Dr. Dean on Nursing

[Salamandrina]

This may be more political than is common on this forum, but here is Democratic Cadidate, Howard Dean's ideas on nursing.


November 3, 2003
Supporting Nurses

Governor Dean today proposed a five-point plan to address the current and impending nursing shortage, warning that a failure to address this crisis threatens the quality and availability of health care for years to come.

"According to a recent government report, the nursing shortage will grow from 6% in 2000 to 12% in 2010, resulting in a shortage of approximately one million nurses. This drastic shortage comes at a time that we need nurses more than ever. This is a problem that this country can't afford to ignore--for the sake of patients and families, our health system, and nurses themselves." Governor Dean said in comments to nurses in Des Moines today.
"The symptoms are already with us. Many American hospitals have nurse staff vacancy rates in double digits--some are already over 20%. As the burden on nurses has increased, their health and safety on the job have become threatened. The stress and strain of large patient loads and low staffing take a toll with one result being injury rates higher than those in many heavy industries."

? Dean explained the nursing crisis facing the U.S. health care system, citing statistics that the average nurse in America is 44 years old and is also planning to leave his or her current job within a year, and hopes to retire within about 10 years. "We have the perfect equation for disaster: we aren't getting enough young people and too many of those at the height of their competence are leaving," Dean said.

"How do we solve this problem?" Dean asked. "Ask a nurse. I have. And that's how I developed my plan to address the nursing shortage, which will restore new health, vitality, safety, and vigor to the nursing profession."

? Governor Dean's plan includes:



1) Banning "mandatory overtime," so nurses aren't forced to work double shifts

2) Improving working conditions and compensation for nurses, by making it easier, safer, and more rewarding for nurses to care for their patients by setting federal minimum staffing ratios that ensure a safe number of nurses to each patient and by providing separate Medicare reimbursement for their services.

3) Opening the door to nursing by improving minority and male recruiting, offering nurses flexible scheduling and part-time work, and improving educational opportunities for nurses.

4) Giving nurses the help they need to do their jobs, by boosting support personnel and reducing paperwork

5) Expanding the role of and compensation for independent nurse practitioners.

? Dean also explained that in addition to the above five initiatives, he would work to support other goals to help alleviate the country's nursing crisis, including: bringing nurses to rural areas and other areas of need through the National Health Service Corps and by adopting scholarship and loan forgiveness programs; providing incentives for hospitals and other practice settings to subsidize nursing education and provide internship and residency opportunities for new nurses; increasing pay for nursing school faculty; engaging actively nursing leaders and front line nurses in the development of proactive policy and programs; and reducing medical errors by promoting doctor-nurse communication systems that respect the value, medical knowledge, and skills of nurses.

"Nursing is the heart of a health care system," says Dean. "If you doubt that, ask a doctor. And if any doctor doubts that, ask a patient. Day in, day out, when we are sick, scared, and in the greatest need of support, care, and technically competent help, nurses are the true helpers there, on the front line, relieving suffering and assuring safety. We know from hard research that when nurse staff ratios decrease, so does patient safety. The same happens when nurses are forced to work long beyond normal shift hours."

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[Newdoc2002]

Obviously a man who has never worked in a hospital. I think much of the current burden on nursing comes from government intervention (declining reimbursements to hospitals from medicare/medicaid, more paperwork and documentation, etc.).

If Medicare can't even pay for hospitals, nursing homes, doctors, PA's and NP's how will they find the money to pay nurses separately and think of the paperwork.

While it's great to encourage nurses into advanced practice, aren't you taking many of them out of traditional roles? Doesn't that just make the shortage worse?

There already is flexible scheduling and part-time. I can't comment on the mandatory overtime.

Most hospitals have minimum staff ratios. It's motivated by accreditation (sp).

Frankly, this is insulting to the intelligence of any nurse with any common sense. I found no real solutions in this diatribe that aren't feasible and haven't already been put in place.

Thanks Dean, you just earned my vote with political speak.

 

[Noeljan]

One of the reasons that I do not want to continue in nursing is quite simple, that most of the work I was made to do was not nursing. I think it's strange to read my Sigma journals or the ANA's journals and see these HUGE proposals to the nursing shortage. The problem is, they sit there and stress education and this and that....so you spend 4 years in a BSN program, then get on the floor to be treated like a non college educated janitor. I'm sorry but I do see how emptying sharps containers have ANYTHING to do with me, my degree or my work. Yes indeed this was part of our jobs at the hospital I started out at this summer. On top of that, you eliminate CNAs and LPNS, ok so now the RN has to do EVERYTHING. It's just ridiculous if you ask me, and the solutions are right in their face. Stop making the RNS do EVERYTHING. I am not a waitress, I am not a cleaning lady. But this is how you are treated on top of your nursing work. Why is that? I just don't get it. I wont do it, so I am not. That is the reason that I will not continue ever into more nursing.
Oh and the paperwork, get rid of secretaries too and don't pay a charge nurse.....Yes let me worry about checking for appointments all day long while caring for too many people....etc, etc, etc.......

 

[agent]

Why dont you just find a hospital that doesnt work that way.. they are out there.

 

[Noeljan]

Hey Agent
you have a good point, it was a county hospital (I was warned by nurses in other hospitals not to go there, but of course I didn't listen Anyways, for now I think it's best that I take some time away before starting a new job. I finished my BSN in May and am now finishing up my bio degree (I had a double major) I will taking the MCAT this year(well technically next year) so I figure I will wait until after the MCAT is over to start a new position. Too much need on my part for time off, and studying.

 

[Salamandrina]

Sorry I have taken so long to reply.

Originally posted by Newdoc2002
Obviously a man who has never worked in a hospital. I think much of the current burden on nursing comes from government intervention (declining reimbursements to hospitals from medicare/medicaid, more paperwork and documentation, etc.).

How does declining reimbursement to hospitals equate to too much intervention (at least that is what I assume you are trying to say when you say that the cause of such trouble is government intervention)? To me, the reduction in reimbursement is evidence of the fact that the system is failing and needs someone in office to address the issue.

If Medicare can't even pay for hospitals, nursing homes, doctors, PA's and NP's how will they find the money to pay nurses separately and think of the paperwork.

That is because the medicare system as it stands right now is inadequate, but Dean does have a plan to increase funding toward Medicare.

While it's great to encourage nurses into advanced practice, aren't you taking many of them out of traditional roles? Doesn't that just make the shortage worse?

Many of the shortages ARE in the advanced practice realm, so to answer your question, no -- it would be a shift in resources but they are not getting out of the medical profession.

Most hospitals have minimum staff ratios. It's motivated by accreditation (sp).

But are the adequate?

Frankly, this is insulting to the intelligence of any nurse with any common sense. I found no real solutions in this diatribe that aren't feasible and haven't already been put in place.

So you are saying, that there is nothing anyone can do to make the working conditions of nurses better? There can't possibly be better compensation, responsibility sharing, opportunities, etc.?

Man, that is some kind of a bleak world view you've got there. You must forgive my optimism in hoping that you are wrong.

 

[Gator05]

Here are some perspectives from a medical student:

1. Nurses are not treated well by the system. 12 hours are simply too many; they should be optional, but the trend should be toward shorter, more civil shifts. Of course, flexibility and options for nurses at different life-stages (part-time mothers, shifts appealing for those post-retirement, those seeking more income, etc).

2. Just like teachers: pay them more. Aim for at least the 50th percentile of all jobs requiring a bachelors degree. And not through "increased medicare/medicaid funding"; this gets lossed in the healthcare industrial complex which already robs those actually providing the healthcare. See numer 3.

3. Tax deductions for nurses in greatly needed areas, such as critical care nursing. Probably best accomplished at the state level.

4. Allow nurses to officially subspecialize. L&D nursing is quite different from CCN, which is different from neonatal nursing, different from ED, different from OR, etc. Instead of completing a master's degree, allow 6 months of extra training in a nursing subspecialty. Pay them for this, the way medical residencies are financed. Oh, and increased pay-demand for nurses holding a subspecialization. Allow grandfather/mothering in, for nurses who have >3 or 5 years of experience in the area.

5. Create more training opportunities at university nursing programs. Ours fills each year, with waiting lists. This should not be.

6. Money should be dumped directly into nursing programs in the way of grants, not as "federal programs" or new departments. Perhaps a grant review committee, to ensure the grants are properly allocated.

7. By creating NP's, you drain the pool of RN's. Not conducive to increasing the supply of RN's.

 

[Salamandrina]

Gator05, I think you are right on with the majority of your ideas.

The only one that I differ on is the creation of NP limiting the pool of RNs. I think that in order (for me) to stay satisfied with my career, I would need to know that I could grow into a new position. I wouldn't was to be an RN at 23 and an RN at 63.

There should be plenty of room for those that burn out to change position while still serving in a care-giving capacity. Should all RNs become NP? No. But those that do want to should be encouraged to do so.

The solution is to draw more prospective into the nursing field, not to pigeon hole those that are already there.

 

[Gator05]

Great point, Salamandrina. I must say, I've been impressed with most mid-level practitioners I've met so far. They've plenty of experience to back up their desire to foray into a different level of care.

However, I worry about the watering down of these requirements; already, the healthcare experience required of applicants before applying to PA school is becoming comical in some instances. I hope these are idiosyncrasies, and not trends.

 

[Razzy]

Originally posted by Salamandrina
November 3, 2003
Supporting Nurses

"Governor Dean today proposed a five-point plan to address the current and impending nursing shortage, warning that a failure to address this crisis threatens the quality and availability of health care for years to come. "

"The stress and strain of large patient loads and low staffing take a toll with one result being injury rates higher than those in many heavy industries."

.....I say, the stress and strain in having to work with control-freak, ultra-authoritarian MD's that only want a nurse to think on her own if she asks him first is another, the stress and strain of dealing with very demanding families and patients as "customer servants" rather than health care professionals is another, the stress and strain of working with no identity (ward clerks, CNA's, LPN's, RN's are all called nurses), the stress and strain of little or no support from some managers who won't even stand behind her nurse's decision-making.....this list could go on and on, but I realize that the patients understand the low staffing thing, so lots of votes there too. It is a start.

"the average nurse in America is 44 years old and is also planning to leave his or her current job within a year, and hopes to retire within about 10 years."

.....I say, why is this? How common is it for NOT highly paid professionals to retire at age 54? The job has become undesireable for many. Who is asking the nurses about "the big why"? A common phrase is "there is no shortage of nurses, just a shortage of nurses willing to work in these conditions". Is he saying that he has the answer? How can he, if all the researchers, and there have been many, aren't able to make a dent? It is good for us though, that he is speaking publically about it, because I don't think the public at large realize the situation at all. The only place we read about it is in the nursing journals, so I suppose that means that the nurses are supposed to fix it themselves, even though we are not the policy makers.

"Improving working conditions and compensation for nurses, by making it easier, safer, and more rewarding for nurses to care for their patients"

...I say, OF COURSE, but this is only a start. Physicians and the public need to realize that nurses have a practice of their own, and they need to be "allowed" to practice with autonomy whenever possible. What other professionals are allowed no autonomy, and remain fulfilled by their jobs?

"Giving nurses the help they need to do their jobs, by boosting support personnel and reducing paperwork"

.....I say, YES! Allow us the time to NURSE our patients! I don't think they should pay us to pass trays, clean units, stuff charts, make snacks, deliver tea and graham crackers, wash IV pumps and poles, scrub instruments used in ER (or anywhere other than the OR). And this is but a partial list!

''engaging actively nursing leaders and front line nurses in the development of proactive policy and programs; and reducing medical errors by promoting doctor-nurse communication systems that respect the value, medical knowledge, and skills of nurses. "

.....I say, Yes, this is a good start: all facilities need a physician behavior policy! I'm all for promoting doctor-nurse communication systems, and most docs are pretty great human beings, but the ones that aren't can really contaminate even the good ones .

"Nursing is the heart of a health care system," says Dean. "If you doubt that, ask a doctor. "

.....I say, this really depends on the doctor. I appreciate that Mr. Dean can articulate this, if he means it. I mean, there are a lot of nurses casting votes. We all know his statement to be true, but how many docs is he reaching?

Don't get me wrong, it is nice to hear someone in a position to actually do something show a spark of interest...it's just that the problem has been simplified for such a long time now, and I'm just really ready for someone to state that they understand the condition fully rather than the usual treat the symptoms approach.

 

[fab4fan]

While it's great to encourage nurses into advanced practice, aren't you taking many of them out of traditional roles? Doesn't that just make the shortage worse?

Yeah, heaven forbid they should step out of the handmaiden role that so many doctors still pidgeon-hole them into.

I am glad Dean is making a stand on mandatory overtime. It is dangerous, putting patients and nurses at risk. It's disappointing that physicians don't see this and take a stand on it; their patients are being put at risk...you'd think this would concern them.

Most hospitals do not have a minimum staffing ratio; maybe they do in a few states (CA, for example), but even if they do, then mandatory overtime is often used to maintain staffing numbers, so it really doesn't do that much good.

There already is flexible scheduling and part-time. I can't comment on the mandatory overtime.

This really isn't true, either. Employers are becoming less willing to offer flex schedules, and many places (at least in my area) won't hire part-time.

I'm also encouraged to see him address the thorny issue of physician/nurse relationships. One of the many reasons nurses have left hospital based care is due to the lack of respect from doctors. Verbal and physical abuse is a real problem, and only recently have some hospitals started to really look at this problem. Until recently, it's been one of those things that hospital admin. dealt with by looking the other way.

 

[MichaelSavage]

The only thing I don't understand is the nurses who work 3 12 hour shifts a week complain about having 3 shifts in 3 consecutive days. How is this so bad, MDs do this everyday they work and it is not so bad. I don't want to hear a nurse complain about working a 12 hour shift especially if I am pushing 24 hours at the time. Nurses may have many real complaints that deserve consideration but this is not one of them.

 

[Ross434]

yeah but are nurses paid what they're worth? no, so they don't feel like working 24/7

 

[agent]

Originally posted by MichaelSavage
The only thing I don't understand is the nurses who work 3 12 hour shifts a week complain about having 3 shifts in 3 consecutive days. How is this so bad, MDs do this everyday they work and it is not so bad. I don't want to hear a nurse complain about working a 12 hour shift especially if I am pushing 24 hours at the time. Nurses may have many real complaints that deserve consideration but this is not one of them.

agreed, 3 12 hr shifts is cushy.

 

[Califlower]

Working 12 hr shifts can take toll on a nurse. While I do agree that having three 12 hr shifts can seem really flexible and give you a 4 day weekend to be joyous about, I can understand why some nurses would bitch about it. True, many residents and MD's and what nots have to take on many more 12+ hr shifts, but that doesn't validate that for other careers as well. Many of these nurses are old (it is an aging workforce with an average nurse's age being in the mid to late 40's) and most likely have families, and children, who do require care every day, not just the four off days of the nurse. So that might be the big concern. I know most (of course that is a generalization as there are more and more non-traditional med students these days) residents who do take on mega work hour loads are in their late 20's and early 30's. Being 45 + years old and being on your feet for 12 hrs seem tougher. Of course there's just some real whiny people out there too. But just wanted to state that it might be a problem (causing more burn-outs of nurses, attributing to the nursing shortage).