April 6, 2001

VUSN combating nurse shortage

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Peter Buerhaus’ study reports that America’s pool of nurses is shrinking rapidly.

VUSN combating nurse shortage

Yolanda Ricci, RN, has seen nursing shortages before – but not like the looming crisis that is facing our health care systems today.

In 1979, Ricci was hired at Vanderbilt University Medical Center during a nursing shortage, but said things were very different then. She was able to secure a day shift position on the pediatric unit, which is considered a coveted post.

“I remember the shortage,” said Ricci, who works on 5S Pediatric Unit. “There were six to eight assignments, but those children didn’t require one-fourth, one-fifth, one-tenth of the care that a three-patient assignment on our myleosuppression unit requires now.

“The patients I saw 20 years ago with cancer were so sick. But what I did then was palliative care, because they did not live as long. Now, with diagnosis and treatment being what it is today, I can look forward to a cure. But it’s a long road with a lot of hard work.

“It’s not a road you can travel along without expertise. It’s not something I learned in school. It’s on-the-job. I’ve done this for 20 years and I am just now getting to where I feel comfortable. It’s hard to teach that to someone.”

It is Ricci’s and thousands of nurses’ history and experience that will be lost in the upcoming nursing shortage – something that is vital when caring for a growing population of sicker patients.

“This is a different type of shortage,” said Colleen Conway-Welch, dean of the Vanderbilt University School of Nursing. “The American public has always assumed that nurses are wonderful, interchangeable and somewhat disposable. That has contributed to a lack of respect for nurses.

“But the truth is – nurses are on the frontline of care. They are being asked to do much more on a daily basis. With the advancements in treatment modalities, nurses are caring for more critically ill patients in a more demanding job environment. Nursing is a lot tougher today than 20 or even 10 years ago.”

Conway-Welch said VUSN has always kept the changing needs of the nurse a top priority when developing its curriculum. Since 1984, the school has sought ways to attract nurses to higher levels of education through its advanced practice nurse programs.

“The perception about nursing was that young women initially go into nursing, marry, have children and don’t make a career out of it,” Conway-Welch said. “But there is so much career mobility in nursing today. Once you become licensed there are a couple of hundred decisions to make – acute care setting, private practice, teach, seek more education. You can literally re-tool or re-conceptualize your career.”

Conway-Welch said the challenge today is to highlight the excitement and rewards of the advanced practice nurse career path.

“This approach to nursing education interests folks who may have never chosen nursing as their first career choice. The opportunities of choosing advanced practice nursing as a second career is fast becoming a very valuable recruitment tool.”

The demand for specialized nurses is especially vital, as the patient population grows increasingly sicker.

Since the initial study by VUSN’s Peter Buerhaus, Ph.D., RN, FAAN, associate dean of research and Valere Potter Distinguished Professor of Nursing, more discussion is taking place.

Buerhaus’ study reports that America’s pool of registered nurses (RNs) is shrinking and the total RN supply by the year 2020 will fall 20 percent below projected requirements.

“Over the last six months, there has been much greater recognition about the shortage within the nursing community and within the health care delivery system,” said Buerhaus. “The slowest movement has been among policymakers. As the significance of the severity of this problem is understood, the quicker we will see action.”

Buerhaus likens the nursing shortage to a pot sitting on a hot stove. “The water is surely boiling,” he said. “If something is not done it will boil over.”

He expects that by this summer the heat will be turned up to a point where a federal special task force will be named to investigate the looming crisis.

“The issues of this nursing shortage are so deep, it needs to be looked at separately from the general health care industry issues. Nursing is the critical glue of health care; it deserves focus and attention.”

Although many have come up with ideas and solutions to the shortage, Buerhaus warns that no one person can resolve the issue – it requires coordination and high-level strategies.

“We have reached a point where we are about to make a turn,” he said. “Either we move the pot or we let it boil and spill everywhere. Getting answers to this problem is not just going to happen at the snap of a finger. We need a major infusion of funds. Time is running out and there is a lot to do.”

Buerhaus agrees that VUSN had been heading in the right direction with its master’s prepared nursing courses – working to attract people into the field, as well as bringing back those nurses seeking higher levels of education. The school has taken a serious look at itself, he said, and is working on what can be done to assist with this problem.

Sean Bunch, CRNFA, is a six-year veteran in the Operating Room at VUMC. He said specialized courses in OR nursing would be a start, when considering specialized programs.

“The shortage in the OR is definitely noticeable,” said Bunch. “The problem is finding experienced people. We just don’t have the pool of nurses to select from when we are short staffed. I believe that offering specialty courses in OR nursing would be helpful.”

When Bunch began working at VUMC, it was a completely different scenario.

“I remember when I got out of school, there were so many nurses,” he said. “I just wonder what it’s going to look like in six more years.”

Marilyn N. Dubree, director of patient care services and chief nursing officer at VUMC, said ensuring that the medical center has positioned itself in the market in terms of compensation, work environment and flexibility are key ways to attract and retain nurses.

Attention has been focused on the creation of an advisory board devoted to retention issues, as well as recruitment efforts. Also a professional practice program was designed to acknowledge and reward various levels of practice.

“Although there is an aging component to this nursing shortage, this is very different, because with that we are retiring (losing) nurses with years of experience,” Dubree said.

“Medical Center leadership and School of Nursing leadership are concerned about the potential impact of the growing shortage. We know that if we build a model where compensation and work environment are good, then we can build on those strategies to attract and retain experienced nurses.

“There are a lot of job opportunities for nurses today,” she said. “It’s a good thing, but it is leaving a gap in the acute care setting and highly specialized areas of health care. With advanced techniques applied to sicker patients, there are fewer people taking care of these patients. We need very bright health care professionals taking care of these people.”

Alaina Underwood, a 2000 nursing school graduate, said the shortage has been discussed among her peers, but the most emphasis was during class discussions.

“We don’t have the same concerns about the shortage possibly as veteran nurses do,” Underwood said. “As a new graduate, we were looking at job opportunities, pay scales and benefits. Because of the shortage, we knew we could get jobs.”

Underwood, a nurse on 7N, said the opportunities are so vast, graduates from her class and beyond have had little time to think about the shortage on the same level as nurses who have been in the field for a number of years.