the nursing shortage, entire health care systems may be disabled. The WHO has sounded a “911” call for nurses. Restoring the profession of nursing to a healthy status will take a combined effort with each nurse playing an important role. As individuals, nurses can borrow from the strategies of Florence Nightingale, who was educated in mathematics and learned early about the power of using statistics. She collected data and used them to show that nursing care could significantly improve health and decrease mortality. Today, staff nurses can document whatever it takes to get the public’s eye. Something as simple as documenting how many shifts are worked by nurses doing mandatory overtime, or how many minutes per day a nurse actually spends with each patient, will be meaningful to a population that wants and pays highly for professional nursing care. Nurses could keep a personal or departmental journal, noting the good times (ie,
The WHO warns that the practice of recruiting nurses from one country into another only exacerbates the home nation’s nursing shortage. personal rewards and triumphs) that remind us of why we like the profession. Good stories tend to be forgotten during the next crisis or after time away from work. The journals could be used to help all nurses enlighten the public about what is so good about nursing. Positive human interest stories counteract the negative headlines that involve nurses, but should not be used to define us. For example, the appeal of television programs (ie, programs that focus on interpersonal relationships and not clinically accurate facts), may be a sign that the general public wants to see health care providers in a more individual way. There must be increased efforts to recruit students to nursing. In the United States, less than 6% of nurses are men and less than 13% are from a racial or ethnic minority.2 These data reflect a missed opportunity to tap into large reservoirs of potential nurses. We need to identify the barriers that prevent men and minorities from entering the APRIL-JUNE 2001
profession and help change those perceptions and issues. In our attempts to diversify nursing, we should not fall into the myopic mind-set of openly recruiting qualified nurses from less developed nations. While we welcome and treasure the international exchange of nursing skill and knowledge, we must be sure that it is an exchange and not simply a skills drain from other nations. The WHO warns that the practice of recruiting nurses from one country into another only exacerbates the home
There have been attempts to keep the number of hospital nurses at an acceptable level, most of which involve either a stick approach or a carrot approach. nation’s nursing shortage.3 We need to remind policy makers that all countries need nurses, not just ours. The International Council of Nurses has established a position statement to help nursing groups prevent the exploitation of our international colleagues.4 There have been attempts to keep the number of hospital nurses at an acceptable level, most of which involve using either a stick approach or a carrot approach. Hospitals that rely on the stick (ie, forcing nurses to do mandatory overtime or float to unfamiliar clinical areas) are destined to fail because nurses are people, not machines. People do not function well without adequate rest, recognition, and rewards. Hospitals that use the carrot offer sign-on bonuses, tuition reimbursement, flexible scheduling, and a system that gives responsibility and recognition to nurses who stay at the bedside. The carrot approach allows nurses to be a part of the solution instead of the problem. Still others are taking a cue from history. During World War II, the need for nurses was high and the supply low. Frances Payne Bolton, a congresswoman from Ohio, introduced the Nurse Training Act in 1943 (also known as the Bolton Act) to finance the costs of accelerating and expanding nursing education.5 There was intense publicity to recruit students to the US Cadet Nurse Corps, including providing cadets with designer uniforms, scholarships, and subsistence grants. INTERNATIONAL JOURNAL OF TRAUMA NURSING/Editorial 41
Students that were accepted into the cadet corps pledged to serve where needed in either military or civilian agencies for the duration of the war and 6 months thereafter. According to the Hernando Today,6 Pasco-Hernando Community College in Florida is working on a partnership with area hospitals to finance the education of 30 nursing students each year in their nursing program. In exchange for the students agreeing to work for 2 years after graduation at their sponsoring hospitals, the hospitals will pay the expenses of the students’ education. Financial assistance and a system of incentives have helped to save plants and animals; let us hope it will also work for nursing. The National Academy Press has just published Crossing the Quality Chasm: A New Health System for the 21st Century,7 which calls for massive, fundamental changes in the organization and delivery of health care in the United States. There is no doubt that nursing will be swept along with the changes taking place. At the risk of sounding frivolous, I fear that we must either pull our profession together or get ready to join the dinosaurs.
REFERENCES 1. US Fish and Wildlife Services. ESA basics, over 25 years of protecting endangered species. Available at: http://endangered.fws.gov/pubs/esa%20basics.pdf. Accessed March 7, 2001. 2. HRSA national survey cites slowdown in number of registered nurses entering profession. HRSA news. Available at: http://www.hrsa.gov/newsroom/releases/2001. Accessed March 12, 2001. 3. World Health Organization. Nursing and midwifery services facing crisis, experts say. Note for the press No. 17. Available at: http://who.int/-pr2000/en/note2000-17.html. Accessed December 20, 2000. 4. International Council on Nurses. Nurse retention, transfer and migration. Position statement. Available at: http://www.icn. ch/psretention.htm. Accessed March 9, 2001. 5. Donohue MP. Nursing, the finest art. 2nd ed. St Louis: Mosby; 1996. 6. Bacon D. Hospitals join PHCC in nursing program push. Available at: http://www.hernandotoday.com/news/MGAEKMVTAIC.html. Accessed March 9, 2001. 7. Committee on Quality Health Care in America, Institute of Medicine. Crossing the quality chasm. The new health system for the 21th century. Washington: National Academy Press; 2001.
Call for Contributions If you have an on-line trauma-related education program, and you would like to have it listed in an upcoming issue, please send the information requested below. Courses can be those that last a few hours, to full-semester college or university courses. • • • • •
Name of program or name of institution Length of course or number of credits Brief synopsis of content Institution address, telephone number, fax, e-mail Name of contact person Mail listings to: Carole Rush, Section Editor 179 Bayview Dr SW Calgary, Alberta, Canada T2V 0L4 Fax (403) 238-6587 e-mail [email protected]
42
INTERNATIONAL JOURNAL OF TRAUMA NURSING/Editorial
VOLUME 7, NUMBER 2
the Nurse Be an Endangered Species? Judith Stoner Halpern, RN, MS, CEN
uring the last half of the twentieth century, scientists from around the world noticed that many plant and animal species had been lost to extinction. It was difficult to accept the realization that living creatures were unable to go on surviving against all odds. The environmental and scientific communities joined efforts and took drastic preventative action to stay the loss of additional species. In 1973, the United States Congress enacted the Endangered Species Act (ESA), which had 3 important aspects: follow the numbers, monitor and strengthen the habitat, and, when planning interventions, think globally.1 The ESA mandated federal agencies and encouraged states to work together by offering financial assistance and a sys-
D
Less than one half of the total estimated number of nurses are employed in hospitals. tem of incentives. If meaningful interventions were not implemented, an endangered species would show “red flags” by progressing from threatened to endangered and finally becoming extinct. Admittedly, using the analogy that professional nursing can be considered a living thing is asking for a stretch of the imagination. However, analogies are used to make a point: to show similarities and to learn from the experience of a nonrelated entity. If we use the ESA template to assess nursing, we discover the following: 1. Follow the numbers: According to the 2000 National Sample Survey of Registered Nurses in the United States,2 there were approxiInt J Trauma Nurs 2001;7:40-2. Copyright © 2001 by the Emergency Nurses Association. 1075-4210/2001/$35.00 + 0 65/1/115595 doi:10.1067/mtn.2001.115595 40 INTERNATIONAL JOURNAL OF TRAUMA NURSING/Editorial
mately 2.7 million persons with an active registered nurse license in the country. Unfortunately, their average age increased (in 1980, 52.9% of RNs were under the age of 40 years; in 2000, 31.7% were under the age of 40 years) and their total number represents a net gain of little more than 130,000 nurses since 1996. The number of persons employ- ed in nursing has dropped by 1% since 1996. There has been a notable decrease in nursing school enrollments, especially of young college graduates selecting nursing as their first career option. Less than one half of the total estimated number of nurses are employed in hospitals. 2. Monitor and strengthen the habitat: Both acute– care and long–care facilities have traditionally served as the major habitat for nurses. Health care institutions are a hub of multidisciplinary professionals, services, and technology and provide a natural setting for providing nursing care and learning about a variety of human needs and disorders. Educational opportunities are lost as hospitals decrease the numbers of professionals who can teach and consult and simultaneously reduce patient contact through shorter length of stay. A flawed educational system threatens the ability of a profession to regenerate. It is a catch-22 situation for trauma care; hospitals need educated, experienced nurses who need hospitals to gain clinical knowledge and skills. 3. When planning interventions, think globally: We no longer think of one nation’s problems as an isolated entity. Increased global trade, communication, and travel have made us all subject to each other’s issues. Therefore, it may not be surprising to learn that there is a worldwide nursing shortage. (See Trauma News Today, p 78, VOLUME 7, NUMBER 2
for specifics from the World Health Organization [WHO].) The WHO has warned that unless the world’s public health community recognizes and deals with the nursing shortage, entire health care systems may be disabled. The WHO has sounded a “911” call for nurses. Restoring the profession of nursing to a healthy status will take a combined effort with each nurse playing an important role. As individuals, nurses can borrow from the strategies of Florence Nightingale, who was educated in mathematics and learned early about the power of using statistics. She collected data and used them to show that nursing care could significantly improve health and decrease mortality. Today, staff nurses can document whatever it takes to get the public’s eye. Something as simple as documenting how many shifts are worked by nurses doing mandatory overtime, or how many minutes per day a nurse actually spends with each patient, will be meaningful to a population that wants and pays highly for professional nursing care. Nurses could keep a personal or departmental journal, noting the good times (ie,
The WHO warns that the practice of recruiting nurses from one country into another only exacerbates the home nation’s nursing shortage. personal rewards and triumphs) that remind us of why we like the profession. Good stories tend to be forgotten during the next crisis or after time away from work. The journals could be used to help all nurses enlighten the public about what is so good about nursing. Positive human interest stories counteract the negative headlines that involve nurses, but should not be used to define us. For example, the appeal of television programs (ie, programs that focus on interpersonal relationships and not clinically accurate facts), may be a sign that the general public wants to see health care providers in a more individual way. There must be increased efforts to recruit students to nursing. In the United States, less than 6% of nurses are men and less than 13% are from a racial or ethnic minority.2 These data reflect a missed opportunity to tap into large reservoirs of potential nurses. We need to identify the barriers that prevent men and minorities from entering the APRIL-JUNE 2001
profession and help change those perceptions and issues. In our attempts to diversify nursing, we should not fall into the myopic mind-set of openly recruiting qualified nurses from less developed nations. While we welcome and treasure the international exchange of nursing skill and knowledge, we must be sure that it is an exchange and not simply a skills drain from other nations. The WHO warns that the practice of recruiting nurses from one country into another only exacerbates the home
There have been attempts to keep the number of hospital nurses at an acceptable level, most of which involve either a stick approach or a carrot approach. nation’s nursing shortage.3 We need to remind policy makers that all countries need nurses, not just ours. The International Council of Nurses has established a position statement to help nursing groups prevent the exploitation of our international colleagues.4 There have been attempts to keep the number of hospital nurses at an acceptable level, most of which involve using either a stick approach or a carrot approach. Hospitals that rely on the stick (ie, forcing nurses to do mandatory overtime or float to unfamiliar clinical areas) are destined to fail because nurses are people, not machines. People do not function well without adequate rest, recognition, and rewards. Hospitals that use the carrot offer sign-on bonuses, tuition reimbursement, flexible scheduling, and a system that gives responsibility and recognition to nurses who stay at the bedside. The carrot approach allows nurses to be a part of the solution instead of the problem. Still others are taking a cue from history. During World War II, the need for nurses was high and the supply low. Frances Payne Bolton, a congresswoman from Ohio, introduced the Nurse Training Act in 1943 (also known as the Bolton Act) to finance the costs of accelerating and expanding nursing education.5 There was intense publicity to recruit students to the US Cadet Nurse Corps, including providing cadets with designer uniforms, scholarships, and subsistence grants. INTERNATIONAL JOURNAL OF TRAUMA NURSING/Editorial 41
Students that were accepted into the cadet corps pledged to serve where needed in either military or civilian agencies for the duration of the war and 6 months thereafter. According to the Hernando Today,6 Pasco-Hernando Community College in Florida is working on a partnership with area hospitals to finance the education of 30 nursing students each year in their nursing program. In exchange for the students agreeing to work for 2 years after graduation at their sponsoring hospitals, the hospitals will pay the expenses of the students’ education. Financial assistance and a system of incentives have helped to save plants and animals; let us hope it will also work for nursing. The National Academy Press has just published Crossing the Quality Chasm: A New Health System for the 21st Century,7 which calls for massive, fundamental changes in the organization and delivery of health care in the United States. There is no doubt that nursing will be swept along with the changes taking place. At the risk of sounding frivolous, I fear that we must either pull our profession together or get ready to join the dinosaurs.
REFERENCES 1. US Fish and Wildlife Services. ESA basics, over 25 years of protecting endangered species. Available at: http://endangered.fws.gov/pubs/esa%20basics.pdf. Accessed March 7, 2001. 2. HRSA national survey cites slowdown in number of registered nurses entering profession. HRSA news. Available at: http://www.hrsa.gov/newsroom/releases/2001. Accessed March 12, 2001. 3. World Health Organization. Nursing and midwifery services facing crisis, experts say. Note for the press No. 17. Available at: http://who.int/-pr2000/en/note2000-17.html. Accessed December 20, 2000. 4. International Council on Nurses. Nurse retention, transfer and migration. Position statement. Available at: http://www.icn. ch/psretention.htm. Accessed March 9, 2001. 5. Donohue MP. Nursing, the finest art. 2nd ed. St Louis: Mosby; 1996. 6. Bacon D. Hospitals join PHCC in nursing program push. Available at: http://www.hernandotoday.com/news/MGAEKMVTAIC.html. Accessed March 9, 2001. 7. Committee on Quality Health Care in America, Institute of Medicine. Crossing the quality chasm. The new health system for the 21th century. Washington: National Academy Press; 2001.
Call for Contributions If you have an on-line trauma-related education program, and you would like to have it listed in an upcoming issue, please send the information requested below. Courses can be those that last a few hours, to full-semester college or university courses. • • • • •
Name of program or name of institution Length of course or number of credits Brief synopsis of content Institution address, telephone number, fax, e-mail Name of contact person Mail listings to: Carole Rush, Section Editor 179 Bayview Dr SW Calgary, Alberta, Canada T2V 0L4 Fax (403) 238-6587 e-mail [email protected]
42
INTERNATIONAL JOURNAL OF TRAUMA NURSING/Editorial
VOLUME 7, NUMBER 2