AACN News—February 2000—Opinions

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Vol. 17, No. 2, FEBRUARY 2000

President's Note: Moguls, Nursing and Aging Knees—Is There Rest for the Weary?

As I write this column, I am resting my knees after an exhausting day of snow skiing, a sport to which I am absolutely addicted.

For me, skiing is not only a terrific way to exercise, but also a time to enjoy the beauty of nature. This sport means so much to me that I recruited my daughters at an early age, to ensure their competence and, ultimately, their confidence, enjoyment, and independence as skiers.

Such encouragement is, of course, the responsibility of a mentor, as well as a mom.

On this day, my mentorship meant working with my 13-year-old daughter, Alexis, on mastering moguls, which come in various shapes and sizes. Alexis had mastered the smaller, more widely spaced moguls long ago, so the focus of this lesson was the unforgiving giants that are situated close together. Now, my knees are letting me know exactly how they feel about today’s exercise.

At the age of 43, I am sad to realize that, despite my physical fitness, I am beginning to feel the toll that aging takes on one’s more vulnerable joints. However, regardless of my woes, I have accomplished today’s mission; Alexis has graduated to a new level of skiing. She will, no doubt, surpass my skiing abilities within one to two years, and I cannot think of a greater compliment with which to pat myself on the back. My succession plan is well under way.

Back at my workplace, the story is different. I am certain that it mirrors the story of your workplace. As an aging group of professionals, the mean age of nurses in academic settings is in the 50s, and the mean age of those working in clinical practice is in the 40s.

AACN members fit this profile as a group. The nursing profession is failing to attract the younger generation, which means that membership numbers are declining within AACN, as well as within other professional nursing organizations. Even the rate of new CCRN� certificants is declining, while the number of CCRN-Retired certificants is increasing. We are like many animal species, threatened with extinction.

The devastating shortage of nurses that many project conjures up images of us, in our 70s and 80s, pushing our own walkers around the ICU, while we continue to tend to our patients’ needs. Personally, I would rather do that than place the practice of critical care nursing in the hands of an unskilled workforce.

According to the American Hospital Association (AHA), it now takes urban hospitals 60 days and rural hospitals 90 days to replace one registered nurse position. The AHA speculates that work dissatisfaction contributes significantly to this growing nursing shortage in hospitals. Less patient contact; reengineering issues; increased administrative layers; coupled with less respect for bedside nurses; higher patient acuity; undesirable shift work; loss of decision making and autonomy; inadequate professional stimulation, growth and mentoring; unclear career paths; lack of a supportive nursing voice within administrative sectors; fewer accessible nurse managers; and less job security are cited by the AHA as hospital-based stressors for RNs.

As the healthcare continuum expands, numerous opportunities have unfolded for RNs to move into nonhospital-based settings offering 9-to-5 work hours. The AHA reports that 60% of RNs are currently employed in sites other than hospitals. It also estimates that, by the end of 2005, the average age of the American RN will reach 50-plus years. In addition, the AHA projects that enrollment in nursing education will be flat or decline, attributable in part to the “graying” of nursing academicians who are far removed from bedside practice and clinical competence.

With fewer nursing applicants, the AHA predicts a shortfall of nearly 291,000 nurses by the 2020. Taking into account the large population of baby boomers who are likely to need critical care by 2020, this prospect is frightening.

As critical care nurses, we have failed to plan for our succession, which, sadly, will come back to haunt us as we age and become consumers of critical care services. Although I am not a “Pollyanna,” I believe that most of us love critical care nursing, in spite of the dissatisfaction that exists today. I believe that the reason we hang on is the deep satisfaction that we feel when we are able to use our nursing artistry and science to its fullest potential.

In the past 30 years, this sense of satisfaction has guided us toward significant professional growth; yet we seem to have lost touch with it and lost our way. We have succumbed to difficult times; yet instead of sticking together we have pulled apart, assuming the role of victim or martyr. This has increased our vulnerability and our susceptibility to manipulation by a third party with different values and interests, and has planted the seed of professional discontent in our hearts.

Interestingly, we are not alone in our failure to plan for our succession. Although succession planning is a hot topic in the business world, healthcare in general has not paid attention to its importance. According to Robert Grossman, the pool of healthcare leaders is shrinking dramatically because of ruthless excising, retirement of the baby boomers and corrosive environments that promote early departure and entrepreneurial activity.1 We have certainly witnessed this in our workplaces; managers and administrators either move on or frequently change positions. I know of one critical care unit that suffered through three changes in nurse leadership within a 12-month period! In circumstances like this, no one is capable of thinking beyond today, because we are justifiably concerned about whether we will even be there tomorrow.

Because of the growing shortage, improving recruitment is not the answer to succession planning. In fact, the only sound strategy is to actively pursue nurse retention by promoting a culture that is nurturing, supportive and professional. This type of nursing culture grows future leaders at all levels of the organization, from staff nurse to nurse administrator. At a time when cost reduction is the norm, we must recognize the significant investment that we make when we develop future nurse leaders from within our organizations.

In the business world, companies like General Electric and IBM have made leadership development a top priority, because they recognize that this kind of investment supports their ability to attain targeted business goals. After all, employees function better when they are allowed to focus on the contributions they can make, and ways in which they can creatively improve.2 We must reemphasize the need for coaching, mentoring and team development at all levels of our organizations, instead of being so nearsightedly concerned with cost that we are unable to see the long-term cost benefits associated with these activities.

We must also establish evaluative mechanisms that allow us to track and develop internal talent for key nursing positions within our organizations. As with professional sports teams, we must develop strong “farm systems” for internal leadership development. These systems must be driven by a policy of talent acceleration. As talents are identified in nurses, an appropriate mentor who is capable of nurturing and building upon the individual’s skill base should be sought. Seek positions that best suit the individual, enabling those with expertise at the bedside or those with a niche for administration to move along logical career paths that promote learning, provide the opportunity for furthering academic education and, ultimately, support business objectives.

Byham and Nelson suggest that it takes up to two-and-a-half years for an individual recruited from an outside organization to fully master all aspects of a new position.3 Mastery of a new position includes not only the technical aspects of the job, but also the politics of influencing others and producing change within the system. During times of rapid change such as these, two-and-a-half years is a long time. Clearly, organizations with successful farm systems will be better positioned to rapidly respond to tomorrow’s healthcare challenges.

We must also tackle the problem of undesirable shift assignments. As a person who despises mornings, I have never understood why 7 a.m. was the only option for starting a shift. We must craft flexible staffing options and incentive programs that transform undesirable shifts into highly sought-after employment options. If we don’t tackle the shift assignment problem, more nurses will continue to seek employment outside the hospital setting.

Lastly, we must eliminate the hiring practices that healthcare organizations turned to in the 1980s, when they first recognized that healthcare was indeed a business. These practices focused on hiring individuals with a business foundation for key executive positions, without ensuring that the organization’s healthcare product was understood. There is no place today for administrators who advocate reductionist thinking, or a belief that nursing care can be accurately predicted by time and motion studies. Instead, we need leaders who understand the significance of nursing acts that meet the needs of our heterogeneous patient population, who acknowledge the significance of our ability not only to meet physiological needs, but also to relieve pain, fear and anxiety for those in our care. Holistic nursing care defies time quantification, and defines the very essence of our professional charge, as well as our personal feelings of well-being and work satisfaction. Nurses should be encouraged to develop as organizational leaders, because they have an intimate knowledge of the healthcare product.

Succession planning doesn’t take an inordinate amount of time; however, it does takes interest and commitment. Each of us must accept that our charge is to find and raise our successors. Even in these difficult times, we can create a future that showcases the value of professional nursing.

We represent the largest group of healthcare workers in every hospital setting, which places us in an advantageous position to create a new nursing image. We must monitor our own professionalism, continuously seek opportunities to improve and grow, and ensure that we exemplify the kind of nurse we would want caring for us. We must reconnect with the pride that we once felt in our significant nursing contributions. If we don’t pull ourselves together and make these changes now, we will be unsuccessful in attracting future generations to our profession.

Let’s start now to recreate ourselves and our workplaces. Let’s each reach out and extend the gift of mentorship to another nurse or two. If we do, the slope ahead of us will certainly be a lot less bumpy.

1. Grossman, R.J. The looming crisis. Health care organizations are behind other industries in cultivating tomorrow’s leaders. Health Forum Journal, 1999:Nov/Dec. p. 18, 20, 22-23.
2. Catlette, W & Hadden R.. Contented Cows Give Better Milk: The Plain Truth About Employee Relations and Your Bottom Line. Willford Communications; 1998
3. Byham W.D., Nelson G.D. Succession planning. Developing the next generation of leaders. Health Forum Journal. 1999: Nov/Dec. p 19, 24-26.


Star Flinger Story Identified
The “Star Flinger” story referred to in the article (AACN News, December 1999) by Beth Glassford is not an “author unknown.” It was written by Loren C. Eiseley in his book The Star Thrower, published in 1979 by Harcourt Brace & Company.
Benton Lutz
Beaufort, S.C.

Journals Appreciated
Last fall, I attended a family nurse practitioner program in which we analyzed and critiqued various journals during a 16-week research class. Approximately 60% of the articles were chosen from your two journals (Critical Care Nurse and American Journal of Critical Care).
The critiques were very positive. The research presented was as described in our text
and the results were easy to understand.
Thank you for publishing articles that can benefit our nursing community.
Sally Carlson, RN, BSN
Vancouver, Wash.

Competent, Caring Nurses Enhance Patient Care
Re: “Landmark Legislation Sets Nurse to Patient Ratio” (December 1999 issue, AACN News)

Administrators in my area base staffing on numbers, not acuity. As charge nurses, we have to argue for extra staff when there are high acuity patients in the unit, because the supervisors, managers and administrators look only at numbers.

Perhaps in theory, new patient care delivery systems could increase the quality of patient care. However, as long as the CEOs and administrators at hospitals and at insurance and drug companies are interested mostly in maintaining their six-figure (or more) incomes, patient care will not be a priority. If our nursing leaders were honest to our profession, they would admit and work for having competent and adequate numbers of RNs at the bedside to increase the quality of patient care.

I have been involved in shared governance at my hospital and in the development of new patient care delivery systems that have not worked. As a staff nurse in a busy ICU, I have seen that new care delivery systems and nonlicensed assistants do not enhance patient care. Only competent caring nurses do.

Now, with a nursing shortage and agencies springing up every day to entice RNs to leave their staff positions at hospitals, hiring competent bedside RNs is increasingly difficult. I hope that our nursing leaders will one day begin to address the real issues confronting nurses today.
Doris L. Kick, RN, CCRN
Baltimore, Md.

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