President's Note: A Journey of Rediscovery: The Nursing Shortage: Easy to Fix?|
By Michael L. Williams, RN, MSN, CCRN
I experienced my first nursing shortage when I was a new nurse. The solutions seemed obvious. Pay us more and everyone will want to be a nurse. Teach physicians how to respect us and every nurse will remain a nurse. Or, so I thought.
As I continue this journey of personal rediscovery, I marvel at my naivet�. The solutions were never simple then, and, they certainly aren’t now.
The AACN Board of Directors receives many thoughtful letters from members who are passionate about a particular issue, including the nursing shortage. Many offer reasons that they think the problem exists, as well as a range of solutions to the problem.
However, if the current shortage and the one that looms even larger when baby boomers start to retire were easy to solve, they would be solved by now. The fact is, there is no single cause or single solution to this multifaceted dilemma.
Some causes reflect workplace deficiencies. For example, decreasing availability of all staff, mandatory overtime, the physical demands of the job, insufficient ergonomically sound equipment and the movement of societal violence into the hospital. Others are the paradoxical side effects of societal advances. For example, expanded career opportunities have made nursing a less desirable career choice for women. At the same time, nursing has failed to become a viable career option for men.
The stark reality is that a shortage so layered and complex demands the collective energy and creativity of every stakeholder to achieve even modest success. How is AACN contributing to these efforts? As the undisputed leader in critical care nursing,
AACN has committed to activities that:
• Educate legislators, the public and ourselves about the complexity of the shortage. The “AACN Nursing Shortage Backgrounder” is
a useful tool highlighting the complexities of the issue.
• Help nurse managers better understand their responsibility for creating healthy work environments that capitalize on nurses’ expertise in recruiting and retaining staff. Our new Nurse Manager Think Tank will help us learn about successful
strategies that give nurse managers the most support.
• Restrict mandatory overtime so that healthcare workers cannot be required or forced to work more than a predetermined schedule.
• Develop educational and leadership resources that help bedside nurses and managers to function optimally despite the shortage. Have you seen the recommendations for staffing and delegation decisions in AACN’s Staffing Blueprint?
• Protect healthcare workers from retaliatory or punitive actions by employers for reporting safety or quality concerns.
• Require the use of valid and reliable tools to determine staffing based on the acuity of patients and the skills needed to deliver care that meets individual needs.
• Implement appropriate salary and benefit programs that include rewards for certification and experience.
• Establish preceptor and orientation programs to maintain an adequate supply of specialty nurses.
• Develop collaborative care models that promote satisfying working environments.
• Recruit qualified individuals into nursing, including those who are now underrepresented, such as men and minorities. We support the work of Nurses for a Healthier Tomorrow, a national coalition of 31 organizations and corporations whose mission is to recruit young people to the profession.
• Work with the U.S. Department of Health and Human Services to secure scholarships for nursing students and loan forgiveness programs for new graduates.
• Fund and promote research that gives us compelling evidence about what we already know from experience–that critical care nurse make a vital difference in the lives of patients and families.
• Celebrate nurses’ accomplishments far and wide. At the NTI in May 2002 in Atlanta, we’ll applaud nearly 100 nurses chosen to receive AACN Circle of Excellence Awards. Watch for next year’s call to nominate yourself or a colleague.
• Forge partnerships with other professional organizations. The American College of Chest Physicians and the Society of Critical Care Medicine have joined us in speaking out to the public about how the nursing shortage is damaging the health
of our communities.
• Above all, keep us focused on patients and their families. When access to care and quality are compromised, every patient suffers. Some die. A scarcity of nurses means less access and quality of healthcare for the public. And for you.
Is AACN on track? Are there causes we have overlooked? Other contributions we should explore? Above all, how are your employer and your community helping to fix the shortage? Tell us about your work in progress and your successes so we can tell others. Write to AACN News, 101 Columbia, Aliso Viejo, CA 92656; e-mail,
email@example.com; fax, (949) 362-2049.
Want to Know More?
Find more information about AACN’s nursing shortage initiatives online at
AACN Staffing Blueprint: Constructing Your Staffing Solutions
> Bookstore > Item #300117 or call (800) 899-2226.
Nursing Shortage Backgrounder
> Clinical Practice > Public Policy > Resources > Position Statements
Circle of Excellence Awards
> Membership > Awards, Grants, Scholarships
Nurses for a Healthier Tomorrow
> Clinical Practice > Public Policy > Resources
Nursing Shortage News Conference with AACN, ACCP and SCCM
> Press Room > Press Releases
Times Are Changing
Many kudos to Michael Williams for his succinct opinions in his “President's Note” (A Journey of Rediscovery: So, How Does It Feel to You? AACN News, August 2001). I have been in nursing for 30 years and, like most of us who have been doing this for awhile (male and female), I could write a book of anecdotes about gender conflicts in our profession.
However, I have seen much positive change toward a reduction of this gender bias. Nevertheless, just as my gray hair now seems to give me somewhat of an advantage, I am reminded that change has come slowly when compared to the life expectancy of a nursing career.
I believe that at a time like this, when the field of nursing is “graying,” and many of us have grown beyond the gender role struggles of our earlier career days, conditions may be ripe for significant improvements:
• Seeing nursing as a core of truly caring adults with many years of education and training and experience
• Viewing nursing as a career where new entrants will be effectively nurtured and mentored
• Recognizing nursing as a true scientific field of study and practice
• Considering nursing as an excellent career advancement opportunity for other allied health professionals, such as paramedics. If people have been deterred from nursing initially because of its daunting appearance, then recruit them secondarily after they have nibbled around the edges and become comfortable with healthcare.
• Seeing the present shortage of nurses, though problematic, as an opportunity for change to occur throughout the profession in terms of recognition, salary improvement, gender relations and nurse-physician relations.
I have truly enjoyed my career in nursing. My coworkers are fantastic and I love the opportunities to teach and mentor.
Michael, you gave a great opening statement. Keep up the good work for all of us in critical care nursing.
John M. Suko, RN, BSN
Re: “Low Road to Self-Doubt Ahead,” President’s Note, AACN News, September 2001:
I enjoyed reading about someone who feels like I do many times a day.
I have been in nursing for over 35 years, most in critical care. I know I must be doing something right or I wouldn’t have lasted this long. However, the pats on the back and even the “thank yous” are few and far between. I am not referring to famlies, but to colleagues who seem to be unaware of the teamwork they are a part of.
When I was recognized for any achievement in the past, my first reaction always was: They must have made a mistake to pick me!
Susan Fox, RN, CCRN