To Improve Patient Care, Remember the Nurses

    • June 24, 2009

Nursing leaders, health care experts and policy-makers came together in Washington, D.C., earlier this month to send a message regarding efforts to overhaul the nation’s health care system: If you want to improve patient care, remember the nurses!

Right now, there is a rare opportunity to curb—and even reverse—a looming shortage of nurses by enacting health care reform that ensures that the supply of nurses meets projected demands, said participants in the June 12 forum on the nursing workforce in the 21st Century. The forum was held by the Center to Champion Nursing in America (CCNA), a joint initiative of the Robert Wood Johnson Foundation (RWJF), AARP and the AARP Foundation.

“This is our time to try to make a difference in health care reform,” said Elaine Ryan, vice president of government relations at AARP. “The nurse is our first responder” and is critical to “making health care reform work in this country.”

The need to address nursing workforce issues may not be apparent to many because the shortage appears to have eased in many parts of the country, said Peter Buerhaus, Ph.D., R.N., F.A.A.N., director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center.

In the wake of the recession, many part-time nurses have taken on additional hours and many retired nurses have returned to work to compensate for lost income from laid-off spouses or shrinking retirement accounts. As a result, jobs are harder to find for unemployed nurses in some parts of the country, a phenomenon that is creating the false impression that the crisis has been averted.

But the shortage still looms—and must be addressed now, Buerhaus warned.

As the recession lifts, nurses—who are graying along with the rest of the population—will begin to retire en masse, and there aren’t enough new nurses in the pipeline to take their places, he said. This mass retirement is projected to come as the baby-boomer population ages, placing greater pressures than ever on the nation’s health care system. The nation’s supply of nurses, in other words, is projected to fall far short of demand.

To reverse the coming imbalance, panelists issued a number of recommendations regarding reforming the nation’s health care system. Those recommendations are included in a series of six studies examining the nursing workforce that were released at the nursing workforce forum. The studies were published by Health Affairs, a health policy journal, and are available on its Web site.

Recommendations Center on Expanding Nurse Education

Several recommendations address ways to increase the number of nurse faculty so nursing education programs can prepare more nurses. Linda Aiken, Ph.D., R.N., F.A.A.N, Director of the Center for Health Outcomes and Policy Research at the School of Nursing at the University of Pennsylvania, urged Congress to set aside more federal dollars for nursing education so schools can accept more applicants into nursing programs.

She also urged lawmakers to provide incentives for nurses to go beyond the associate’s degree in nursing and earn bachelor’s degrees, which prepare young nurses to pursue the kind of advanced degrees needed to become faculty members—as well as to meet the chronic care, transitional care, preventive care and primary care needs of patients. Aiken said funding for nurse education needs come from a permanent, dedicated source so that it can withstand the vicissitudes of appropriators who dole out state and federal dollars. “This is the opportunity to ask for a bailout” for nursing education, she said.

Colleges and universities can also take steps to stem the nursing faculty shortage by raising nurse salaries to lure more clinical nurses away from the bedside and into the classroom, and by making nursing education more efficient through shared faculty, curricula, and simulation and clinical facilities, added CCNA Director Brenda Cleary, Ph.D., R.N., F.A.A.N.

Oregon Health and Science University, School of Nursing professor Chris Tanner, Ph.D., R.N., F.A.A.N. noted that nursing curricula need to be redesigned to better prepare students for the health care demands of the future. Nursing schools, she said, should put a greater emphasis on health care promotion and management of chronic care conditions to be ready to address for the future needs of an aging population.

Other recommendations included lifting restrictions on nurses so they can provide a fuller range of care for more patients; improving the ergonomic environment of the clinical workplace to retain more experienced nurses; promoting nursing careers to underrepresented populations in the field such as men and Latinos; and conducting further studies into nursing workforce issues.

Panelists expressed cautious optimism that policy-makers will take at least some of the steps needed to address the nursing shortage. Congress is on the cusp of a major health care overhaul, and nursing workforce issues are part of the discussion, they said. Still, Buerhaus said, “I worry that we won’t seize the day.”

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