"The Nursing Shortage!" These words resonated across the television set recently. I asked myself what caused it and why can’t it be fixed? I reflect back over my 25-years in nursing, thinking back to times when there was no shortage.
Early on, the hospital-based nursing programs focused on teaching clinical skills; some programs even required that the nursing students be scheduled as staff on a team. In contrast, the degree programs focused more on providing a general education, with less emphasis on clinical skills. Hospital-based schools phased out and ADN / BSN programs grew in number. Many LPN programs closed. New graduates were coming into the worked force lacking in clinical skills, and the hospitals that hired them were unable to provide the clinical support they desperately needed. In the 1970s and 1980s the delivery of care changed from Team Nursing to Primary Nursing.
Primary care was a novel idea that sounded good on paper. On admission a patient would be assigned a primary care RN who would follow this patient throughout the hospitalization. This primary nurse was responsible for the care provided to this patient. At about this time LPNs were laid off and the nursing assistants were given less responsibility. The RNs, however, became burned out; they requested shorter workweeks.
Discharge planners, social workers and clinical nurse specialists were laid off and RNs were then required to perform even more tasks. The nursing shortage began.
I have to ask:
- Should we go back to team nursing?
Perhaps we could modify the system.
- Should we re-open the LPN schools and use more LPNs on our teams?
Definitely. Getting as many nurses into the work force as quickly as possible should be a priority. LPN schools can educate nurses in 1 year vs. 4 years for baccalaureate program.
- Should we hire and train more nursing assistants?
Yes. Each hospital should make an effort to recruit and train nurses aides to assist the nurses.
- Should we recruit nursing students into internship programs?
Why not? Medical students work on teams with Interns and Residents.
- Can we afford to sacrifice patient care for something that clearly does not work?
I became a nurse because I wanted to care for the sick. How can that be accomplished if nurses are being asked to perform so many tasks that should be delegated to others?
I ask you to look at these questions and see if you come up with the same thoughts. Maybe it is time to look back in order to look forward.
Nancie Cummings, MSN, APRN-BC, FNP
Program in Heart Failure
Beth Israel-Deaconess Medical Center