The other day I was hiking with a friend, another former nurse, and she told me about an acquaintance who is trying to get into a community college nursing program. She’s been accepted, but without financial aid, can’t attend. I guess community college tuition has gone up, and the program is geared so that working adults will have supreme difficulty in attending.

Anyway, that’s another story in and of itself (hello, what happened to the nursing shortage and the desperate attempts to get students pushed through at maximum speed), but just out of curiosity, I looked up the school that she is currently taking her prereqs at. I wanted to see the tuition, but got another surprise instead, when I looked at the particulars of their nursing program.

Yes, times have changed. I’m not going to name the school, but this really borders on the ludicrous, especially their first sentence.

Clinical placements, employment, and licensure in a healthcare field often require a background and drug check. XXX school will conduct a XX State Patrol background check on applicants to the Nursing Program. Students need to pay the $10 fee for background checks to the business office, obtain a receipt, and attach that receipt to their application. Results of the background check will be given to the Nursing Program Coordinator.

Excuse me, but since when does getting hired as a nurse require a background check? Drug screens are becoming more common, but considering that there is no national database to keep track of licensed personnel, this seems a bit excessive. And totally unnecessary. The person is entering a nursing program, not applying to the CIA. I can honestly say that no one ever did a background check on me for a nursing job–not for full time, per diem, or with a registry. And I don’t know any other nurse who has ever had one done either.

But that’s just to apply to the program. Now if you’re lucky enough to be accepted….

Students accepted into the Nursing Program will need to complete a more extensive background and drug check as required by the local hospital for clinical placement. Cost for the extensive checks varies between $50 and $110 depending upon the number of states the student has lived in. Results of the background checks will be sent to the Nursing Program Director.

Have these people gone off the deep end? A more extensive background check, just to be a nursing student. Like anyone is going to hand over the narc keys to a student, unsupervised. Are they going to call the FBI, and have a spook go and talk to your former neighbors, your priest, and your parole officer?

Now, how on earth do they know which states the student lived in? They have to go by what the student tells them. So if a student did have a shady past in one state, it could be very easy to omit it.

Now they also want you to have a negative TB test or chest x-ray, Immunization record: recent diphtheria-tetanus vaccination; Positive Titer (German Measles) or measles, mumps and rubella vaccination; varicella; Hepatitis B vaccination series.

That’s something that hospitals do when you’re hired, at their expense. That was never needed just for school. So in addition to tuition, this place is really milking students dry for background checks, drug screens, getting blood titers if you don’t happen to have your little babyhood shot card handy, and you have to get a Hep B vaccine.

Cool. I wish they had done background checks and drug screens when I was first applying. And tried to force me to pay for titers and shots…uh no, sorry. School was expensive enough. And just the thought of it–a background check to apply, and then another one when accepted? I may as well join the military, or the CIA! But if that had been the case, I never would have gone to nursing school. I would have switched to another program, and been a lot happier. As it was, I spent most of my nursing career trying to get out of it.

But maybe this is just one of the school’s tactics for weeding people out. If they are willing to put up with all this crap and expense, then they must truly want to go to nursing school. Those unwilling to submit to unreasonable bureaucracy aren’t wanted or needed. Besides, they would never survive in today’s healthcare system!

Don’t these newspapers ever get tired of printing the same story over and over and over and over and over again? I mean, really. The nursing shortage news in most outlets seems to be simply a cut and paste of previous stories, with names, dates and locations changed. That’s it. Nothing that shows that the reporter crept outside the box, or even bothered to find out what an RN even is.

Take this masterpiece from the Dowagiac Daily News. I’m not really sure where it is, but I’m assuming that it’s in Michigan, since it refers to the great shortage of nurses in that state.

Did you know that Michigan is expected to have a shortage of about 7,000 Registered Nurses by 2010 and a shortage of 18,000 RNs by 2015?

No, I didn’t. Please tell me about it. See what I mean about just changing numbers and locations?

There is a growing nursing shortage in Michigan - and the United States. Michigan’s nursing education programs are bottlenecked in their ability to admit, educate and graduate all qualified applicants.

At the same time, our population is aging and will need much more health care in the future.

Still awake? Now how many times has this same tired argument been repeated. Not too long ago, I posted about a website which lists schools that do not have waiting lists. And I clearly recall that when I was looking to get into a nursing program, state schools also had waiting lists. That was in the 1980s, when interest in nursing was pretty low. The reason was the same as now. State schools are cheaper, and nursing programs can only hold xxx amount of students, due to nature of the program. Clinical rotation groups have to be small, and even lecture groups have to be limited in size. And schools are all competing for clinical space at hospitals.

This article goes on to talk about some initiative that will provide tuition and stipends to allow graduate-level nursing students to enroll in full-time programs and graduate as future faculty. In return, they have to teach in a Michigan nursing program for 5 years.

Its’ about time that someone thought of something intelligent to lure nurses into teaching, but even so, this idea still may not do the trick–unless the individual really wants to teach. Is it full tuition, and is the stipend enough to allow the nurse to live on, so he/she doesn’t have to work? How intense is the program? Can a nurse still pull a few shifts if the stipend just doesn’t cut it, ie, the need to eat still exists?

Second, the 5 year obligation. It really may not be worth the nurse’s while in the long run. Paying for grad school is expensive, but working as a teacher for 5 years, at the median pay scales for instructors (and I’m assuming that they’re talking master’s trained, in which the pay would be less than PhD) may not even it out. Other types of jobs for graduate trained nurses pay far more, and they will probably be far ahead, moneywise, if they pay for their own schooling and then get a more lucrative job at the end of the five years.

Plus, if they want tenure, they will have to go on to get a doctoral.

Put it this way, the only way that anyone is going to beef up the instructor market is to pay market wages. A teacher is just going to have to earn more money than the average nurse working on a med/surg floor, which at the moment, they don’t.

So nice try, but no cigar.

Imagine that–there are nursing schools with no waiting list. This certainly flies in the face of the stories about how “if only there were more nursing schools, the nursing shortage would be solved.” And how “tens of thousands of students are turned away every year” because schools have no room.

Well here it is. Here is a list of nursing schools that have no waiting list. And this is undoubtedly a partial list, because the schools have submitted their names voluntarily so it is quite likely that there are many other schools that have zero wait for anyone wishing to enter a nursing program.

This list of schools can be found on discovernursing.com, the sweet sugar coated website of nursing put together by Johnson & Johnson. But nevertheless, while the website paints an overall picture of nursing minus any of the gore, blood, issues, problems or gives any indication of what a nurse actually does all day–this list is an interesting twist.

It debunks the myth that the nursing shortage is caused solely by lack of schools, space, and teachers. It shows that all nursing schools aren’t filled to the brim, and that many, indeed, have space for anyone interested. And what are these schools?

Well, you can look at the list for yourself, but it includes private and state schools, as well as community colleges. And no, they are not all located in Podunk, USA, or institutions hanging by a thread to their accreditation.

Palm Beach Community College and Seminole Community College are on the list, and Florida has one of the worst nursing shortages in the country. Not only can’t they get nurses to work there, but they can’t even get students to go to school there!

Surprisingly, prestigious schools like Columbia University and University of Michigan, Ann Arbor, are on the list. U of M is also a state school, so the price tag is lower. The Medical College of South Carolina is also on the list.

And as I said, these are only schools which have been submitted to Discover Nursing. I would guess that the actual number of schools without waiting lists is much higher.

And here I thought I was up on everything to do with nursing. Apparently, there is a movement to create an Office of the National Nurse–and have it be on the same par as the Surgeon General. According to the supporters, this is what the Office of National Nurse would be/would do:

* Elevate the Chief Nurse Officer (CNO) of the US Public Health Service to full time status within the Office of the Surgeon General to become the National Nurse to enhance prevention efforts in all communities.
* Complement the work of the US Surgeon General.
* Promote involvement in the Medical Reserve Corps to improve the health and safety of the community.
* Incorporate proven evidence-based public health education when delivering prevention.

HR 4903 was introduced into the 109th Congress, to make this a reality.

Laura Stokowski MSN, RN testified before the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020, on the behalf of creating the Office of the National Nurse. She closed her statement with this:

We believe that creating an Office of the National Nurse is a way to bring attention to nursing, to instill pride and to recruit new nurses. But most importantly, it is a way to achieve better health for the citizens of this country by effectively utilizing nurses to improve health outcomes.”

I really haven’t thought too much about this issue, and don’t really have an opinion on it. But realistically, is the ONN really going to make that much of a difference in the health of Americans? That is, is the ONN really going to go to bat and fight the huge agribusinesses that promote junk food, factory farming, and the mass industrial complex that producing food has become? The industrial complex that doesn’t want to hear about the detrimental effects that its products are having not only on health, but on the environment and the degradation of prime farmland?

Is the ONN going to work on exposing the shenanigans that go on behind the scenes, between the FDA and big pharma? Or how the FDA is still working hard to undermine the alternative health community, the availability of supplements, or allowing any sort of health information (notice the word information, not claims to cure diseases) of some of these products?

Is the ONN going to help people get health insurance–for a price they can afford and that provides decent coverage?

Is the ONN going to stop Congress from cutting Medicaid and Medicare payments to practitioners–and this includes advance nurse practitioners as well? Hint–lower payments to clinicians means that fewer and fewer are going to accept patients on Medicaid and Medicare.

Is creating an ONN really going to help nurse recruit? What about nurse retention? Is the ONN really going to do anything about working environments, pay, schedules, abuse, and all the other negatives that nurses in hospitals have to deal with it?

These are issues to think about it, before making sweeping statements about what this position is going to do. Many of the surgeon generals find their hands tied, and do little to nothing by the time their tenure is over. And if a president doesn’t like them, they get the boot.

C. Everett Koop was perhaps the Surgeon General who made the greatest impact, in that he bucked the Reagan administration and attacked the AIDS epidemic head-on. I think Reagan was torn between staying the darling of conservatives and his Hollywood friends dying of AIDS–so closing his eyes and allowing Koop to take the heat was a nice compromise. But aside from Koop, I think most Americans would have a hard time recalling the name of any of the Surgeon Generals, or tying their names with a major inroad in the health of our nation.

Anyway, if you want to read more about the National Nurse:

http://nationalnurse.org/

Yes it’s true, nurses are packing it in and moving on. Moving on from hospitals, that is. As working conditions within hospitals continue to deteriorate, and opportunities outside the hospital continue to proliferate, what do you think the outcome will be? Will nurses remain angels of mercy or martyrs, or will they get out of Dodge while they’re still in one piece?

From Modern Healthcare:

If hospital administrators think they face a nursing shortage now, they have more than another thing coming.

That’s because the looming problem has many parts to it, experts say. First, there continues to be great demand for Nursing care outside the hospital setting, a need that will persist as the baby boomer generation ages and seeks care at home, in skilled-nursing facilities, and in outpatient clinics. At the same time, the average age of nurses who work outside hospitals is older than the age of those who work in acute-care settings. So as they retire, these other facilities will look to hospitals to replenish their workforce. And data from the National League for Nursing just compound the problem. The league estimates that 3,500 nursing faculty will retire in 2009, with that number growing steadily to 11,500 in 2013 and just under 28,000 in 2023.

“We are not replacing the nurses in retirement as fast as they are aging,” says Mary Jean Schumann, director of nursing practice and policy at the American Nurses Association. “And the ones that we are putting out are not your 19- to 22-year-old nurses; they’re older. It’s a problem that self-perpetuates.”

Peter Buerhaus is the director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center in Nashville, Tenn. He notes that 73% of registered nurses worked in hospitals and 27% served in other settings in 1983, compared with 60% of nurses who worked in hospitals and 40% who worked in nonacute-care settings in 2006. As the population ages, Buerhaus says, there will continue to be a demand for healthcare services, and many baby boomer patients will be unwilling or uninterested in receiving care within hospitals. In addition, the nursing workforce is also aging, according to Buerhaus….

Of course, this article is the usual regurgitated pablum, in that it ignores the fact that nurses are leaving hospitals because working conditions suck. And no, most are not going to work in long term care or skilled nursing facilities–those places have even worse staffing problems than hospitals. But then, Modern Healthcare isn’t going to say anything negative about hospitals. The reason I quoted this was just for the stats. Compares with 20 years ago, the number of nurses working in hospitals has dropped dramatically. And will continue to drop, and mass producing nurses on the assembly line isn’t going to change that trend.

I’ve been away for a change of pace, covering the American Society of Clinical Oncologists annual meeting. I was frantically busy there, scurrying through a convention center that is larger than some cities, attending sessions and writing up reports. Once home, then I had to continue writing up reports. Now I’m off again to another conference, but by mid-week, I should be back and then be able to get into a normal blogging mode again. Plus, I will be revamping this site, and that is also taking some work behind the scenes.

Oh, and by the way, did you know that there’s a nursing shortage? And did you know that everyone is still spewing out their conjectures as to the cause of it? And as I write, some poor nurse is getting whacked in the face by a patient, and the hospital is telling her to “just forget it” because its bad for PR. And in another hospital, nurses are being told that housekeeping services are being curtailed and that they have to pick up the slack (grab that mop, baby!). And in another facility, the union busters are gloating and patting themselves on the back.

And so it goes. Can’t figure out why anyone wants to leave hospital nursing.

That’s essentially, what the expert talking heads are saying about nursing. In these economic downtimes, nursing suddenly becomes an attractive profession. But when the going gets good, and things improve, the floodgates reopen and nurses pour out of the profession and enrollment in nursing programs whittles away to a trickle.

So what does that say about nursing? Not much.

From the Wall Street Journal:

For the past few decades, nursing has been a kind of reverse economic indicator. In periods of economic weakness or recession — including in the early 1980s, the early 1990s and earlier this decade following the technology-company bust and the Sept. 11 attacks — the number of full-time nurses grew at an average annual rate of 3.5%. By contrast, in times of healthy economic expansion, the increase has averaged just 2.4%, according to an analysis of government data in “The Future of the Nursing Workforce in the U.S.,” a book by Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center, Douglas Staiger, a Dartmouth College economics professor, and David Auerbach, a principal analyst in the Health and Human Resources Division of the Congressional Budget Office.

In other words, nursing isn’t a first choice of profession, but something people turn to when the economy sucks and its hard to find a job. So why are there always jobs in nursing? Because working conditions suck and nurses get out of it if something better comes along.

Well, I guess this solves the nursing shortage. Just keep the nation in a recession, and we’ll have all the nurses that we’ll ever need.

In a blog, someone commented on this article and wrote that: This easing could be temporary, of course; one hospital administrator quoted in the article notes that as soon as the economy picks up, nurses could leave the field again.

Hey, no kidding. It’s not that nurses “could leave the field again,” it’s they “will leave the field again,” unless hospitals get their act together and make some real changes.

Today is Memorial Day, and for most of us, a holiday. For those who have to work, it may be a day to earn time and a half and bulk up the bank account. That was one of the few perks of nursing–working on holidays like this one, where I really didn’t celebrate it (veggies aren’t much into barbecues), and it was an opportunity to be paid extra. Closer to what I was worth, as opposed to the normal pay.

But the real purpose of having this holiday, which was carved out of VE Day (Victory in Europe) and VJ Day (Victory in Japan) at the end of WW II, was to honor our military. In particular, to honor those who died.

I’m not going to give a history lesson here, but as you can see, the photo is of the Vietnam Memorial which sits on the mall in Washington DC. Well, I tried to upload a photo but it didn’t seem to take. Anyway, Vietnam. A controversial war, a dirty war (as though any war is ever clean), and one which threatened to tear this country apart. However, it is notable in the annuals of nursing history as the first war in which MEN were allowed to serve as nurse. That’s right, the first war where nurses of the male persuasion could actually tend the wounded and sick, and not have to pick up a gun.

In previous wars, and in the military in general, a male nurse was a non-entity. If you were a man and a nurse, you were not permitted to serve as such. Granted, there weren’t all that many male nurses in WW II and Korea, but the military was certainly in dire need of them. There were plenty of able bodied men to draft as soldiers, but the supply of nurses was rather scant. And yet, rather than allow these men to nurse, they gave them a gun and sent them to the front. A poor use of personnel and skill, considering the dire need for nurses, especially towards the end of WWII.

So I thought a photo of the Vietnam War Memorial was fitting. Nurses served and died in every war that this country has fought, so here’s a toast to the brave.

Now how could I have possibly missed National Nurses Week. I mean, why wasn’t it highlighted on my calendar in dayglo green, or why didn’t I have some sort of alarm system chiming…”We are now entering National Nurses Week, please put a smile on your face.”

National Nurses Week is one of those things, something that some dweeb thought up to “honor” nurses. It runs from May 6-May 12, this year, to coincide with the birthday of the grand-dam of nursing herself, Florence Nightingale. It would be one thing if it was a sort of May Day type thing, where nurses all over the country dropped their bedpans and took to the streets. It would be one thing if facilities thought to actually honor nurses during this sacred week, by doing something that shows that nurses are respected and considered an important member of the team, instead of something they figure that they can work to death, and toss out the door if they think they need to make cuts somewhere.

This is from the American Nurses Association:

As we celebrate National Nurses Week 2008 (NNW) May 6 - 12, the American Nurses Association (ANA) and its constituent member associations (CMAs) salute nurses across the country with the theme Nurses: Making a Difference Every Day. Nursing is often described as both an art and a science; this year’s theme reflects the commitment nurses make every day for their patients and the compassion and quality of care they provide for their community.

Today’s nurses must have the strength to care for patients during times of disaster and crisis; the commitment to remain involved in continuing education throughout their careers; and the compassion to provide hands-on patient care at the bedside – as they have done throughout the centuries. Moreover, at 2.9 million strong, nurses represent the largest group of health care workers in America, and we have the power to achieve much-needed reform in nursing and in health care. That is why it is important to take time out during National Nurses Week to thank nurses for what they do and to remind the public just how vital our nation’s nurses are to patients, their families and society.

It shows you just how out of touch with reality they are. Nurses don’t want to be thanked, they want to be treated as professionals, respected, and paid what they are worth. Of course, far too many nurses still believe that it’s okay to be abused on the job, okay if a patient hits them or a physician smacks them around….hospitals tend to think so as well. It would be really nice if the ANA was an organization akin to the American Medical Association, and had real clout and a real vision.

But less than 10% of all nurses belong to the ANA, and it’s not hard to understand why. They do nothing, have no vision except to throw around fancy rhetoric, and tend to skim over real issues. Like last week, which was supposed to honor nurses. How about getting a little more militant, and striving to motivate nurses to stand up for themselves, to organize and fight abuse?

I guess that would go against the spirit of National Nurses Week, though. Nurses are supposed to be sweet and compassionate. They should be thankful that their employers don’t kick them in the ass more than once a day. Right?

They’re on the move, the nurses that is. Going on strike it seems.

From SF Gate:

As many as 4,000 registered nurses are expected to begin a 10-day strike this morning at eight Bay Area hospitals operated by the Sutter Health network.

This is the third action in six months against Sutter Health hospitals by nurses represented by the California Nurses Association, and today’s walkout is scheduled to be the longest. The union held two-day strikes in October and December, but nurses at some facilities were kept off their jobs longer because hospital managers said they needed to hire replacement workers for longer than two days.

This post sort of continues the previous one, about violent attacks against nurses. There is an interesting new thread about on allnurses.com, about the Tao of being hit by a patient.

What I find astonishing, that in this day and age, the nurse is asking what to do about it. As though assault is still a fuzzy area, and the wonderful professional called nurse should still be wondering if it is okay for a patient (who is completely coherent and not suffering from dementia) to slap her across the face. And wondering what she should do about it.

Fortunately, most of the responses are positive, in that they are telling her to file charges against the person who hit her. Afterall, if someone slaps you in the supermarket, would you just smile and say that it’s okay? That the person who hit you is a little stressed and need to get out their aggression. What if you were working as a supermarket checker and a customer slapped you across the face, because she said you were moving too slow? Would it be okay?

Is it okay for a child/teen to smack his teacher? Does the teacher just say, “Oh, that’s okay. I know this is a rough class.”

What would your doctor do if you smacked him/her? Would the CEO of the hospital take kindly to be being whacked across the face? Or some middle-management weenie who crunches numbers all day? Would they just say that the customer is always right, even though that’s often still the message given to nurses?

If You Get Hit…

If you are working as a nurse in a clinical area, or any area, it is NEVER okay for anyone to abuse you. I don’t care about the idiocy that instructors are still dishing out, or the “customer training” that is becoming rampant in hospitals today (they think its a solution to the nursing shortage). It is not okay.

If the patient has dementia, or is otherwise not in the right mind, then it would be difficult to press charges. However, you should never again be alone with that patient and if the patient is prone to violence, the facility needs to take appropriate precautions. Do not place yourself in danger. Tell the CEO to go in and give the patient his medication, if he doesn’t think there is a need to hire on extra security.

But if anyone in their right state of mind (arguable, of course, as to who really is right in the mind) ever hits you, immediately react. I don’t care if its the Chief of Staff. Call the police and press charges. File an incident report. Don’t let anyone talk you out of it. If you don’t do it, then not only are you telling the world that nurses are somehow “different” from everyone else, and not entitled to the same protection, but it will happen again. The same person that hit you may again strike you, only next time harder. He/she may also feel free to attack someone else, since they know there are no consequences. And your hospital won’t do anything to protect its nurses.

As a human being, you have a right to a safe and stable work environment. Don’t let anyone tell you otherwise.

FYI, the person who posted this says she is a new nurse and still on orientation. That means that her schooling was insufficient, and that her instructors managed to skim over that huge white elephant sitting in the classroom–that nurses are vulnerable to physical and mental abuse. Or they delivered the old school line of thought about how the nurse should rise above that, she should report it to her charge nurse, etc. In other words, suck it up baby.

This is part of what this nurse wrote:

So, my question is this….at what point does a nurse actually look at a situation as being assaulted. If this lady slapped me across the face in the middle of the grocery store, I would have called the police.

What is that fine line? What if she bruised my face? Is that different?

I think she answered her own question, but isn’t it sad, that she thinks that because she’s a nurse, there is somehow another standard for assault. Or that a certain amount of damage needs to be done before a nurse can consider a physical attack “assault.”

It seems that’s what needed in addition to education and getting a license in the UK. A startling news release from Unison, a British nursing union, reported that one in three nurses in the UK have been attacked. Where is Rambo when you need him most?

Nurses are vulnerable to both physical and verbal attack in the U.S., but these stats are ludicrous. Why are nurses in so much danger? Do hospitals just consider violent attacks on nurses akin to vandalism–you know, that nurses are things not people, and attacking a nurse is similar to painting graffiti on the hospital wall? Do the words “increase security” ring a bell?

And then hospitals around the world wonder why no one wants to be a sweet nursey anymore.

From Unison:

04/03/08) Almost a third of UK nurses suffer frequent violence at work, according to new research.

UNISON has condemned the findings, which reveal one of the highest rates in Europe. Only in France are more nurses attacked.

The study, published in the journal Occupational Medicine, found that 29% of UK nurses had suffered frequent violent incidents at the hands of patients or their relatives.

“These statistics should make people in the UK ashamed,” said UNISON head of nursing Gail Adams.

“It is totally unacceptable for nurses to face rising levels of violence, when all they are trying to do is help and care for their patients.”

More needs to be done to protect staff, Ms Adams said.

She stressed that prevention is the key, coupled with better training and tough penalties for anyone found guilty of assault.

And she urged hospitals to review the support they offer staff, to ensure they offer good occupational health services.

“The survey shows many feel abandoned and depressed following an assault, which should not be allowed to happen.”

The researchers surveyed 39,894 nurses in 10 countries.

They found that violence had wide-reaching effects including recruitment and retention problems, increased amounts of sick leave and burnout.

Whatever happened to those dear beloved nurse angels? Hospitals would like to know, especially when faced with angels who have been unionized.

Sutter facilities in the San Francisco Bay Area may soon be faced with a strike, but it seems a little unclear what the strike is about, or how serious the infractions are.

From the MercuryNews.com:

A strike could come as soon as the middle of the month for the nurses, who are represented by the California Nurses Association. The union and management have failed to reach an agreement in contract negotiations that began in May. The dispute has already resulted in two strikes, each lasting two days, in October and December.

The nurses say the stalemate is not about salaries, but the issues of patient care, under-staffing and their health and retirement benefits. The nurses described a “hostile” bargaining attitude by Sutter Health, and expect to approve the strike vote.

In general, hospitals are not known for being benevolent employers and their attitude towards nurses is usually deplorable. Nurses are a service, not people, and its something that’s thrown in with the laundry, dietary service, and housekeeping. In fact, a nurse can double for all of those.

But in this case, I’ve seen a few differing reports about the strike, so I don’t have an opinion on it at the moment. Perhaps as the story unfolds…

The solution to the nursing shortage is simple–pay instructors more money. How is it that no one thought of that before?

That is one of the politically correct responses to the late great shortage of nurses, that it is merely a matter of not enough slots in school and a lack of instructors.

This article appeared in October 2007, and I never got around to linking to it. But it is from Health Care blog, which says that it will tell you everything you ever wanted to know about healthcare but were afraid to ask. This particular article was penned by Maggie Mahar, and it is entitled: HOSPITALS: Why We Don‘t Have Enough Nurses (It’s Not Low Wages)

Consider this: In the San Francisco area, a nurse with a bachelor’s degree can hope to start out with a salary of $104,000. The salary for a nursing professor with a Ph.D. at University of California San Francisco starts at about $60,000.

This goes a long way toward explaining why nursing schools turned away 42,000 qualified applications in 2006-2007—even as U.S. hospitals scramble to find nurses. We don’t have enough teachers in nursing schools and the fact that the average nursing professor is nearly 59 while the average assistant professor is about 52 suggests that, as they retire, the shortage could turn into a crisis. The most recent issue of JAMA (October 10, 1007) reports that in 2005 we had 218,800 fewer nurses than we needed and by 2012, it’s estimated that we’ll be short some 1 million nurses.

So according to Mahar’s report, nurses are now all making 6 figure salaries when they are fresh out of school, and the only reason that there is a nursing shortage is that there just aren’t enough teachers or schools to train them.

There are a few hospitals in the Bay Area, notably Kaiser facilities, that are organized by the CNA and pay high wages. Although, someone fresh out of school is not going to get top dollar instantaneously. Even at Kaiser, which is probably the highest paying, a new grad may earn $40/hour, which is good money to be sure, but doesn’t translate to $104,000 (where on earth did she get that figure from?) It’s more like $80,000.

And that’s Kaiser. Small hospitals don’t come near that figure, and once you leave the heart of the Bay Area, wages vary considerably. So Mahar is using a small sliver of very high paying facilities in one small section of the U.S. (and still overinflating the amount for new grads) and using that as a basis for her argument–that salary is not a reason for the nursing shortage.

Hospitals have had to raise nursing salaries (as well they should), not just because nurses are scarce but because, in our chaotic hospital system, the work can be extraordinarily stressful.

I hate to break this to Mahar, but nursing has always been stressful. And chaotic. And nurses have always been for the most part, treated poorly. This is nothing new, and most hospitals are not jumping on the bandwagon to improve either salaries or working conditions. Perhaps Mahar might remove her blinders and look at the salary stats in other part of the country, or even in California. For example, new grads in Florida (and this reported from a recent new grad) are making $16/ hour. Now isn’t that a stimulus to go into nursing. The average nursing salary nationwide is about $50,000–that’s averaging out the very high and the very low.

Mahar is also ignoring the fact that isn’t just money which keeps nurses out of teaching. The climate of academia can be just as stressful as working in a hospital, albeit in a different manner. There’s the pressure to publish, to kiss ass, to deal with students and university politics, etc. Universities also want their nursing professors to have a PhD, and many nurses just aren’t interested in going to school for that long, just to teach. If they do get a PhD, they can get a more interesting job. An advanced degree in nursing can open the door to a lot of different opportunities, and teaching just isn’t high on the list of being either well paid, or all that enticing.

Many of the nursing programs that have these huge lists of applicants are state funded universities or community colleges. The schools are cheaper, so people apply there first. I wonder if private universities have long lists to get into their nursing programs. It has always been harder to get into state schools, even back in the early 80s when I was attending. So this really isn’t anything new, although this small part of the nursing shortage is being targeted and highlighted.

Mahar also didn’t mention nurses leaving the profession, or hospital jobs, another source of the chronic vacancies. She also didn’t mention how some hospitals have very low turnover and vacancy rates, despite the nursing shortage.

All in all, its a rather myopic little ditty of trying to explain the nursing shortage in 10 words or less.

The nursing shortage is widespread and worldwide, primarily because it is poorly paid, considered a lowly job, and many nurses are abused and mistreated. By abuse, I mean that they are subject to sexual harassment, physical violence, and verbal insults. And in many nations, the workloads are generally horrific, kind that make working conditions in the U.S. seem like a trip to Disneyland.

The level of pay, prestige, abuse, etc, do vary by country or even by regions within nations, but they all have one thing in common–whatever they’re doing is not attracting people to the nursing profession, or keeping them at the bedside.

Here’s an interesting story about the situation in India, from the Times of India.:

India, which has 1,597 nursing schools, 833 BSc (nursing) colleges and 97 MSc (nursing) colleges, has a capacity to train 79,850 diploma nurses, 41,650 graduate nurses and 1,940 post-graduate nurses a year.

However, over 20% of this number every year head to foreign shores in search of better pay. Britain’s National Health Service alone recruits over 1,000 Indian nurses annually. Nearly 12,500 of the 33,250 nurses who registered to work in Britain in 2005 had qualified abroad, mostly from India.

India’s nursing advisor T Dileep Kumar says: “States like UP, Bihar, Orissa, MP and Rajasthan are the worst affected by shortage of nurses. Also, for every doctor, there should be three nurses. But at present, the doctor nurse ratio in India is 1:1.5.”

To add to the ministry’s woes, a recent survey published in the Nursing Journal of India found a tremendously low interest among students wanting to take up nursing as a profession. A study of 200 children in Pune who opted for biology in class 12 found only 3.9% interested in nursing as a first priority.

I can’t blame nurses from India going abroad to seek better opportunities, but it is really sad. I would guess that most of them don’t want to leave India, and be separated from their friends and family, but foreign recruiters make them offers that they have trouble turning down. If India would boost salaries and improve working conditions, I’m sure the exodus would shrink. But then, that always circles back to how women are treated within a culture, and how they are valued.

The second part of the equation is for developed nations to solve their own problems without resorting to poaching resources from those who can’t compete with them. While there are not that many Indian nurses being poached to the U.S., recruiters have their eye on India as the “next Philippines.” With an enormous population, India can mass produce nurses for import, and that’s the answer to the prayers of American hospitals who see nurses as commodities to be gotten at the lowest price possible. Things that can be worked to death, and when they’re too worn out to be of use, tossed out the door and replaced.

This was part of an ad that I saw somewhere, to work at a children’s hospital:

Kids have heroes…so do we, they’re called nurses. Our nurses face complex medical challenges head on and provide exceptional care with sensitivity and compassion. They do it all, knowing that there is nothing more rewarding than helping a kid believe anything is possible.

While it’s not a really hokey ad for nursing jobs, it makes it sound like taking a job at this hospital is akin to some heroic episode. It mentions that the nurses are sensitive and compassionate (like sweet angels should be), but what about skilled? And helping a child believe that “anything is possible?” What do the nurses do, take courses in the Secret and from Tony Robbins, and then drill the kids?

And of course, these ad never say much about the reality of working in their facility. They just hope that nurses will get all teary and dreamy eyed about tiny tots, that they won’t ask such obnoxious questions like:

What is your nurse to patient ratio?
Do I get sent home if you are overstaffed and lose a day’s pay?
Do I get forcibly floated to units where I am untrained, and don’t have any desire to work on?
Do I get treated like day old bread that’s starting to grow mold?
What is your turnover rate?
How does your pay compare to other facilities in the area?
Is your hospital unionized?
Do you have mandatory overtime?
Are your units staffed with aides, housekeepers and clerks, or are nurses supposed to be the jack of all trades while doling out sensitivity and compassion?

Yes, the questions that no hospital wants to hear….

Hey, just be an angel and shut up!

There are so many great health stories swirling around the press, but I just have not been up to blogging. I’m lucky that I can walk up and down the stairs without getting too out of breath. Being sick really sucks, which is why I probably just kept ignoring the fact that I was getting sick, hoping that it would just vanish.

I’m managing to get my medical writing work done, albeit slower than normal. But it is still an effort to do anything else. I guess all those weeks of lost sleep are catching up with me, as well as my body screaming that I need to rest so it can continue healing.

But here’s something for weekend reading. This sounds like a really weird case, and as usual in a mainstream media story, there is a lot that remains unsaid.

From AP:

RIVERHEAD, N.Y. (AP) — For months, the nurses complained that they were subject to demeaning and unfair working conditions — not what they were promised when they came to America from the Philippines in search of a better life. So they abruptly quit.

But in doing so, they put more than their careers at risk: Prosecutors hit them with criminal charges for allegedly jeopardizing the lives of terminally ill children they were in charge of watching.

The 10 nurses and the attorney who advised them were charged with conspiracy and child endangerment in what defense lawyers say is an unprecedented use of criminal law in a labor dispute. If convicted of the misdemeanor offenses, they face up to a year in jail on each of 13 counts, and could lose their nursing licenses and be deported.

The nurse patient ratio mandate in California went into its final phase as of Jan 1, 2008. So far, it is the only mandate of its kind in the nation, even though similar laws have been proposed in several states.

From the AHA:

California implemented lower nurse-to-patient staffing ratios in three hospital units effective Jan. 1, completing its phase-in of a 1999 state law requiring specific nurse-to-patient staffing ratios by unit. Nurse-to-patient ratios were lowered to 1:3 from 1:4 in step-down units, and to 1:4 from 1:5 in telemetry and other specialty care units. “California hospitals are doing the best they can to comply with the ratio requirement, “said California Hospital Association spokesman Jan Emerson. “This includes the use of traveler nurses, which are necessary because of the continuing shortage of nurses in California.”

This is an interesting thread on allnurses.com, that flies in the face of the usual “we need more nurses,” whimpering. One nurse started the thread by writing about how her hospital is cutting back on the use of travelers and that there is obvious “wage-fixing” in the area. How’s that for trying to entice nurses to work at your facility, or making an effort to “reduce” the shortage.

I will say it again- there are too many nurses in this country. Too many nurses being churned out every six months from ABC Community College. Hospitals count on nurses getting burned out and leaving after 2- 3 years. Then they can bring in another group of new grads and pay them several dollars less than they are paying you.

Sounds like a clear notion of what is really going on. There are almost 3 million RNs in the U.S., and new grads are churned out every six months from community colleges and BSN programs. The idea is that if enough new grads are pushed into the profession, then wages can be lowered because it will become a seller’s market. Too many nurses grabbing for the same miserable jobs.

Of course, the spinning heads don’t realize that has already happened. Back in the early-mid 1990s, when they were laying off nurses and it was virtually impossible for a new grad to get a job, nurses didn’t sit around and clamor for the jobs available. Or take cuts in pay. Or take impossible patient loads. They left the profession entirely, or entered non-hospital positions.

As most nurses know, sometimes you’re faced with some really…umm…uncomfortable situations that can really test your nerves. Some situations can really be a challenge to one’s ethics.

That said, there was an article in Nurse.com about how to deal with “moral distress.” Interesting terminology, but fair enough, it is an issue. However, the examples they gave are just so lame. There are so many real and pressing issues that can cause real “moral distress” in any nurse with half a conscience, so I have no idea how they came up with these watered down silly scenarios.

Story #1

Rick is a nurse at a health clinic that provides vaccines required for school entry to eligible children at no charge. However, his agency does not provide additional vaccines that recently have been recommended by the Centers for Disease Control and Prevention for free as well, including rotavirus and human papillomavirus.

Rick is frustrated because he cannot reconcile his belief that the policy is a barrier to his responsibility to care for the health needs of the public. He also experiences feelings of anxiety and anger because of a policy that conflicts with his beliefs about professional practice and the commitment he made to protect the health of the public. He questions whether he made the right career choice.

Is this really a case for severe moral distress? The guy works in a clinic that provides school entry vaccines for children free of charge. Repeat, it supplies required vaccines that children need to attend school. Rotavirus and HPV are not required for school entry. There are other places that people can go to obtain those vaccines if they want them. So what is Rick’s problem? That he can’t provide everyone who enters his clinic with every kind of healthcare need and desire? Is that a moral dilemma?

Doesn’t he think that what he’s doing helps a lot of people? Is it an all or nothing proposition? The guy sounds a little mentally unstable to me.

Story #2

Sue is a staff nurse in an orthopedic unit. The nurse/patient ratio is adequate for the level of patient acuity, but Sue believes multitasking and assisting agency staff prevent her from delivering the level of care she expects from herself and the standard of care she perceives her patients deserve. She feels guilty that sometimes an hour passes before she can respond to a patient’s request. Sue also experiences feelings of frustration, anxiety, and anger because of this recurring situation, which conflicts with her beliefs about professional practice. Sue’s sensitivity to patient vulnerability and the trust that patients place in her contribute to her distress.

Sue begins to question her effectiveness as a nurse, and because Sue is dissatisfied with her work situation, she contemplates a transfer to another unit.

Well Sue, join the club. And in this case, most nurses would not question their effectiveness as a nurse (unless, of course, they are endowed with the martyr/angel of mercy complex), but would question the staffing and the practices of the facility. Again, this is a silly scenario because there is no moral distress here, just poor staffing practices. And Sue shouldn’t be questioning her competence–she should be demanding better staffing and more help; or working to organize/unionize the facility so that patient care improves.

What is it with these nursing articles? Why are they so afraid of speaking on a level that is meaningful to readers? Why not give real examples of hard choices and situations that nurses are in, rather than this silly drivel?