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Benign Neglect and the Nursing Shortage – Brian Klepper

I sit on the Dean’s Advisory Councils of the Colleges of Health at two public universities in Florida. Both Colleges are led by extremely capable PhD nurses, and have a variety of programs that train students to be health professionals, including nurses.

A few months ago, I was startled when one of the Deans mentioned that
her Nursing program had 500 qualified applicants for 132 student slots.
In other words, at a time when the market wants her to gear up, she
turns away 3 qualified applicants for each one she accepts. As it turns
out, it’s a national problem. In 2006, Colleges of Nursing turned away 43,000 qualified applicants.

It’s not news that health care institutions face a critical nursing shortage. An April 2006 AHA report estimated that American hospitals currently need 118,000 RNs to fill vacancies. That number is expected to triple by 2020, to 340,000 vacancies.

What is less clear to most of us is exactly why the shortage exists. Most of the facts in this piece were drawn from an excellent presentation by Geraldine Polly Bednash, PhD RN. Dr. Bednash is the Executive Director of the American Association of Colleges of Nursing (AACN). AACN’s site has a wealth of data on the problem, and the distinguished members of that association draw a VERY compelling picture of benign neglect of the training process by the sector it serves.

Almost three-quarters of Nursing schools surveyed said the main reason that they can’t train enough new nurses is a lack of qualified faculty. When I first heard this, it seemed counter-intuitive. There must be thousands of very seasoned and appropriately trained nurses who would be glad to go into the classroom.

Not so. A July 2005 survey of Colleges of Nursing around the country found that 2/3 of all respondents said they had nursing faculty vacancies and needed to hire additional faculty. Of course they want nurses with PhDs, if possible, but with a range of specializations and the ability to both teach and do research. Even so, between 1992 and 2000, the percentage of Nursing faculty positions occupied by PhDs dropped 19%, from two-thirds to less than half.

Data from 2001 showed it took a PhD nurse almost 21 years on average after receiving her undergraduate degree to get her terminal degree. The average age of full time Nursing faculty in 2001 was 51, and its almost certainly older now. As many a 300 PhD Nursing faculty are expected to retire in the next decade, exacerbating the problem.

There are many reasons why Nursing faculty are difficult to come by, but one is overwhelmingly dominant. Nurses qualified to be faculty have to take significant pay cuts for the privilege of taking a teaching position. Nursing schools are unable to pay Nursing faculty candidates what they would make working as nurses in clinical positions in the marketplace. Academic institutions are on tight budgets, especially during times of economic instability, and so cannot compete with the marketplace. Meanwhile, to a large degree, the organizations that employ nurses – typically very affluent entities in the scheme of things – stand by and assume that it is not their responsibility.

Comparison of Nursing Salaries: Instructional and Non-Academic Positions

Nursing_salaries2004_2

American Association of Colleges of Nursing, White Paper of Faculty Shortages

On average, each Nursing faculty position produces about 10 new nurses per year, a pretty impressive production figure. As jobs go, nurses are well paid, and with so many other American jobs on the decline, one would think that nursing would look like a great future to many students.

What is needed is for hospitals and other health care organizations to collaborate with universities to subsidize nursing faculty salaries so the bottleneck is eliminated, and so we can prepare for the deluge of need coming down the pike. A failure to do this would be irresponsible. The leadership on this issue must come from the tops of health care organizations within each community around the country.

This one is easily solvable. There is no excuse for not having enough nurses, who are among our best, most capable and most caring professionals.

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34 replies »

  1. Admittedly, nursing shortage problem is really profound in U.S. It is estimated that by 2020 nursing vacancy will be 800,000. I believe without government intervention, this problems will be even worse.
    But I know Johnson & Johnson, the US largest pharmaceutical company, has launched a national awareness campaign Johnson & Johnson Campaign for Nursing’s Future to alleviate this problem through multifocal endeavors in retaining and recruiting nurses from diverse backgrounds.
    Since its initiation in 2002, Johnson & Johnson unwavering efforts in improving nurses’ image and welfare systems have made great headways in this issue.
    Particularly, Johnson & Johnson believed that male nurses would significantly mitigate the nursing shortage problem and thus it exerted a great effort in attracting more males nurses into the working force. Johnson & Johnson put both men and women on the cover of their monthly – issued newsletters in turns. They understood to apply both men and women in their TV commercials, etc.
    According to Vanderbilt University School of Nursing recently, the number of male nurses had been doubled compared to twenty years ago. A recent Gallup Poll throughout the whole country, turned out to rank the nursing profession as the most credible profession, even won over doctors, teachers and military officers.
    Andrea Higham, director of The Johnson & Johnson Campaign for Nursing’s Future,said: “men are a key target of their campaign, for the nursing shortage would cease to exist, if the number of men entering nursing each year grew to anywhere near the number of women entering the field.”

  2. I am immensely proud of M’Lissa Edwards, who happens to be my daughter, and also one of the most intelligent people I ever met, making a difference in this world

  3. I am a midlife Master’s degreed nurse who went into debt for both BS and MS level education, taught for awhile and now am back to a staff nurse position for $20K per year more pay. Why? Because I have education loans!
    All it would take for me to teach fulltime would be a federally funded education loan repayment program for nursing faculty, regardless of ethnicity, background, etc. Just pay my loans in exchange for me to teach, and I’ll do it for the rest of my career. Simple, eh? Oh no, maybe not, since they’d rather I pay for my Ph.D. instead of teaching with my Masters. What’s wrong with this picture? Lack of government commitment to solve this shortage.

  4. If the problem is really a shortage of faculty, then what is being done to recruit faculty? There are plenty of experienced nurse clinicians out there who might enjoy having regular hours and slightly less pay if there were real trade-offs. What might the perks be in the absence of better pay? Market intelligently to these experienced clinicians and you might see a flood of applicants. An ad in a paper might not spark the interest of a nurse who has the brains and experience to teach but more active recruitment methods might make the difference. Some people just don’t see themselves in the instructor role but would make excellent instructors. Older nurses as a whole are not a self-aggrandizing bunch and many have pretty battered egos from years of service in an emotionally draining environment. The very best nurses are wise, intelligent, and humble. That third piece might be a barrier to considering a transition to academia. A good number of unit educators might consider a role in academia if they were subsidized for the MSN (there are plenty of very bright, very capable BSN holders who went into debt for the BSN and aren’t about to go into even more debt for a degree required for teaching). Let’s face it, most bedside RNs are NOT making the big bucks. They can’t afford the time off for school or the money to pay for an advanced degree. If they are going to invest money in an education to get out of a burnout job, they are likely to put their hard-earned dollars into something that promises a good return on their investment.

  5. As a nurse of over 20 years with an MSN, I believe that the degree-inflation argument holds water. Nursing needs to re-organize its educational process — the initial training should be at the LPN level, then the graduate should be required to work in nursing for a year. Then, if the LPN qualifies on the entry exams after one year, they would be fully-subsidized to go to school for an Associate Degree RN. After that, if the nurse wants an advanced degree, they would take a combined BSN/MSN program with partial subsidy and part-time work if they choose. This educational path would 1)Provide a larger pool of qualified nursing staff, 2) Prepare many individuals for competent patient care at basic levels (LPN or ADRN), 3) Support those who want further training and education to obtain their goals.

  6. The biggest deciding factor for many nurses in leaving their jobs and nursing practice is the lack of a supportive atmosphere within the nursing culture. This will have to change before we see the tide turn. Retention of nursing personnel is the crux of the problem. Bringing out of practice nurses back into the workforce doesn’t address the main issue of why these nurses left their jobs in the first place. I’m an NP, and always wanted to be an NP. I am happy in this role, but I was very unhappy as a staff nurse. I am also a second career nurse, earning my RN at the age of 30. The lack of a cohesive culture, as well as a general unpreparedness in the sciences really disillusioned me. Incidentally, having a PhD or any other doctorate helps create an identity and provides an expert knowledge base much the same as a doctorate of physical therapy or pharmacology. It’s not a necessity for everyone, but I would feel a lot more comfortable if my nurse had a high degree of knowledge as I gaze up at her or him after a complicated surgery. I would depend upon my nurse to save my ass if anything was amiss.

  7. To “Joe Blow” and other readers of this blog: You don’t get your groceries for free; why do you expect nurses and doctors to work for free?
    How to Fix the United States Health Care System
    We Must Do It Ourselves
    “Problems cannot be solved at the same level of awareness that created them.”
    –Albert Einstein
    Identify the Components: Ones That Work and Ones That Don’t
    The first step to solving any seemingly daunting problems is to break it down into component parts, identify what works about the existing status; and what doesn’t. It’s crucial to learn from the past.
    As a physician and owner of a solo practice (small business) I’ve experienced the health care system from all sides. I’m intimately familiar with how Medicaid, Medicare, and for-profit insurance companies such as Blue Cross, United Healthcare, Aetna, and others work. I am also a consumer of health care services. I’ve had babies, knee surgeries, and other personal interactions with the American medical system. I have witnessed first-hand the extent to which non-citizens are receiving benefits paid for by working Americans. I am a small business owner so I’ve had to decide whether and how to offer health insurance to my employees. I, and others like me, am among the most qualified people in America to help fix the health care system because we have experienced health care from all angles: health care providers, patients, business owners, and tax payers.
    In this chapter we’ll explore what works and what does not work about the existing U.S. health care system. We’ll also address how to fix what doesn’t work and improve upon what does work.
    What Does Not Work
    Big Government Entitlement Programs
    Big Government does not work. Entitlement programs such as Medicare and Medicaid have spiraled out of control, increased our debt, and are a huge burden to existing and as-yet unborn taxpayers. Many people have figured out how to “game” the system and receive benefits they don’t deserve.
    In my county the office that determines Medicaid benefits is populated by some former illegal migrants who are now citizens. Through knowing people who work in that office and are dismayed by current practices, I am aware some staff members are dispensing Medicaid benefits to those who don’t deserve them. We all pay for this. I don’t want my children bearing the cost of the ballooning U.S. entitlement programs, as it will impact their and their children’s standard of living.
    Medicaid “Emergency Services Only” is a perfect of example of an entitlement program gone woefully wrong. Don’t misunderstand me – some of the recipients of this entitlement program truly deserve it. However, this benefit is dispensed to some citizens and non-citizens alike who drive brand new large SUV’s, and reside in single family homes – I’ve literally seen them deliver a baby at the taxpayer’s expense and drive away in a shiny brand new Cadillac SUV. They pay through these luxuries with cash earned “under the table,” not subject to income tax.
    The Medicare Part D prescription drug program is another example of an entitlement program which benefits pharmaceutical companies and wealthy Americans at the expense of middle class and younger Americans. Most beneficiaries of Part D are retired older Americans who did not pay enough into the system to cover this benefit during their working years. As a consequence working Americans and future working Americans as yet unborn will pay for this program. Pharmaceutical companies are guaranteed a “permanent” revenue stream through Part D unless the system is revoked or revamped. As drug costs increase, which they inevitably will, Part D will balloon out of control as has the rest of Medicare and Medicaid and be another source of national debt and excess tax burden.
    Big government does not work because it’s too costly to administer and it is too easy to take advantage of.
    For the first time in U.S. history we are seeing new generations’ standard of living decline compared to the generations that preceded them. This should be a wake-up call to all of us. If you live in the moment and have the attitude, “It won’t affect me,” think again. Your children or your friends’ children, or mother Earth will bear the brunt of our existing behaviors. Examine your motives. Be honest. Do you feel like you need more money or more stuff? Do you really need these things? Or do you need a healthy earth in which you and your children can live sustainably? Now that you’re making a baby it’s up to you to create the best world possible for them.
    Inequities in Wealth Distribution Harm Everyone
    As a species we have not solved the problems engendered by unequal distribution of wealth. The rich getting richer and the poor getting poorer is not simply an economic problem. It’s an environmental and moral one: It’s hard to care about the pollution you create as an individual when you’re worried about how you’re going to feed your family from day-to-day.
    Ostentatious displays of wealth accentuate inequities and engender jealousy. This sentiment leads to the emotion of rage and ultimately to behaviors of radical and violent extremism, terrorism being just one example.
    Dramatic inequity in wealth distribution is a moral problem that engenders social ills such as thievery, violence, and mistaken beliefs.
    National Health Care Administered by the Government is a Bad Idea
    Several countries already have national health care systems in Canada and Europe. This approach has resulted in a two tiered system: A “private” system in which the wealthy can receive any and all healthcare when they desire it; and a “public” system in which the average person must sit on a waiting list for a year or more to have their knee replacement or their heart surgery. Many of these countries have high income taxes on the order of eighty percent to pay for their entitlement programs. The government decides how the individual citizen’s money is spent. Do you think the U.S. Federal Government has proven it is the best entity to determine how your health care dollar is spent? That is the inevitable outcome of a “National Healthcare System”.
    A national health care system already exists in the United States. It’s called Medicare and Medicaid. These programs have failed miserably in several aspects: Lack of coverage: The number of uninsured citizens keeps rising despite the ever increasing money spent on Medicaid and Medicare. Those who are on Medicaid and Medicare are under-insured because these systems reimburse physicians at a rate of roughly twenty cents on the dollar. Most primary care physician practices’ overhead averages forty to fifty or more percent. Thus, physicians lose thirty cents on the dollar for every Medicaid and Medicare patient they see. This necessitates physicians to either refuse to accept Medicaid and Medicare; or to be forced to go out of business through lack of financial viability.
    Entitlement programs charge working Americans twice, and in some cases three times, for the benefits they provide their recipients: through taxes, through cost-shifting of high insurance premiums; and through obligating physicians and hospitals to provide free care to anyone who walks through the door, be they tax-paying citizens or not.
    Just so you’re under no illusions this is a small problem, look at the 2006 statistics published in the American College of Obstetricians and Gynecologists’ newsletter: Seven percent of obstetricians quit delivering babies altogether and another twelve percent curtailed services to accept only low risk clients. The reasons cited for this were declining reimbursement for deliveries and increase financial and emotional cost of malpractice insurance. A large portion of obstetric patients are illegal immigrants who are either uninsured or covered by Medicaid “Emergency Services Only” which pays dismally. This twenty percent reduction in obstetric services in a single year is truly astounding.
    The main reason reimbursement by Medicare and Medicaid is insufficient is because there is a tremendous disconnect between the consumers of these benefits and those paying for these benefits. The payers are middle class working Americans. The consumers are retirees, people below the poverty level, and people who are illegal migrants. There is a complete disconnect between those who pay for the system (middle class Americans) and those who receive the benefits.
    Disconnect between payer and recipient results in over-utilization of expensive services. If you don’t have to pay for something why hesitate to use it? Many people on Medicaid use the nation’s emergency departments like clinics because they don’t have to foot the several thousand dollar bill for an emergency department visit. If people are insulated from the cost of their prescription medications they are likely to use expensive heavily marketed drugs even if they have no proven benefit over older generic drugs.
    Solving the health care crisis in this country requires increasing the connection between the payers and recipients and dispensers (health care providers and organizations) of health care services.
    Profit Incentives…well…raise profits (and cost)
    Why should commercial insurance companies and pharmaceutical companies make billions in profits when there are 46 million uninsured Americans? It just does not make sense. That is the multi-million dollar question. How can, for example the CEO of United Healthcare justify taking home a multi-million dollar annual compensation package when there are children and adults in this country who go without basic health care needs such as vaccinations and access to medical providers?
    Commercial Insurance Companies:
    Increasing Transparency and Evaluating “Managed Care”
    Increasing Transparency
    How do you know you’re getting the health care benefits for which you’ve paid? Do you understand your EOB (Explanation of Benefits) you receive in the mail after you’ve visited a health care provider or pharmacy? Have you checked to see if the insurance company has paid the correct percentage (accounting for deductibles and co-pays) according to your written policy? Have you read your insurance policy?
    The average person (including me) has not read her insurance policy word for word. It’s usually a dense 50 or 60 page document written in legalese. The fine print within this document can contain many exceptions to the summary of the policy, of which you are unaware.
    Does your insurance company pay for “out-of-network” providers in strict accordance with the written policy?
    If you don’t know the answers to all these questions you may not be (probably aren’t) receiving the full benefits for which you are paying. Ask your insurance policy to account proportionally for every dollar of your premium – write to their CEO or CFO. They should at least send you an “annual report” – the company summary they mail yearly to investors. If you can’t get the information by asking, state you’re interested in investing in the company and can they send you an annual report? Money talks and information is power. We can’t do anything about rising health care premiums until we understand where each dollar goes. Once we understand where the dollars go, we can work to control the components eating those dollars.
    Part of how insurance companies have made away with so much of our money is because we don’t demand the information. If we sit passively and complain it accomplishes nothing. Do something! Start by demanding an accounting of where your money goes. You have a right to know.
    If we curtail existing entitlement programs we decrease the administrative burden of the Federal Government. There is a National body, the Joint Commission on Accreditation of Hospital Organizations (JCAHO), whose job is to regularly visit every hospital in the United States to see if they are living up to standards of safety and hygiene. Why not demand a Federal body that does for commercial insurance companies what JCAHO does for hospitals? Given that the largest portion of our national gross domestic product goes to health care it’s only appropriate the insurance companies be held accountable for responsible use of those dollars.
    Evaluating Managed Care
    Managed Care is a model that originated in the 1980’s to attempt to control heath care costs. The original intention behind it was to link quality to cost and use the scientific method to evaluate the merit of various medical treatments. It has undergone much iteration over the past three decades. However, managed care has failed to control cost. Indeed costs have risen hundreds of percentiles over the past three decades.
    Original versions of managed care involved a “gatekeeper” system in which insurance companies dictated patients must see a primary care physician before obtaining a referral to a specialist. Patients also had to jump through hoops to get basic services or tests ordered by the doctor covered. These factors caused great dissatisfaction among consumers of healthcare.
    The present version of managed care involves “Preferred Provider Organizations” (PPO’s): establishing “in-network” and “out-of-network” benefits paid at different levels. The idea behind this is an insurance company negotiates “discounted rates” with a group of physicians or hospitals then drives consumers to use those physicians or hospitals. The advent of PPO’s has also failed to result in controlling health care costs.
    Some of the greatest reductions in health care costs have come from hospitals and physicians themselves. Many physician groups and hospitals have taken the initiative to develop “Disease State Management Protocols” and “Clinical Pathways”. These are tools used to standardize care for common illnesses using evidence-based medicine and proven methods to control the cost of in-patient hospital care. These and similar efforts have produced the most dramatic control of health care costs, while actually improving and standardizing the quality of medical care delivered.
    Pharmaceuticals
    The FDA incentivizes pharmaceutical companies to develop and market “new and better” drugs because patents on drugs expire after ten years and the drugs can then be produced as generics. Pharmaceutical companies are under minimal obligation to prove their “new and better” drug really is more effective than older, cheaper generic drugs. Pharmaceutical companies aggressively market new expensive drugs direct to consumers on television and to physicians without being required to prove they are more effective than their predecessors. Why? They should at least be required to disclose data about efficacy, just as they’re required to disclose side effects of their drugs.
    Often new drugs are simply old drugs that have been “tweaked” by adding a minor chemical appendage so as to technically make them into new chemical compounds, although they don’t act any differently than their older predecessors. Some examples are “new” birth control pills touted to improve premenstrual syndrome and acne, which are variations on older generic birth control pills. Newer birth control pills sell for about $50 to $60 per month; whereas generic pills sell for about $7 to $10 per month. Both types of pills improve acne and premenstrual syndrome.
    Another example is newer anti-depressants such as Lexapro and Celexa. These drugs are off-shoots of the old stand-by, Prozac (fluoxetine). Prozac is now generic (fluoxetine) and cheap whereas these newer drugs are not. They are touted to have fewer side effects; and they may indeed have fewer side effects. But they have not been required by the FDA to prove it in head-to-head randomized double-blinded, placebo-controlled trials. Are they required to disclose this fact in direct-to-consumer advertising? Why not? Moreover, there are new concerns about all the anti-depressants and increased risk of suicidal or violent behavior.
    What is the logic insurance companies use to determine what they will and will not cover? For example, some insurance companies cover drugs to treat erectile dysfunction but they don’t offer maternity coverage, or coverage for contraception. Or they offer these benefits for additional premium. Why?
    We certainly don’t want to discourage development of new drugs by removing the profit incentive. However, companies should be required to disclose efficacy data in marketing to consumers and physicians. Drug development must become more transparent to consumers so they can make the best choices for their physical well-being and the well-being of their wallets.
    Malpractice Risk Drives Up Cost Via Defensive Medicine
    You’ve all heard the politicians and the media bemoan the fact that malpractice risk increases costs for everyone so I don’t want to tire you with repetition of this other than to summarize. The high cost of malpractice insurance and the emotional toll of malpractice suits cause physicians and hospitals to engage in “defensive medicine”. Defensive medicine is ordering unnecessary tests in order to prove the patient doesn’t have a serious illness and thereby avoid a malpractice suits. There is no evidence that defensive medicine results in better medical care or reduces malpractice suit. The only reliable conclusion drawn by studies of defensive medicine is that it increases the overall cost of health care.
    Malpractice suits have become something of a “lottery” – consumers looking for the multi-million dollar payoff. Defendants (physicians or hospitals) “win” eighty percent of malpractice suits that go to trial – usually after an expensive, drawn out, draining battle. The only people who truly win in these cases are the trial lawyers. Even the malpractice insurance companies take a hit but at least they can pass their cost onto the physician. Guess who the physician passes the cost onto?
    However, if physicians passed on the entire cost of rising malpractice premiums to patients, no one would be able to afford to visit the doctor. Therefore, they only pass on a portion of the increased cost and they absorb the remainder. As malpractice insurance premiums rise, guess what happens to the business bottom line? This is a large contributor to the exodus of physicians from obstetrics: rising malpractice cost and declining reimbursement. If it actually costs you money to get up at 3 a.m. and go deliver someone’s baby, why do it? It makes no sense.
    Money Spent on Extremes of Life
    Ninety percent of the health care dollar is spent on the last six months of life. This often involves intensive care for people afflicted with terminal illnesses who are on life support. They
    may require a tube to breathe, medication to keep their heart rate going and blood pressure normal, a tube for feeding in the stomach, or intravenous nutrition. We often die in hospitals hooked up to machines and being pumped full of drugs. We may not even be conscious. Is this how you want to die?
    Just because we possess the technology does not mean it is best for us to use it. In the past we died with dignity in our homes, surrounded by family members. You should consider how you want to die at a time when you have full mental faculties and can make an advance directive. An advance directive is a document specifying what measures you want taken to extend your life should you not be able to decide for yourself. Don’t leave it up to your family members to make the decision because no one wants the responsibility of “pulling the plug”.
    These extreme measures often consume the final dollars of a family’s savings and are a large component of Medicare expenses. This is money that could go to your children and grandchildren. It could pay for someone to go to college or someone to have a place to live. We have to decide for ourselves how much is enough and how much is too much?
    Okay, so I’ve identified this, that and the other thing that are wrong with our health care system. What is right with it? Well we have access to advanced technology, well-trained physicians and nurses, antibiotics, and the best science money can offer. Too bad such a huge number of people struggle to get basic health care needs met. How do we get out of this mess?
    Addressing the Big Four will “Fix” the United States Health Care System
    In summary there are four big offenders in producing out-of-control health care costs:
    Addressing each of these will decrease the cost of health care while preserving the advantages of technology and science, and increase access for everyone to basic health care services.
    The silent underpinning of many of these problems is risk. So how we manage risk determines the cost of our health care.
    Connecting the Payer with the Recipient
    It is crucial to connect the recipient of health care directly with the payer. The consumer needs to bear the risk of his health care decisions. The consumer of health care needs to directly feel the impact of system utilization in their wallet.
    Eliminating or reducing the scope of entitlement programs would go a long way toward reducing the burden of health care costs for the middle class. Recipients of Medicaid should be required to prove they are U.S. citizens. Non-citizens should not be eligible to receive benefits for free. They should have to pay for their health care just like the rest of us.
    If we do issue driver’s licenses or identification cards to non-citizens, it should be tied to proof of health insurance, proof of auto insurance, and proof of paying taxes.
    We need to decrease the influence of the middle man and limit the role of private health care insurers and the government. One approach to this would be for groups of people to participate in pooled risk plans in which premiums and benefits are determined impartially by an actuarial company. This could be self-directed, for example, by employees of large companies or other pooled risk groups. Alternatively the existing insurance company framework could be restructured so as to decrease the “fat” in the system. This would require government or some outside agency regulating insurance profitability. What justification is there for the CEO of an insurance company making millions of dollars while many Americans go without basic services? Insurance companies would certainly balk at government regulation.
    Consumers must demand greater transparency from commercial insurance companies regarding how their health care premium dollars are spent. Only when we understand where the money goes can we solve the problem of high cost.
    Exert Your Own Cost Control
    You have the power to control your individual health care costs. If everyone reduces her individual costs, the collective cost of health care will decline. Examine your utilization. The most expensive healthcare services are emergency room care, intensive care units (ICU’s), surgery, and advanced imaging studies such as MRI’s and CT scans.
    Examine your utilization of the system. First, if you are ill after regular business hours, decide if you’re sick enough to need to go to the Emergency Room at a cost of thousands per visit; or can your condition wait until your doctor is available during regular business hours for a fraction of the cost?
    Of course for emergencies like chest pain or hemorrhage you should proceed to the emergency room. But if you have chronic pelvic pain and have developed a worsening of pelvic pain the emergency department is not the best place to receive care for this problem. Childhood runny noses and rashes also don’t need to be seen in the Emergency department unless you’re concerned your child may be seriously ill (e.g. have a high fever, or is unable to keep food and water down).
    If your doctor recommends a test, ask why? What is the doctor trying to learn with the test? What are the benefits, risks, and costs of the test? Will this test lead to further testing or surgery? Are you asking for the test because you want to know a certain result? Is the test going provide the information you desire? Will the test give you any useful clinical information to better understand your health? You should know the answers to all these questions before submitting to tests.
    A perfect example of useless tests is “hormone levels”. Women ask me every day to check their hormone levels. If I can’t talk them out of it I usually oblige to satisfy them. However, female hormone tests do not tell us anything your own body can’t tell. For example, if you are having regular monthly periods your hormones will be “in the normal range”. The “normal range” is determined by measuring hormones of millions of “average” people to establish normal values. If you are over thirty, skipping periods, having night sweats, or have stopped having periods, your hormones will be in the “menopausal range” because these values are established by measuring hormone levels of millions of menopausal women. If you are skipping periods before age thirty, you probably have “polycystic ovary syndrome” caused by irregular ovulation. I can test your hormone levels to confirm, but this is usually a diagnosis that can be made by asking questions and doing a physical exam.
    If you are having raging premenstrual syndrome (PMS) I can test your hormone levels. They will most likely be “in the normal range” because hormone levels vary depending on time of cycle, age, and other factors. I can be of much more help by addressing your symptoms and developing a plan to manage them than I can by testing your hormone levels.
    Knowing your actual hormone levels does not help us treat hormonal disorders most of the time because treatment is based on symptoms, not on a number from a lab.
    If you have excess acne or hair growth it is likely your testosterone is high. I can measure it to be sure, but your body is telling me, by producing excess hair and acne that your testosterone level is high. Now if you have these symptoms a hormone level would be useful to exclude a testosterone-producing ovarian tumor. However, testosterone-producing ovarian tumors are exceedingly rare (<1/100,000). I will still recommend the test if I think it’s necessary based on your symptoms and physical findings.
    Be careful of independent labs that offer “saliva tests” for hormones. These are expensive and can be misleading. Saliva levels of hormones can be quite variable from time of cycle and time of day.
    Develop an advance directive while you’re at an age when you have full mental capacity and you can consider these decisions in a thoughtful manner. Write it down. You don’t need an attorney to create an advance directive. Simply writing it down in one page or one paragraph is sufficient. If you want it to be “official” have it notarized. Make sure it answers crucial questions in a clear fashion for your relatives to understand. Advise your relatives you have an advance directive; review it with them; and make sure they know its location. At the end of life do you want to be kept alive with a breathing tube, intravenous feedings, or drugs? To what extent and expense do you want your body to be preserved, possibly with your mind in a vegetative state? Do you want to be resuscitated (brought back to life) if your heart or breathing stops? What would be the criteria you would want established for any of these measures to be taken?
    Require Insurance Companies and Pharmaceutical Companies to Increase Disclosure, Transparency, and Accountability
    We must hold big business accountable for making the most of the dollars we pay them. Insurance companies should be required to present policies in clear, consistent, standardized language to make it easy for the consumer to compare policies. An objective oversight body similar to the Joint Commission for Accreditation of Hospital Organizations (JCAHO) should be established to assess insurance companies and pharmaceutical companies to determine if they hold up to their promises.
    Pharmaceutical companies or an outside agency (don’t we pay the FDA to do this?) should be required to conduct studies of efficacy of new drugs in an objective manner and disclose these results to the public along with the rest of their direct-to-consumer advertising.
    The free market system works: competition encourages innovation and fosters incentives for cost control. We want to preserve the elements of the free market system that function well, while not sacrificing accountability and quality control.
    Doctors Can Impact Cost by Using Evidence Based Medicine and Resisting the Temptation to Practice Defensive Medicine
    Doctors, nurses, and other healthcare providers can dramatically impact the cost of health care by resisting pressures to practice defensive medicine. One would not want to deny access to a necessary diagnostic test or treatment based on price. However, so many tests and treatments are ordered as “cya” measures.
    Often patients request tests that are unnecessary. Usually one can explain the rationale behind testing or not testing and advise the patient to make an informed decision. However, some people are set on the idea that they need this or that test to understand their health. In this instance it is usually counter-productive to try to “talk” the patient out of it, and just go ahead and order the test.
    In order for health care professionals to reduce the habit of defensive medicine, they need relief from the pressures to do so. A revamping of the “malpractice” system in the United States is long overdue.
    Eighty percent of “malpractice” suits are won by the doctor or hospital being sued. This means in most cases that go to trial, evidence of malpractice cannot be found. The stress and cost of malpractice suits is discouraging good people from entering the field of medicine; and causing many to leave medicine or limit their practice to “low risk” disease conditions.
    It has been suggested by consumer groups, physician groups, politicians, and government agencies that it is time to move to institutionalizing compensation for bad medical outcomes. The extent of damage and amount of compensation could be determined by an arbitration group. Funds for this should come from a number of sources: insurance premiums, lawyers, physicians, and consumers. Everyone should have to bear the cost of bad medical outcomes in order to curtail frivolous law suits and keep overall health care costs down over the long term.
    It is much more effective to use a carrot to get people to do the right thing, than to beat them with a stick. For the most part doctors are smart, conscientious – often perfectionist – people who strive to do their best; and if you prove to them certain disease management protocols improve care and reduce cost, they will use these disease protocols. Doctors have studied long and hard to become physicians and it is a life-long learning process that involves accumulating “continuing medical education credits” throughout one’s career.
    Evaluate How We Manage Extremes of Life
    You can maximize your chances of having a healthy term baby by following the advice in this book. You have more control than you may realize. Overall, though, ninety percent of the health care dollar is spent on the last six months of life. Premature babies are expensive and we should strive to reduce prematurity.
    This phenomenon has occurred because advances in technology have outpaced the study of ethics and responsibilities of a society to its members to provide the greatest good to the most number of people.
    We need to decide as a society: How do we want to enter and exit life? Do we want to die hooked up to machines in a vegetative state? Is this the best use of our precious resources? Do we want to risk leaving a legacy of health care debt to our heirs?
    You actually have complete control over this. By writing your advance directive, you remove the burden of your life’s decisions from others and take the initiative. I encourage you to write an advance directive and make your friends and family aware it exists. It doesn’t have to be long – a page or a paragraph. It doesn’t need to be written by a lawyer or notarized. However, if you take the trouble to have it notarized it may increase the likelihood it is taken very seriously.
    You must consider all the possibilities: What if you’re completely paralyzed or brain damaged in an accident? Or rendered into a coma? What type of medical interventions do you want to take place? I urge you to think about these things and write them down: Your family’s lives depend upon it.
    Only by tackling the four major factors increasing health care cost in this country can we obtain a safe, logical, cost-effective health care system. I encourage you to do your part.

  8. It seems it is a self image issue. Are we trying affirm our identity and worth from a career??? Nurses are not the head of the health care team, and neither are physicians. PATIENTS ARE!!! When we stop fighting among the ranks and stop the finger pointing and the “I’m more important than you, because I have more education” attitude, we will get somewhere. Let’s get over ourselves and get to work!!!

  9. I’m not sure what joeblow’s problem is with nurses? We are highly trained professionals who are responsible for patient safety and care, not simply asswipers as you put it. The next time you are in the hospital, we will simply grab someone off the street and tell them that all you have to do is wipe his ass and shovel some food in his mouth. I’m sure that will assist in your overall wellness.
    Being a nurse involves a huge gamet of patient care from assisting in activities of daily living to DOUBLE CHECKING MEDS as doctors are simply human and do make mistakes. If you do not understand the reason a patient is to receive a certain medication, than why would you even give it?
    Today, more than ever, nurses are being looked to to step out of the traditional roles of nursing and becoming an intricate member of the overall health care team to improve patient wellness.
    Joeblow- I suggest you rethink your comments and just for fun, follow a nurse for one 12 hour shift just to confirm your ideas of all we do is asswiping. You may change your mind.

  10. As a nurse, I appreciate all the comments. The nursing profession needs educators, but the universities are not producing enough to educate the nurses we will need in the future. Online nursing degree programs may be helpful.

  11. I am a Nurse Recruiter with a current degree in University Studies, and I was/is one of the many nursing school applicants who was accepted into a 2yr nursing program but I would have had a 2yr waiting list before I would have actually started. I have since decided to work on a Bachelors of Business Administration in Management. I will graduate next May ’08 and at that I point I hope that I will be able to get into a program rather quickly this time around considering my A&P’s will be set to expire in the next year sometime.
    I want to thank all of you nurses who are completely dedicated to your jobs!!!!
    You can’t even begin understand how many nurses who I interview on a daily basis who never mention the word “patient” once! I can sit through entire interviews with out the topic of “patient care” even being discussed! Normally the topic is $, shift, $, patient ratio, $, location, $, tuition assistance, $, student stipends, $, loan repayment, $, and housing.
    YET, because of the unfortunate shortage that we have in our country these nurses will be employed somewhere!!!
    I have to be honest with you, I am a single mother with two small children and when I do complete my nursing program I will be looking for a position that will be able to support us well and one that will be able to assist with the outstanding 30K of student loans!!
    There are so many other professions today that require a nursing degree that if working bedside is not for you then look elsewhere. That license can open so many doors and take you so many places!
    As a nurse recruiter who doesn’t have a license my opportunities are diminishing due to the fact that some of the larger acute care hospitals are now looking for RN licensed Nurse Recruiters.
    We need nurses,….caring and dedicated nurses. We need to support them and empower them…..and to Joe Blow may god bless you and give you wisdom.

  12. “First of all, nurses are EDUCATED not trained. According to Miss Nightingale dogs and horses are trained–nurses are educated.”
    Ms. Meyers, I would rather have a nurse looking after me who is educated rather than trained. Depending on the teacher the student can turn out as either, no matter the degree. I wish we had more educated doctors then trained ones as well.
    Training suggests blind reaction to events or information and education hopefully allows a better more reasoned evalualtion (sometimes outside the books)of a situation to get to the truth. But the (educated?)BSN students hired on my wife’s NIC unit fare no better at getting up to speed than the 2 year grads. My wife “is only” a three year grad but who nursed at teaching hospitals, and being the type of person she is, IS educated, as long as you view education as realizing you never really knowing enough and always want to learn more. Education should teach you how to think, not how to nurse.

  13. Two things to input: 1) I believe there is a factual error in the original article, if my memory serves me, at last count there were well over 3,000 (not 300) nursing faculty planning to retire in the next 5-10 years, and 2) to Joe Blow, whatever you think nurses do (apparently you don’t think we think), I would hope you would respect the science. Research data clearly demonstrates that there are better clinical outcomes (including fewer patient deaths) when there is a higher percentage of BSN nurses providing the care (see the work of Linda Aiken)

  14. “We are shame-faced that pharmacy and much of PT has gone to doctoral preparation and we continue fighting to keep the two year degree as entry to practice. I suppose nurses aren’t bright enough for us to implement the baccalaureate as entry level. I find it very odd that pharmacy and PT (one wonders who is next) can enter at the professional level and nursing just can’t. Poor dears. ”
    Yes, the solution to the nursing shortage is to make PhD an entry level degree required for all nurses. That will really solve the shortage.
    You gotta be kidding me. The problem to start with is all this BS degree inflation that nursing has imposed on itself. Its a recent phenomenon only over the last 20 years that its expected that PhD nurses teach all RNs in nursing school.
    Nurses monitor patients, take vital signs, give meds, and do some patient education. To insist that only a bachelors level or doctorate level person can do those tasks is absolutely insane.

  15. There is a shortage becuase healthcare is not as fun as it used to be and people are not excited about it. As in days of old. However new projects like telemedicine are helping to promote new people to get excited about healthcare! http://www.myeclinic.com

  16. Fascinating discussion but not a new discussion! Kudos to Grace Meyers for reminding the world that we train monkeys, educate human beings. And yes, nursing has one professional organization, ANA, geared to address our ills–even in academia. Join it! Non-members benefit daily from the dues I pay and the time I give–come help us and do your share!
    After recently choosing to leave years of full time teaching in the academy here’s my bet (may I say prediction?): the answer to the nation’s nursing faculty supply won’t be solved with money. Repeat: it will never, ever, be solved with an infusion of money.
    When I listen (privately) to my colleagues from all over talk about why they plan to retire or move on as soon as they can, the issues don’t have money fixes.
    Until nursing education (and faculty dynamics!!) undergo deep, fundamental, internally-drive change, nursing academia, business, and government can pour all the resources possible into educating and recruiting nursing faculty and it won’t make a dab of long term difference. I do think we will see an early-on spike (reactionary) in faculty numbers. However, if we wait a bit for long term outcomes, we’ll find the supply has dwindled again. Folks! Nursing ed, as the saying goes, keeps doing the same thing it’s always done and it keeps getting what it’s always got (nope, not good grammar).
    Here’s a litmus test: when a high schooler says to us, “I’ve been accepted to both nursing school and to law school–and I’m choosing nursing school,” we will have arrived and our faculty supply will remain reasonably stable over the long term. We aren’t there yet. Yes, demographics do impact supply, but demos don’t explain the relatively recent gush of faculty leaving nursing ed.
    One could go on and on. The public perception of nursing must also change if we want to move out of our reactionary mode to faculty supply. It doesn’t matter who I talk with–neighbors, high schoolers, non-nursing friends, there is STILL little understanding of nursing as anything more than a sick-care, acute care, bedpan occupation. I am regarded as the worker-bees who do the dirty stuff and I haven’t been in a hospital in years.
    We are shame-faced that pharmacy and much of PT has gone to doctoral preparation and we continue fighting to keep the two year degree as entry to practice. I suppose nurses aren’t bright enough for us to implement the baccalaureate as entry level. I find it very odd that pharmacy and PT (one wonders who is next) can enter at the professional level and nursing just can’t. Poor dears.
    I’ll hush, for books are written about this and I’m unlikely to extend our understanding of the issues here.

  17. First of all, nurses are EDUCATED not trained. According to Miss Nightingale dogs and horses are trained–nurses are educated. I am a Nurse Educator and love every minute of my time in the classroom. I’ve taught in the traditonal programs and now teach in a RN-BSN program. I agree with the writer that said all teachers make less than their graduates. Isn’t that a sad epitaph for our society! We are remanded to graduate nurses who are able to face the challenges of a fast paced profession and we do that with every graduating class. Yet our ranks are being depleted daily as non-professional areas hire and pay well for their nursing skills. Get a PhD? Who can afford it when there is no recompense for the expenses and time. More knowledge and educational experience and availability equals more educators which equals accepting more students into programs.
    Another change must be in the attitude nurse educators have towards today’s students. This is not the 1900’s where the attitude was to make things as difficult as possible for the students. It is no longer a rite of Passage. It is morally and ethically unacceptable to tell students they are going to fail before they even have a class.And Yes, it is still being said and done in the majority of nursing programs. We must undertake a mentoring system that will follow the students through their chosen program, and at the same time instill mentoring as a way of nursing life. Other professions mentor very successfully and it is unconscionable that nurses, who are taught Tender Loving Care do not use this skill among themselves. In the 140+ years since the beginning of professional nursing our knowledge and scopes of practice have increased faster than any other and we must be proud of our accomplishments. Nurses have the ability to increase nursing education and therefore increase the availability of nurses into the health care industry. Make our legislators listen. Become an ANA/SNA member if you are not already. Support ANA’s PAC as they lobby for better educational benefits. The forerunners that brought us to where we are today were activists and what we have today as a profession was hard won by them. We must make this work becasue if we do not, others, who are not in nursing will find a way of doing just that and Nursing will have no sayand we will have lost Nursing as we know it. Is that acceptable, Nurses?

  18. I am a graduate of an Associates degree program that went on to BSN. I worked as a staff nurse for over 20 years. There is no difference in pay for a 2-3 year nurse or a 4 year nurse. I believe there should be compensation for education and became frustrated with the fact that there is no incentive for nurses to advance their education and professionalism. I have worked with student nurses and have a strong desire to become an instructor, but I would have to finance most of my education to get a master’s and nurse instructors make much less money. I am the breadwinner of the family and have to look for earning potential. I have gone into case management and nurse management for the money. I would love to teach for the sake of the idealism, but the reality is benefits and money. This is why I have gone into the private sector. I do not believe there is a real shortage of nurses, just nurses who have gone out of the hospital for many complex reasons. If there were incentives for me to continue my education and it was somewhat compensable, I would do it in a heartbeat.

  19. I am a graduate of an Associates degree program that went on to BSN. I worked as a staff nurse for over 20 years. There is no difference in pay for a 2-3 year nurse or a 4 year nurse. I believe there should be compensation for education and became frustrated with the fact that there is no incentive for nurses to advance their education and professionalism. I have worked with student nurses and have a strong desire to become an instructor, but I would have to finance most of my education to get a master’s and nurse instructors make much less money. I am the breadwinner of the family and have to look for earning potential. I have gone into case management and nurse management for the money. I would love to teach for the sake of the idealism, but the reality is benefits and money. This is why I have gone into the private sector. I do not believe there is a real shortage of nurses, just nurses who have gone out of the hospital for many complex reasons. If there were incentives for me to continue my education and it was somewhat compensable, I would do it in a heartbeat.

  20. Baptist Health Systems of South Florida provides scholarships for Associates, Bacherlors and Masters Degrees, and they even offer them on site through a combined effort with Miami-Dade College and Barry University.
    As a recepient of such scholarship and a Baptist Scholar, I think that is the best investment a hospital can do for the future of its nurses and its institution.

  21. Actually, Schools of Nursong attached to a medical facility shouls “grow their own faculty” Nurses already BSN prepared should be hand picked by the School of Nursing to advance their education to the masters level. The hospital should pay for the tuition. While the nurse is obtaining her advanced degree, she can work at the SON as an “adjunct professor” assisting the students in the clinical setting. The nurse, upon completing her degree, will have an obligation to the SON to teach there for a predetermined amount of time. The new faculty member would already be familiar with the system. This is also a great recruitment and retention tactict the hospital can use.

  22. Bill, can you tell me any profession/occupation that pays more to its teachers than it does its graduates? I think teachers teach for other reasons than money, at least they seem to have to anyway. Teaching has never been the way to wealth. I don’t know how many teachers are retirees from their profession, and that might be a good way to get teachers for nursing. The nurses applying for jobs on my wife’s unit are mostly now 2 year community college grads. The BSN grads that are hired are paid the same and both have to undergo a 13 week on-the-unit training program after which they are “qualified” to be neonatal intensive care nurses. The job pays what the job pays. The community college hires have had much more hands on practical training while the BSNs for the four years they put in, two have been general subjects with another two active nursing training. The BSNs take about as much time as the community college grads to get up to speed on the unit. Many of the BSNs will go on to be nurse practitioners, now that’s where the money seems to be and they are in high demand.

  23. If you assume that candidates apply to multiple schools, each of which would count the same person as an applicant, the turn-down rate might not be as bad as you indicate. The real issue is: can nursing schools train enough nurses annually to replace the losses in the profession.
    I was on the faculty of GA State University from 1972 to 1992. The faculty in the School of Allied Health was leaving in droves because their students were making better incomes than they were. Ultimately I left the faculty to take a private sector job that paid 3x more than GSU.
    While college administrators are hamstrung by state legislatures and salary policies, they don’t “get it” — i.e. they are competing with the private sector for talent.
    Please answer the question (if you can) concerning double counting the turn-down rate of applicants or give me a citation source. I’m in the healthcare staffing business and one of our companies staffs traveling nurses. I’d like to send this blog to the president of that company if I can show that the statistics are well-founded.

  24. “not the IV pushing skillsets of a 2-year or 3-year grad”
    Heideana, is that comment an elite, “I have a Masters Degree” opinion? Or is it more related to Joe Blows – “ass wipers” characterization? :>)
    Maybe you should work with my 3 year grad wife who, as head nurse, pulled a disfunctional L&D ward back from the brink, her first management assignment by the way. And maybe you would like to know how many patients she has helped by being the best patient advocate I have ever seen as an L&D and Neonatal Intensive Care nurse who has the knowledge, experience and backbone to question docs practice when she sees harm for the patient. And maybe you would like to see her outperform any PHD or Master’s on a daily, practical, bedside and management skill set basis.
    Not that I don’t like PHD’s or Master,s, if I wanted an academic research naval gazer. Sorry, I couldn’t resist.

  25. It sounds like joe, in the post above, doesn’t understand what Nursing is or that these days Nursing is being called upon to develop/oversee the Q/A and Q/M functions of healthcare by the Institute of Medicine, among other entities. The underlying argument is that its’ because Nurses are actually at the bedside 24/7, they really know what’s going on in the practical situation and best situated to solve/develop/oversee the management of it in a nut-shell. Ditto the argument for outpatient nursing…
    The other issue to point out is that the “bread & butter” degree in the work place for Nurses is a Master’s. Also that its’ the “critical problem solving and clinical research skillsets” provided by a Master’s level education that makes it the real “bread & butter” degree, not the IV pushing skillsets of a 2-year or 3-year grad. The PhD degree is needed to oversee Master’s level education by, which is dictated by various educational credentialing bodies. Additionally, I believe that many nurses would gladly step over to faculty positions and take pay-cuts if their work was more “integrated” in medical education and the academic public health sector. In Nursing, like Medicine, I think respect goes a long ways’ to providing incentive for truly gifted individuals to excel in the academic environment. Currently, I don’t see many Nursing educators’ receiving the same kind of respect as Medical educators in the general population or media….
    I suspect that many of my nursing colleagues will have different voices about the issue….Heideana

  26. I like the idea of nursing schools partnering with health care delivery organizations (hospital, clinic, nursing home, hospice).
    In fact, one approach could be an interdisciplinary program where students receiving subsidized tuition perform non-skilled (or less skilled) work within the health care delivery organization for a slightly reduced pay rate. That would allow prospective nurses to learn the ropes from the ground, while earning a stipend that simultaneously meets the staffing needs of the organization. That, or some kind of a service contract for the student – an agreement to work for the subsidizing organization for a period of time after obtaining the degree. You could include a reasonable “buy out” clause so that other health care delivery organizations could buy out the new nurse’s contract if s/he wants to move, or wants to work elsewhere.

  27. Uhh medical doctors make a lot less money in academics/teaching than they make in private practice, so why is it that its only the nurses who refuse to teach and instead run off to the private sector?
    The bottom line is the nurses are being unreasonable. We trained decades of nurses without having to rely on PhDs to teach them, so its absolutely assanine and ridiculous for all the nursing associations to sit there and lie and claim that PhD nurses are an absolute must for teaching RNs how to wipe peoples asses.
    Nursing has had incredible degree inflation over the years, when their basic job duties dont require it. Now they have the audacity to tell us that only PhDs can teach RNs how to change IVs, give injections, etc. What a crock of shit.

  28. Suvi, I guess I was more comparing salary to the expected degrees. The duties of nursing did not change when degrees were pushed on them, neither did their skill set for bedside. My wife IS well paid, but she would not be paid any more with a degree, not quite what other people are being told; better education = more pay and job satisfaction. The duties are the same, the shift work still there and the expectations that nurses do more and more remains. I think the requirement for degrees is over emphasized unless you want to go into management and teaching. But nursing managament, like head nurses, is not the greatest job enhancement vocation. Long hours with no overtime (now calculate your hourly pay) and everyone dumping on you. When nursing pushed for degrees I don’t think they thought it right through, they just wanted that professional image, whether that really mattered to the job or not.

  29. Encouraging returnee nurses,
    “Bringing back Matron,”
    Setting up more urban residential units for nurses,
    Extending nurses’ prescribing rights,
    Higher salaries —
    These are some of the ideas they have for increasing the supply of nurses in England. (see BMJ 2002 Sept 7.)
    Some of them worth thinking about here.
    Yet I do believe, with all due respect to Peter, that we should consider if some nurses are not paid quite well enough here already,
    some even overpaid. Of course not as overpaid as many medical specialists.
    We might also look at how to make nursing a more viable second career. I’m pleased to see that quite a number of schools
    are teaching nursing with the internet. Could that be made more “standardized” and cheaper?

  30. My wife was trained in Canada at the last 3 year nursing program there before they went to 2 years. She never obtained a degree but has looked at getting one from time to time. She has never be able to justify the time/cost input to the reward either in pay or job enhancement. Nurses are still expected to do all the dirty jobs – now with a degree. In Canada and here pay for degreed nurses is not much higher than non-degree ones even though HR wants the degrees. Nursing grew to expect degrees to boost its “professional” image but never had the control of budgets to offer the corresponding pay incentives. They wanted something for nothing. And that’s the problem, nurses have never had management control on par with doctors.
    One world wide drawback to the nursing shortage here is how global qualified nursing staffs are being raided by U.S. headhunters. Countries that can not afford to loose nurses but also have little resources to match pay here find themselves in a tough postion providing basic care. Here we go again, want cheap vegetables hire foreigners, want cheap goods export jobs, want to keep nursing budgets down hire other peoples already trained and paid for nurses.

  31. Actually, there are hospital systems which are collaborating with local nursing schools and universities on training nurses. The Inova hospital system in Northern Virginia is one example. Unfortunately, it has to be a large system in good financial shape to do so, and of course those systems expect to employ the trained nurses, so in a way it’s not fair to the poorer/more rural hospitals. But what else is new.
    ps another idea is for the schools to train retired physicians to teach at least some of the courses. Restricting themselves to PhD nurses is drawing a pretty small circle around this problem.

  32. Brian,
    You’re absolutely right. This is an easy one to solve. However, rather than have hospitals subsidize nursing faculty compensation, I would rather see it done by federal taxpayers. It could be another federal budget line item similar to NIH, CDC, FDA, and medical education subsidies to train doctors.
    It might well be that if we could turn out more nurses and NP’s, we might even save money as they take on more of the tasks currently performed by PCP’s while freeing up the latter to do more sophisticated work that would more fully utilize their skills and training.
    In the hospital setting, it is absolutely critical that we have enough nurses to provide good patient care. As one who has been a hospital patient on several occasions, I am keenly aware of the quality of the nursing care. I’m pleased and relieved when it’s good and not so pleased (and sometimes even scared) when it isn’t.

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