The fundamental problem may not be supply of graduates but retention. Nurses are leaving the profession because of the stress of working in woefully understaffed facilities and because they lack administrative support or control over their environments. In many settings, nurses are responsible for coordination and continuity of their patients’ care, yet they feel they have little authority for many aspects of their job.10 Fifty-five percent of nurses would not recommend a nursing career to their children and friends.7 In a recent survey, 41% of respondents indicated job dissatisfaction, 43% showed strong indicators of burnout, and almost 25% planned on quitting their jobs in the next year. Of this last group, one third were not yet even 30 years old.11

Newly licensed nurses are leaving the workforce at a disturbingly rapid rate. In New York City, as many as 50% of newly licensed nurses are leaving their hospital jobs before the end of their second year of employment.12 The proportion of recently graduated male nurses who are not working in nursing more than doubled between 1992 and 1996 and increased from 2% in 1992 to 7.5 % in 2000, according to a recent study.10

Set in the managed care milieu of the 1990s, some of the sources of nurse dissatisfaction can be traced to hospital cost containment. Hospitals reorganized and restructured, downsized staff in anticipation of shorter hospital stays, and deemphasized the importance of the nurse-patient relationship and the need for mentoring and leadership training. Nurses cite understaffing, the stress and physical demands of the job, lagging salaries, and lack of career advancement as the biggest problems within their profession.

The JCAHO’s analysis likens nurses to “the canaries in the coal mine.” The report states: “Many have been sacrificed before the now widespread realization that there is something wrong with the work environment.”7 The JCAHO urges that hospitals create cultures of retention that include the use of information and ergonomic technologies and that staffing levels be based on competency and skill mix relative to patient acuity.

More PAs are already functioning as administrators and moving into hospital jobs in response to the mandatory reduction in resident physicans’ working hours. This is a great opportunity for them to become involved in redesigning models of hospital health care delivery to improve the working conditions for nurses and to create environments of teamwork and shared leadership. For example, we can lobby for measures to ease physical strain, such as the installation of lifting devices, or to return the nurse to the bedside by removing excessive paperwork, or to restore decent nurse-to-patient ratios.

Staff nurses are on the front lines of inpatient care. They are the guardians of recovery and the watchdogs of adverse outcome, the ones who notify us when a patient deteriorates or is ready to go home. Vital to patient safety, quality of patient care, and crisis management in the event of bioterrorism, nurses need our help. The nurse shortage is not just a dilemma for the hospital administrator or the charge nurse trying to cover her shift. The nurse deficit is a problem for us all.

Share this post: | | Google+ | |