The nursing shortage has many causes and many possible solutions, some of which will require action by the federal government and by the health care industry as a whole. But health care professionals at the local level still can contribute, says Keith F. Safian, president and CEO of Phelps Memorial Hospital Center in Sleepy Hollow, NY.
Safian is a member of the Joint Commission on Accreditation of Healthcare Organizations’ round-table addressing the nursing shortage, and he tells Hospital Peer Review that quality improvement and peer review professionals should consider themselves key to solving the problem. "We see this as a problem that needs to be addressed from all sides," he says. "The Joint Commission is taking steps on Capitol Hill, but there are numerous things that health care providers can do in their own communities and in their own hospitals."
Much of that work involves improving the working conditions for nurses, says Marilyn P. Chow, RN, DNSc, FAAN, vice president of patient care services for Kaiser Permanente. Hospitals must stress the "culture of retention," establishing a work environment in which nurses want to stay in the jobs, she says. "This is not just about focusing on recruitment and scholarship strategies to attract new nurses. We also have to work with existing nurses," Chow says. "Nurses are recruiters. When they are satisfied and happy about their work conditions, they recruit their family, their friends, anyone they encounter. When they’re frustrated and unhappy with their jobs, they steer people away from nursing."
Some action already has been taken on a federal level, but it remains to be seen how significant it will be in solving the problem. In August, President Bush signed into law the Nurse Reinvestment Act, which authorizes financial aid programs for nursing students. The law is expected to make $30 million available for nursing scholarships between 2003 and 2007, but the Joint Commission is urging Congress to take more action. In its recent report, the Joint Commission roundtable identified these three overall strategies:
• Transform the workplace to give nurses the independence and support they need to do their work well, thereby creating a culture of professional satisfaction and encouraging retention. Setting staffing levels that take into account the complexities of patient needs and nurses’ skills and competencies also must be part of the solution. Hospitals must adopt zero-tolerance policies for abusive behaviors by physicians and other health care practitioners.
• Bolster nursing education to ensure that new graduates are better prepared to care for fragile patients. This means re-invigoration of nursing schools by funding new faculty positions and encouraging nurses to seek advanced degrees. It also means creating standardized postgraduate nursing residency programs. Increased federal funding for nursing education also is needed to encourage greater interest in the profession.
• Make new federal money available to encourage hospitals to invest in nursing services. Continued receipt of these monies should be conditioned on achievement of evidence-based, nursing-sensitive goals, including patient outcomes.
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