Curing the nursing profession’s ills

Nurses from Hygeia Hospital in Athens, Greece

Hospitals all over the world are facing shortages and high turnover rates in nursing, and increasingly find that nursing issues are among their top concerns and priorities for change. Elizabeth Brown, HMI’s director of clinical services and a registered nurse with extensive experience working in international health, speaks about the problems and potential cures for the nursing profession.

All clinicians can remember an encounter with a patient that made them stop and realize the impact that two people can have on each other. I vividly remember a patient I took care of years ago when I was working in the surgical intensive care unit. The night after open-heart surgery my patient cardiac arrested. Certified in Advanced Cardiac Life Support, I was actively involved in the resuscitation with an amazing team of clinicians who worked extremely well together. I remember telling my patient not to be afraid, that he would be okay.

I was away for a few days and the patient was subsequently transferred out of the unit by the time I returned. A few days later, he visited the unit with his wife and said he could not leave without thanking me. He said he had no recollection of that night, except for my voice telling him not to be afraid. We stayed in touch for years.

Elizabeth Brown, RN, MSN, MBA

Many nurses can share patient stories such as this one, where the art and science of nursing are truly integrated. The skills learned through intense training, combined with a caring approach, create expert clinicians who practice well independently and as team members.

Yet more recently we are hearing less of these types of narratives and more about the concerns nurses are voicing. They worry that high vacancy and turnover rates are making the work environment too stressful and impacting communication with team members. They are questioning how to resolve the increased demand for patient care services in an environment where there are less health care professionals available. They are disappointed in a work environment that does not provide enough time for professional development and advancement. But most importantly, nurses are concerned about the quality of patient care ^{1, 2, 3}.

These concerns are not only in the United States but in many parts of the world. Nurses in other countries are feeling dissatisfied and concerned that the quality of patient care has deteriorated (see sidebar) ⁴. Globally, nurses face challenges related to shortages, staffing, salaries and benefits, working conditions, safety, and the need for further education and career development ^{5, 6}.

Providing patient care in an era of acute, complicated and shortened hospital stays is becoming more challenging for all clinicians. In the United States, the utilization of allied health professions, physician assistants, advanced practice nurses, and unlicensed assistive personnel has helped to meet the diverse needs of patients, but has also created confusion about how the role of the nurse is defined, and who should take responsibility for different roles in the delivery of patient care. To improve the situation and integrate these roles, there has been an emphasis on creating teams of health professionals who coordinate safe, effective, efficient, and compassionate patient care in an environment that respects and supports each employee. Schools and hospital continuing education programs are working to augment this approach by offering courses focusing on leadership, facilitation, delegation, conflict resolution, and change management.

Many of the recommendations to address these issues also stem from an integrative approach, bringing together government, industry, academic, and private leaders, both nursing and non-nursing. These studies offer strategies to improve the image of nurses, increase enrollment in schools, strengthen education, training and lifelong learning of nurses and support personnel, and develop better practice models and work environments ^{7, 8, 9}.

Organizations can also learn from best practices, such as ones cited in the Magnet studies ¹⁰. These hospitals have been studied to see why their work settings attract and retain nurses, even during times of nursing shortages. Many hospitals are working hard to create and sustain the best possible patient care and work environments and hope to recognize their employees with the Magnet Nursing Services Recognition for Excellence Award, awarded by the American Nurses Credentialing Center.

Nurses are working day in and day out behind the scenes to make changes. In my international work, I have seen that nurses in many hospitals are struggling with similar problems, even in very different health care environments. The importance of sharing experiences, challenges, and solutions becomes more and more clear, because the ultimate goal of nurses everywhere is the same: to have more of those moments where we are using our clinical skills to make a difference in the lives of patients.

References:
¹ Needlemen, et al. “Nurse-staffing levels and the quality of care in hospitals.” N Engl J Med. 2002 May 30;346(22):1715-22.

² Clarke, et al. “Organizational climate, staffing and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses.” Am J Infect Control. 2002 Jun;30(4):207-16.

³ Aiken, et al. "Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction." JAMA. 2002 Oct 23/30;288: 1987-1993.

⁴ Aiken, et al. “Nurses' reports on hospital care in five countries” Health Aff (Millwood). 2001 May-Jun;20(3):43-53.

⁵ “Worldwide Nursing Shortage Has Reached Crisis Proportions”. Clark, et al. “Challenges Facing Nurses’ Associations and Unions: A Global Perspective.” J of the Intl Labor Review, in press.

⁶ Pearson, A. International Journal of Nursing Practice, 2001;7: Special Supplement (S1-S30).

⁷ Joint Commission on Accreditation of Healthcare Organizations. “Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis.”

⁸ Kimball, et al. “Health Care’s Crisis: The American Nursing Shortage.” The Robert Wood Johnson Foundation. Apr 2002.

⁹ “Hallmarks of the Professional Nursing Practice Environment.” American Association of Colleges of Nursing. Jan 2002.

¹⁰ McClure and Hinshaw, eds. “Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses.” American Nurses Publishing, Washington, DC, 2002.