- Email: [email protected]
Nursing’s Future Under Fire
How Nursing Associations, Legislators Are Addressing the Shortage
T
he word is finally out-the U.S. is facing a new and different kind of nursing shortage. Extensive media coverage, compelling organizational and government data and attention from legislators at the state and federal levels have accomplished the first step to solving any dilemma-people are convinced there is a serious problem of an impending, and in some cases immediate, nursing shortage. During this process, the nursing community has enjoyed increased attention from decision makers who have the power to change policies to the benefit of nurses and consumers nationwide. The players in the process-including registered nurses and their professional nursing organizations, and elected representatives-are now considering the dynamics of the shortage and deciding how to best address its many problems. The challenges to consider are varied and numerous because the sources of the shortage derive from so many different sources. The dominating factor in this shortage is the impending retirement of up to 40 percent of the workforce by or soon after 2010. These retirements are projected to occur at the same time that demand for health care services, and the services of registered nurses, is increasing to meet the needs of the aging baby boomer population.
Counting the Nurses Probably the most compelling source that documents the impending shortage is the HRSA (Health Resources Service Administration) National Sample Survey of Registered Nurses (NSSRN),conducted every four years and re-
Shelagh Roberts
Under Fire
cently released in 2001. The survey is the most extensive and comprehensive source of statistics on registered nurses, providing information on the number of ms,their educational background and specialty areas, their employment status and employment setting, average salary information, geographic distribution, and personal characteristics of the nursing population. As had been widely anticipated, the survey’s preliminary data provided compellinginformation about the dangers of the projected nursing shortage. The data pinpointed in stark numbers the problems that have been discussed by nurses and nursing associations anecdotally for years. General key findings from the preliminary data reveal that the average age of nurses continues to increase and there are an insufficient number of new nurses in the pipeline waiting to take their places. Enrollment at schools of nursing is down, and the age of nurse educators is up. More nurses are entering the profession at the entry-into-practice level with basic nursing education instead of diploma programs. Salary increases, when considered in relation to the rate of inflation, have been relatively flat over the past few years. Minorities and men are grossly underrepresented in the profession and don’t come close to reflecting their actual distribution in the population. (To review the HRSA data in full, visit the HRSA Web site at http://bhpr.hrsa.gov/dn/ survey.htm.) The numerical data, which received widespread media attention, spawned the obvious question that solution seekers are looking to answer-why is the supply of nurses
dwindling? Like the indisputable reality of the shortage itself, many of the reasons for its existence are now uniformly accepted. Nursing today is unpopular as a career choice, and women particularly are exploring other professional opportunities for reasons that the most recent literature points to as including: unfavorable working conditions such as mandatory overtime long shifts inadequate staffing and its natural partner, increased workload insufficient time to practice patient care physical demands stagnant pay lack of autonomy and/or respect increased opportunities for great professional opportunity and financial rewards in other professions Because these reasons have been widely documented, they’ve also been widely accepted as valid criticisms of the state of the profession. What’s critical at this point is moving toward solutions to these criticisms and problems.
Reaching for Solutions With the release of the HRSA data, national media coverage such as the series of articles in the Chicago Tribune regarding nursing and patient errors, and the ever-prevalent anecdotal evidence regarding the nursing shortage, policy makers and
nursing organizations have joined forces to try to create solutions both practical and reasonable. The obvious challenge for both nursing organizations and policy makers is to recognize that while nursing organizations represent the collective voice of the nursing profession, most nursing organizations also represent specific specialty constituencies within the profession. Therefore, each nursing association or organization must balance the concerns of its membership and constituency while considering the benefits to the overall umbrella of the nursing profession. At first glance, it might seem that, for example, the American Association of Colleges of Nursing (AACN) would be most likely to advocate for increased grants and training for education purposes and faculty development, while the National Black Nurses Association’s primary priorities would be toward recruitment and scholarship efforts to increase enhancements for minority nurses, and the Association of Women’s Health, Obstetric and Neonatal Nurses might advocate most strongly for provisions related to development in the fields of specialty nursing, that is, women’s health and newborn care. It would be naive to suspect that these issues are not of primary importance to each of these organizations, and it’s enlightening and encouraging to consider the broad scope that the leading nursing associations have taken toward approaching the nursing shortage. Professional associations such as the American Nurses Association (ANA), the American Organization of Nurse Executives (AONE), the National Black Nurses Association, the Emergency Nurses Association, the AACN, and AWHONN, to name but a few, have embraced the power in numbers approach and advocated solutions that build on the similarities that nurses face rather than the differences among specialty areas in advocating for solutions to the shortage. Recognizing the broad scope and deep origins of the problem and the unique opportunity that the shortage has presented to increase attention on the nursing profession by state and federal legislators, leading organizations have come together to build consensus on many provisions to combat and ease the shortage. Most compelling is the consensus document released by the ANSR (Americans for Nursing Shortage Relief) Coalition at a press conference in April 2001. The consensus document, “Assuring Quality Health Care for the United States: Supporting Nurse Education and Training, Building an Adequate Supply of Nurses, Consensus Issues,” includes commonly agreed upon federal public policy initiatives that will assist in reducing the impact of the nursing shortage. Issued by 27 of the leading nursing associations representing nearly all of the nation’s 2.7 million nurses at all levels of nursing practice, education, administration and research, the document represents months of careful strategic planning and negotiation among the various organizations. Nursing organizations are also seeking the support of additional, nonnurse Shekzgb Roberts is position statement specialist within Health Policy/ Legislative Affairs of AWHONN.
58
A W H O N N Lifelines
Want to check out what various nursing associations are doing to address the shortage? Surf to the following Web s i k t Association of Women’s Health, Obstetric and
Neonatal Nurses: www.awhonn.org t
Department of Health and Human Services, Division of Nursing: bhpr.hrsa.gov
t
American Nurses Association: www.nursingworld.org
t
American Hospita I Association/America n Organization of Nurse Executives: www.aha.org
t National Black Nurses Association: www.nbna.org t
Emergency Nurses Association: www.ena.org
t
National League for Nursing: www.nln.org
t
American Academy of Nurse Practitioners: www.aanp.org
t
American College of Nurse-Midwives: www.a c n m.org
t
American Association of Colleges of Nursing: www.aacn.nche.edu
t American Association of Critical-Care Nurses:
www.aac n.org t
National Association of Hispanic Nurses: www. na h n hq.org
t
National Association of School Nurses: www.nasn.org
interest groups and organizations, a development that will provide it with a greater scope of influence and a larger audience. The suggested actions include, recruiting and retaining nurses expanding nurse education community involvement public awareness of the nursing shortage addressing a shortage of nurse faculty, among others (For a complete listing of participating organizations, and to view the consensus document in detail, go to www.
awhonn.org. ) Key provisions that the associations are calling for include, Increased funding for loan and scholarship programs to bring more young people into nursing Increased funding for recruitment and retention of minority nurses Increased funding for scholarships, loans and stipends aimed at developing nursing faculty at schools and universities Establishing a National Nurse Corps to serve communities hardest hit by the nursing shortage Volume 5,Issue 6
Adopting tax incentives for employers and for individuals to increase the supply of nurses in the pipeline Creating Department of Labor initiatives to recruit and retain nurses Developing models for collaboration between communities and states to design programs to recruit and retain nurses Increasing funding for research on the impact of nursing practices on patient outcomes Improving the process for data collection on the nurse workforce
Tracking Legislation Related to the Nursing Shortage Follow these bills as they progress and develop a t www.awhonn.org: e H.R. 1436/S. 706: Caps-Kerry Nurse Reinvestment Act
+ S. 721: Hutchinson-Mikulski Nursing Employment and Education Development (NEED) Act t
The consensus follows on the heels of a national, self-tided Tri-Council release of the white paper, “Strategies to Reverse the New Nursing Shortage.” The Tri-Council is composed of four nursing organizations-AACN, ANA, AONE and the National League for Nursing (NLN). The white paper also included a set of recommendations for changes or enhancements in education, work environment, legislation and regulation, technology, research and data collection, aimed at attracting and retaining nursing professionals. (Todownload the white paper, visit the American Nurses Association Web site at www.ana.org.) Additionally, in early September, 60 nursing associations including AWHONN came together to discuss and build support for A N A ’ s newest initiative to address the shortage, ANA’s “Call to the Nursing Profession.” The goal of the meeting was to produce a comprehensive plan to address the internal and external causes and effects of the current and impending nursing shortage. The meeting focused on nursing groups to work on issues related to, work environment economic value recruitment and retention education legislation regulation and policy nursing models diversity public relations and communications professional culture Work plans resulting from that meeting will be distributed to the larger nursing community, and individual groups will
Documenting the Problem Get the latest and most up-to-date data from the following sources: Health Resources Service Administration National Sample Survey of Registered Nurses: http://bhpr.hrsa.gov/dn/survey.htm Americans for Nursing Shortage Relief: www.nurse.org/acnp/leg/ansr.coalition.shtml e
American Nurses Association: www.ana.org
December 2001/January 2002
H.R. 1897: Engle-Bono-McCarthy Nurse of Tomorrow Act of 2001
+ H.R. 2594: Jones Nursing Shortage Response Act of 2001
have the opportunity to decide where their efforts might be best utilized.
Legislative Initiatives Associations’ activities on the nursing shortage have included targeted lobbying initiatives to build support for remedies to the nursing shortage, and the educational interaction between legislative offices and nursing organizations have been instrumental in the introduction of numerous bills in Congress related to the shortage. Some legislative initiatives call for expansion or increased funding for existing programs, such as increasing funding by a minimum of $25 million for the programs of the Health Professions Education Partnerships Act of 1998-Title WII of the Public Health Service Act (formerly the Nurse Education Act) and increasing funding for the Nursing Education Loan Repayment Program, Section 846 of the Public Health Service Act. Other remedies rely on outside-the-box thinking and creative approaches such as the establishment of a National Nurse Corps to ensure the nation’s registered nurse supply to urban centers, rural areas, underserved communities and regions that are experiencing shortages. So far in the 107th Congress, four bills have been introduced specific to the nursing shortage. While the detailed provisions of the bills vary and the approaches to stopping the shortage are multifaceted, the very fact that so many leading members of Congress have introduced legislation on this topic within one year, where there were no previous existing bills on the issue, is a testament to the public outreach and educationbuilding initiatives of the nation’s nursing leaders. While the nursing shortage, in all its complexity, presents challenges for policy makers and nursing leaders, the nation’s nursing associations have answered a call to action by working together to strengthen the proud profession of nursing. When weighed against the individual scopes and interests of each association, it would appear that the collective voice of nursing will win out, and with that, so will nurses and the women, men and families whom they serve. + AWHONN Lifelines
6@
T
he word is finally out-the U.S. is facing a new and different kind of nursing shortage. Extensive media coverage, compelling organizational and government data and attention from legislators at the state and federal levels have accomplished the first step to solving any dilemma-people are convinced there is a serious problem of an impending, and in some cases immediate, nursing shortage. During this process, the nursing community has enjoyed increased attention from decision makers who have the power to change policies to the benefit of nurses and consumers nationwide. The players in the process-including registered nurses and their professional nursing organizations, and elected representatives-are now considering the dynamics of the shortage and deciding how to best address its many problems. The challenges to consider are varied and numerous because the sources of the shortage derive from so many different sources. The dominating factor in this shortage is the impending retirement of up to 40 percent of the workforce by or soon after 2010. These retirements are projected to occur at the same time that demand for health care services, and the services of registered nurses, is increasing to meet the needs of the aging baby boomer population.
Counting the Nurses Probably the most compelling source that documents the impending shortage is the HRSA (Health Resources Service Administration) National Sample Survey of Registered Nurses (NSSRN),conducted every four years and re-
Shelagh Roberts
Under Fire
cently released in 2001. The survey is the most extensive and comprehensive source of statistics on registered nurses, providing information on the number of ms,their educational background and specialty areas, their employment status and employment setting, average salary information, geographic distribution, and personal characteristics of the nursing population. As had been widely anticipated, the survey’s preliminary data provided compellinginformation about the dangers of the projected nursing shortage. The data pinpointed in stark numbers the problems that have been discussed by nurses and nursing associations anecdotally for years. General key findings from the preliminary data reveal that the average age of nurses continues to increase and there are an insufficient number of new nurses in the pipeline waiting to take their places. Enrollment at schools of nursing is down, and the age of nurse educators is up. More nurses are entering the profession at the entry-into-practice level with basic nursing education instead of diploma programs. Salary increases, when considered in relation to the rate of inflation, have been relatively flat over the past few years. Minorities and men are grossly underrepresented in the profession and don’t come close to reflecting their actual distribution in the population. (To review the HRSA data in full, visit the HRSA Web site at http://bhpr.hrsa.gov/dn/ survey.htm.) The numerical data, which received widespread media attention, spawned the obvious question that solution seekers are looking to answer-why is the supply of nurses
dwindling? Like the indisputable reality of the shortage itself, many of the reasons for its existence are now uniformly accepted. Nursing today is unpopular as a career choice, and women particularly are exploring other professional opportunities for reasons that the most recent literature points to as including: unfavorable working conditions such as mandatory overtime long shifts inadequate staffing and its natural partner, increased workload insufficient time to practice patient care physical demands stagnant pay lack of autonomy and/or respect increased opportunities for great professional opportunity and financial rewards in other professions Because these reasons have been widely documented, they’ve also been widely accepted as valid criticisms of the state of the profession. What’s critical at this point is moving toward solutions to these criticisms and problems.
Reaching for Solutions With the release of the HRSA data, national media coverage such as the series of articles in the Chicago Tribune regarding nursing and patient errors, and the ever-prevalent anecdotal evidence regarding the nursing shortage, policy makers and
nursing organizations have joined forces to try to create solutions both practical and reasonable. The obvious challenge for both nursing organizations and policy makers is to recognize that while nursing organizations represent the collective voice of the nursing profession, most nursing organizations also represent specific specialty constituencies within the profession. Therefore, each nursing association or organization must balance the concerns of its membership and constituency while considering the benefits to the overall umbrella of the nursing profession. At first glance, it might seem that, for example, the American Association of Colleges of Nursing (AACN) would be most likely to advocate for increased grants and training for education purposes and faculty development, while the National Black Nurses Association’s primary priorities would be toward recruitment and scholarship efforts to increase enhancements for minority nurses, and the Association of Women’s Health, Obstetric and Neonatal Nurses might advocate most strongly for provisions related to development in the fields of specialty nursing, that is, women’s health and newborn care. It would be naive to suspect that these issues are not of primary importance to each of these organizations, and it’s enlightening and encouraging to consider the broad scope that the leading nursing associations have taken toward approaching the nursing shortage. Professional associations such as the American Nurses Association (ANA), the American Organization of Nurse Executives (AONE), the National Black Nurses Association, the Emergency Nurses Association, the AACN, and AWHONN, to name but a few, have embraced the power in numbers approach and advocated solutions that build on the similarities that nurses face rather than the differences among specialty areas in advocating for solutions to the shortage. Recognizing the broad scope and deep origins of the problem and the unique opportunity that the shortage has presented to increase attention on the nursing profession by state and federal legislators, leading organizations have come together to build consensus on many provisions to combat and ease the shortage. Most compelling is the consensus document released by the ANSR (Americans for Nursing Shortage Relief) Coalition at a press conference in April 2001. The consensus document, “Assuring Quality Health Care for the United States: Supporting Nurse Education and Training, Building an Adequate Supply of Nurses, Consensus Issues,” includes commonly agreed upon federal public policy initiatives that will assist in reducing the impact of the nursing shortage. Issued by 27 of the leading nursing associations representing nearly all of the nation’s 2.7 million nurses at all levels of nursing practice, education, administration and research, the document represents months of careful strategic planning and negotiation among the various organizations. Nursing organizations are also seeking the support of additional, nonnurse Shekzgb Roberts is position statement specialist within Health Policy/ Legislative Affairs of AWHONN.
58
A W H O N N Lifelines
Want to check out what various nursing associations are doing to address the shortage? Surf to the following Web s i k t Association of Women’s Health, Obstetric and
Neonatal Nurses: www.awhonn.org t
Department of Health and Human Services, Division of Nursing: bhpr.hrsa.gov
t
American Nurses Association: www.nursingworld.org
t
American Hospita I Association/America n Organization of Nurse Executives: www.aha.org
t National Black Nurses Association: www.nbna.org t
Emergency Nurses Association: www.ena.org
t
National League for Nursing: www.nln.org
t
American Academy of Nurse Practitioners: www.aanp.org
t
American College of Nurse-Midwives: www.a c n m.org
t
American Association of Colleges of Nursing: www.aacn.nche.edu
t American Association of Critical-Care Nurses:
www.aac n.org t
National Association of Hispanic Nurses: www. na h n hq.org
t
National Association of School Nurses: www.nasn.org
interest groups and organizations, a development that will provide it with a greater scope of influence and a larger audience. The suggested actions include, recruiting and retaining nurses expanding nurse education community involvement public awareness of the nursing shortage addressing a shortage of nurse faculty, among others (For a complete listing of participating organizations, and to view the consensus document in detail, go to www.
awhonn.org. ) Key provisions that the associations are calling for include, Increased funding for loan and scholarship programs to bring more young people into nursing Increased funding for recruitment and retention of minority nurses Increased funding for scholarships, loans and stipends aimed at developing nursing faculty at schools and universities Establishing a National Nurse Corps to serve communities hardest hit by the nursing shortage Volume 5,Issue 6
Adopting tax incentives for employers and for individuals to increase the supply of nurses in the pipeline Creating Department of Labor initiatives to recruit and retain nurses Developing models for collaboration between communities and states to design programs to recruit and retain nurses Increasing funding for research on the impact of nursing practices on patient outcomes Improving the process for data collection on the nurse workforce
Tracking Legislation Related to the Nursing Shortage Follow these bills as they progress and develop a t www.awhonn.org: e H.R. 1436/S. 706: Caps-Kerry Nurse Reinvestment Act
+ S. 721: Hutchinson-Mikulski Nursing Employment and Education Development (NEED) Act t
The consensus follows on the heels of a national, self-tided Tri-Council release of the white paper, “Strategies to Reverse the New Nursing Shortage.” The Tri-Council is composed of four nursing organizations-AACN, ANA, AONE and the National League for Nursing (NLN). The white paper also included a set of recommendations for changes or enhancements in education, work environment, legislation and regulation, technology, research and data collection, aimed at attracting and retaining nursing professionals. (Todownload the white paper, visit the American Nurses Association Web site at www.ana.org.) Additionally, in early September, 60 nursing associations including AWHONN came together to discuss and build support for A N A ’ s newest initiative to address the shortage, ANA’s “Call to the Nursing Profession.” The goal of the meeting was to produce a comprehensive plan to address the internal and external causes and effects of the current and impending nursing shortage. The meeting focused on nursing groups to work on issues related to, work environment economic value recruitment and retention education legislation regulation and policy nursing models diversity public relations and communications professional culture Work plans resulting from that meeting will be distributed to the larger nursing community, and individual groups will
Documenting the Problem Get the latest and most up-to-date data from the following sources: Health Resources Service Administration National Sample Survey of Registered Nurses: http://bhpr.hrsa.gov/dn/survey.htm Americans for Nursing Shortage Relief: www.nurse.org/acnp/leg/ansr.coalition.shtml e
American Nurses Association: www.ana.org
December 2001/January 2002
H.R. 1897: Engle-Bono-McCarthy Nurse of Tomorrow Act of 2001
+ H.R. 2594: Jones Nursing Shortage Response Act of 2001
have the opportunity to decide where their efforts might be best utilized.
Legislative Initiatives Associations’ activities on the nursing shortage have included targeted lobbying initiatives to build support for remedies to the nursing shortage, and the educational interaction between legislative offices and nursing organizations have been instrumental in the introduction of numerous bills in Congress related to the shortage. Some legislative initiatives call for expansion or increased funding for existing programs, such as increasing funding by a minimum of $25 million for the programs of the Health Professions Education Partnerships Act of 1998-Title WII of the Public Health Service Act (formerly the Nurse Education Act) and increasing funding for the Nursing Education Loan Repayment Program, Section 846 of the Public Health Service Act. Other remedies rely on outside-the-box thinking and creative approaches such as the establishment of a National Nurse Corps to ensure the nation’s registered nurse supply to urban centers, rural areas, underserved communities and regions that are experiencing shortages. So far in the 107th Congress, four bills have been introduced specific to the nursing shortage. While the detailed provisions of the bills vary and the approaches to stopping the shortage are multifaceted, the very fact that so many leading members of Congress have introduced legislation on this topic within one year, where there were no previous existing bills on the issue, is a testament to the public outreach and educationbuilding initiatives of the nation’s nursing leaders. While the nursing shortage, in all its complexity, presents challenges for policy makers and nursing leaders, the nation’s nursing associations have answered a call to action by working together to strengthen the proud profession of nursing. When weighed against the individual scopes and interests of each association, it would appear that the collective voice of nursing will win out, and with that, so will nurses and the women, men and families whom they serve. + AWHONN Lifelines
6@