The issue: A shortage of more than 1 million nurses in the United States is projected by 2020. This stems from a combination of factors: the aging of the nursing workforce, nurses leaving the profession and a shortage of new nurses entering the profession.
Yet, nursing is attracting applicants. According to 2007 statistics from the Journal of the American Medical Association, more than 42,000 qualified nursing school applicants were turned away at nursing schools last year, compared with less than 5,000 in 2002. Why is this happening? Nursing schools have a shortage of faculty.
An RWJF-funded study by the Harvard School of Public Health found that concern about the availability of nurses is one of the top three reasons people think hospital care is poor in America-with two-thirds of those surveyed blaming poor quality on overworked, stressed or fatigued nurses.
Grantee background: Years ago, when Susan C. Reinhard returned home from a day of nursing in Orange, N. J., her husband remarked that a career taking care of others must be rewarding. "People say 'thank you' to you all day long," he said.
So when Reinhard recently had surgery and experienced the other side of patient care, the professional nurse sent an enormous sheet cake as a thank you to the hospital nurses who took care of her. "There is never a time when you are more vulnerable than when you are a patient and someone takes care of you," she said. "It is an intense relationship. As a nurse, you literally save lives. And it is very rewarding."
With a bachelor of science in nursing from the College of New Jersey, and a master's in nursing from the University of Cincinnati, Reinhard's career has spanned the gamut of nursing from clinical care (staff nurse, public health nurse, visiting nurse and bedside nurse) to nursing education-and research, and policy development.
Her appreciation for the concerns of both nursing students and bedside patients led Reinhard to policy development and state governmental relations in 1983. For 10 years she was director of the Institute for Nursing and a legislative agent with the New Jersey State Nurses Association in Trenton, while also serving as the Community Health Nursing Program director and assistant professor at Rutgers, the State University of New Jersey, where she received her Ph.D. in sociology.
Reinhard then moved into state government as the director of the Office of Policy and Research in the New Jersey Department of Health and Senior Services, where she designed and analyzed policy initiatives in managed care, children's health insurance, long-term care, women's health and public health. Appointed deputy commissioner in the department, she worked with three governors from 1996 to 2005 to develop new programs for home care and respite for family caregivers. She also consolidated all senior services into one state department, the largest re-engineering effort in the department's history.
Reinhard's association with the Robert Wood Johnson Foundation (RWJF) began in 2000 when she was named co-director of the Center for State Health Policy at Rutgers, a center co-funded by RWJF. The next year, when RWJF announced its $2.2-million program State Solutions: An Initiative to Improve Enrollment in Medicare Savings Programs, Reinhard agreed to serve as national program director. She has collaborated with RWJF on a number of programs related to nursing and long-term care.
In the spring of 2007, Reinhard accepted the position of director of AARP's Public Policy Institute, the "think tank" of the Washington-based AARP. Barely six months later, her association with RWJF came full circle when the two organizations launched the Center to Champion Nursing in America and named Reinhard its director and, later, chief strategist.
Grantee approach: After a career that has touched on almost every aspect of nursing, Reinhard now will work to champion nursing and help reverse a nursing shortage in the United States that threatens the quality of health care. Her strategy is twofold:
- Work to retain experienced nurses who provide the key to quality care.
- Educate more nurses by developing more nursing educators.
"We need a huge spotlight on these issues," says Reinhard, "and AARP is accustomed to spotlighting major issues of our day. The decision by RWJF to put the center within AARP is a brilliant idea. Even if I weren't here, I would say that. Putting this powerful, consumer-driven organization behind this, we can bring a public voice to this issue."
At the center, Reinhard plans first to focus on the need to retain nurses. "Society has an insatiable demand for nurses. Because they can fill so many important positions in the health care system, nurses are pulled away from the beside," she says. "But if we are going to deal with this crisis over the next couple of years, we have to retain the nurses we have. RWJF's strategy always has been retention of nurses. To help do that, we are going to take steps to make sure that nurses and their ideas to improve patient care are heard."
Next, Reinhard wants to work through private and public policy channels to address the shortage of nursing professors, which is at the heart of why nursing schools turn away qualified applicants. Says Reinhard, "We want to speed up how quickly a nurse can get a master's or doctorate degree. We have to prepare educators."
As the new center's chief strategist, Reinhard realizes that her lifelong nursing pursuits have culminated in a near perfect storm, pulling together all aspects of her career. "I consider myself very fortunate to be able to put together all three—RWJF, AARP and nursing—to lead the Center to Champion Nursing in America."
RWJF perspective: The Center to Champion Nursing will address the nursing shortage by pressing for:
- Greater state and federal funding to support expanded nursing education, particularly addressing severe faculty shortages at nurse training institutions across the country.
- Places for nurse leaders on the governing boards of hospitals and other health care organizations to provide critically needed perspective on improving quality and safety of care.
- An educational movement based on new research to inform the public and policy-makers about nurse workforce issues and the link between a trained and adequate nursing workforce and high quality health care.
- We must engage all of the stakeholders-from nurses and other health care providers to policy-makers to business leaders and consumers-if we are going to have meaningful and lasting change in what has become a dysfunctional health care system," says Susan Hassmiller, Ph.D., R.N., senior program officer at RWJF and Building Human Capital team leader. "This unique partnership between RWJF and AARP sends a clear message that no one sector can address all the problems plaguing our health care system."