December 2002 | January 2003 AWHONN Lifelines 479

i If you’re like me, you’re somewhat tired of

hearing about the nursing shortage. Yet, I keep

coming back to it, as I find it a pervasive sub-

ject and, frankly, of fascinating importance. It’s

hard to believe that we’ve had at least six prior

shortages starting as early as 1918. One would

think that by now we would be expert in han-

dling such difficulties, but we are not. Maybe

that is what keeps my interest level high.

The current situation is basically different

from the prior ones in that our supply of

potential nurses, primarily women, is inade-

quate. According to the Robert Wood Johnson

(RWJ) Foundation’s report on Health Care’s

Human Crisis: The American Nursing Shortage,

the current dilemma reflects competition from

other career opportunities for women who find

nursing to be less and less attractive, and “until

nurses gain a real place at the decision-making

table, we’ll continue to have a shortage of nurs-

es.” Other factors contributing to the shortage

include an aging nursing workforce, failure to

attract more men and minorities into nursing

and increased health care demands by the

aging baby boomers.

We can no longer afford wishful thinking.

We must look at situations as they actually

exist. For example, one of the most severe

shortages occurs in California which ranks

49th out of 50 states in nurse-to-population

ratios. There are 265,000 RNs in California

with 90 percent working. Some “experts” claim

that the other 10 percent should be recruited

back into the workforce and this would allevi-

ate the problem. Wrong! When investigated, we

find that older nurses and those who are physi-

cally incapacitated tend to maintain their

license even though they are incapable of

working, that nurses who move to other states

maintain their license, in case they return, and

that RNs who are well ensconced in other

fields keep their license, mostly for nostalgic

reasons. California does not have a 10 percent

pool of potential RNs; its workforce is working

pretty close to capacity. Other states may not

have as severe a shortage, but the U.S.

Department of Health and Human Services

reports that the country as a whole will have a

22 percent shortfall of nurses by 2015. We must

do something now.

NursingShortage

Barbara PetersonSinclair, MN, RNC,OGNP, FAAN, is anacademic specialist innursing programdevelopment atCalifornia StateUniversity Northridge.

Revisited

The

We can no longer

afford to have only 37

percent of nurses’

time in direct patient

care and a whopping

33 percent of their

time in documentation

In addition to inadequate numbers is the

fact that current policy initiatives are not

focusing on the challenges necessary to meet

nursing needs within overall health care deliv-

ery. The first challenge is to create a practice

setting that attracts and retains nurses. The sys-

tem must be redesigned to accommodate elim-

ination of waste and redundancy—we can no

longer afford to have only 37 percent of nurses’

time in direct patient care and a whopping 33

percent of their time in documentation.

Advanced technology must be utilized to its

fullest as a means to assist the provider. The

environment in which care is delivered by

nurses must be improved including physical

plant, scheduling and especially relationships

with other team members.

The second challenge involves a more

responsive educational system that functions as

a whole rather than separate entities. The sys-

tem must address the needs of those currently

in the profession and also appeal to a new gen-

eration of nurses. Of equal concern is the need

for service to accept its educational responsibil-

ities and assist in the development of creative

partnerships with education. A third challenge

involves moving nursing into a strategic level

in which nurses’ performance is recognized as

value added for health care outcomes, con-

sumer satisfaction and financial stability.

The RWJ report finds that sustainable solu-

tions to the nursing shortage will require col-

lective efforts by all concerned groups. With

goals of re-envisioning the nursing profession

and helping it to establish a full partnership with

the profession of medicine, the report suggests

the establishment of a national nursing work-

force measurement and data collection system;

creation of a clearinghouse of effective strate-

gies to advance cultural change within the

nursing profession; and the formation of a

National Forum to Advance Nursing, an inde-

pendent body that would draw together a wide

range of interested parties to work on chal-

lenges and recommendations. How exciting!

However, I believe that all of us must

assume some responsibility in this time of crit-

ical need. At the workforce level, we must share

opinions of situations that enhance or retard

nursing function, contribute ideas to improve

situations and willingly try new things. On the

overall nursing level, we must demand more

action, more money and more influence. We

cannot do this alone. Talk to your nursing

leaders; yes, but also talk to your physician and

health care system administrators, your

patients, your community and your legislators.

Let everyone know of the critical status of

nurses and, just in case, recruit one new nurs-

ing student.

480 AWHONN Lifelines Volume 6 Issue 6