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Professional practice
Professional Practice Supply is Not the Only Answer
R
ECENTLY, I READ yet another editorial exhorting us to expand the supply of nurses as the solution to the nursing shortage. I agree that we need more nurses. However, assuring an adequate work force is a 3-legged stool, and increasing supply is only one leg. Before exploring these other two legs, let me state some assumptions about health care in the foreseeable future: ● ● ● ● ●
Turbulent change will continue Organizations will need to deliver quality services and a strong bottom-line There will never be enough nurses The nursing shortage is a symptom of a health care system in need of overhaul Each of us has a role to play in assuring an adequate work force
What do these assumptions suggest? First, that change is a constant and we need to develop not only tolerance, but appetites for change. Second, leaders must master the paradox of delivering quality learning experiences or patient care episodes, and contributing to a strong bottom line. Third, even with the most effective recruitment and retention strategies, we will fall short of an adequate number of nurses. We must structure our care delivery models and organizational systems to make the most of what we have. Fourth, nursing is not the only profession with a shortage. Our shortage is a symptom, not the problem. Finally, every one of us has to identify what we individually can do to positively impact the nursing shortage and the healthcare environment. One of the reasons why we so intently focus on increasing the supply as the number one and only solution may be that it puts the burden of responsibility on deans and directors of schools of nursing. “If we only had more nursing students, we’d be fine.” There are three legs to this stool. Increasing the supply is one of them. The other two are: Number two: Decrease the demand on nurses. Given that nurses are precious resources, we need to see
JOANNE DISCH, PHD, RN, FAAN Director, Katharine J. Deusford International Center for Nursing Leadership University of Minnesota School of Nursing, 308 Harvard St Minneapolis, MN 55408 Copyright © 2001 by W.B. Saunders Company 8755-7223/01/1702-0004$35.00/0 doi:10.1053/jpnu.2001.22253
72
care delivery models that enable nurses to practice nursing. We waste these resources when nurses clean beds or clinic rooms; pass trays; transport noncritically ill patients; run to pharmacy for drugs or to the blood bank for blood; or spend time on the phone seeking supplies, drugs, or linen. Nurses waste time when they have to conduct comprehensive patient assessments on readmissions, or for patients with known short stays. New graduates waste time when, as students, they were taught idealistic models of care delivery that are not realistic and then have to learn the realities of clinical practice as a new grad. Such waste flies in the face of responsible stewardship, not to mention healthy bottom lines. A few suggestions: (1) create care delivery models that are workable, realistic, efficient, and have nurses doing nursing; (2) streamline patient admission tools and processes; (3) bring ambulatory and inpatient nursing staffs together to cocreate efficient pathways of care for their patient populations; (4) bring together faculty responsible for senior clinical courses and staff development educators from clinical settings to create transition programs for new graduates that effectively bridge the gap for students becoming new graduates. Number three: Improve the environment of care. How people work together affects everything. When a healthy work environment is present, and this includes in schools of nursing, everything is possible. Although the work can be hard, and usually without enough resources, people pitch in to help each other. When the work environment is not healthy, work may get done but data increasingly show that retention of staff and faculty is poorer, patient outcomes are compromised, and the financial performance is affected. Creating the environment requires both system-wide structures (e.g., clear expectations, support systems, rewards and consequences, training) and individual effort. Each one of us is responsible for ourselves. Although we cannot control much of what happens in health care today, we can control how we choose to respond to it. Every interaction with patients, families, students, and colleagues either adds to today’s problems, or helps maximize tomorrow’s work force. What’s your choice?
Reference Aiken, L. H., Haven, D. S., and Sloane, D. M. (2000). The Magnet Nursing Services Recognition Program. AJN, 100(3), 26-36.
Journal of Professional Nursing, Vol 17, No 2 (March–April), 2001: p 72
R
ECENTLY, I READ yet another editorial exhorting us to expand the supply of nurses as the solution to the nursing shortage. I agree that we need more nurses. However, assuring an adequate work force is a 3-legged stool, and increasing supply is only one leg. Before exploring these other two legs, let me state some assumptions about health care in the foreseeable future: ● ● ● ● ●
Turbulent change will continue Organizations will need to deliver quality services and a strong bottom-line There will never be enough nurses The nursing shortage is a symptom of a health care system in need of overhaul Each of us has a role to play in assuring an adequate work force
What do these assumptions suggest? First, that change is a constant and we need to develop not only tolerance, but appetites for change. Second, leaders must master the paradox of delivering quality learning experiences or patient care episodes, and contributing to a strong bottom line. Third, even with the most effective recruitment and retention strategies, we will fall short of an adequate number of nurses. We must structure our care delivery models and organizational systems to make the most of what we have. Fourth, nursing is not the only profession with a shortage. Our shortage is a symptom, not the problem. Finally, every one of us has to identify what we individually can do to positively impact the nursing shortage and the healthcare environment. One of the reasons why we so intently focus on increasing the supply as the number one and only solution may be that it puts the burden of responsibility on deans and directors of schools of nursing. “If we only had more nursing students, we’d be fine.” There are three legs to this stool. Increasing the supply is one of them. The other two are: Number two: Decrease the demand on nurses. Given that nurses are precious resources, we need to see
JOANNE DISCH, PHD, RN, FAAN Director, Katharine J. Deusford International Center for Nursing Leadership University of Minnesota School of Nursing, 308 Harvard St Minneapolis, MN 55408 Copyright © 2001 by W.B. Saunders Company 8755-7223/01/1702-0004$35.00/0 doi:10.1053/jpnu.2001.22253
72
care delivery models that enable nurses to practice nursing. We waste these resources when nurses clean beds or clinic rooms; pass trays; transport noncritically ill patients; run to pharmacy for drugs or to the blood bank for blood; or spend time on the phone seeking supplies, drugs, or linen. Nurses waste time when they have to conduct comprehensive patient assessments on readmissions, or for patients with known short stays. New graduates waste time when, as students, they were taught idealistic models of care delivery that are not realistic and then have to learn the realities of clinical practice as a new grad. Such waste flies in the face of responsible stewardship, not to mention healthy bottom lines. A few suggestions: (1) create care delivery models that are workable, realistic, efficient, and have nurses doing nursing; (2) streamline patient admission tools and processes; (3) bring ambulatory and inpatient nursing staffs together to cocreate efficient pathways of care for their patient populations; (4) bring together faculty responsible for senior clinical courses and staff development educators from clinical settings to create transition programs for new graduates that effectively bridge the gap for students becoming new graduates. Number three: Improve the environment of care. How people work together affects everything. When a healthy work environment is present, and this includes in schools of nursing, everything is possible. Although the work can be hard, and usually without enough resources, people pitch in to help each other. When the work environment is not healthy, work may get done but data increasingly show that retention of staff and faculty is poorer, patient outcomes are compromised, and the financial performance is affected. Creating the environment requires both system-wide structures (e.g., clear expectations, support systems, rewards and consequences, training) and individual effort. Each one of us is responsible for ourselves. Although we cannot control much of what happens in health care today, we can control how we choose to respond to it. Every interaction with patients, families, students, and colleagues either adds to today’s problems, or helps maximize tomorrow’s work force. What’s your choice?
Reference Aiken, L. H., Haven, D. S., and Sloane, D. M. (2000). The Magnet Nursing Services Recognition Program. AJN, 100(3), 26-36.
Journal of Professional Nursing, Vol 17, No 2 (March–April), 2001: p 72