TAN Issue: March/April 1998: News: Noted Economist Predicts Nurses will be in Demand

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ANA conference looks at nursing workforce as a "commodity"

The uninsured, managed care and the nursing workforce as a commodity were among the national health care issues explored at ANA's Workplace Advocacy and Economic Leadership Development Conference. Roughly 100 nurse leaders, including state nurses association executive directors, attended the two-day event in Washington, DC, in February.

In his keynote speech, noted economist Stuart Altman, PhD, discussed the complexities of attempting to predict trends in health care. "This prediction business is a tricky business," said Altman, professor of national health policy at Brandeis University and a long-time tracker of nursing workforce trends. "They (futurists) often tell you what they want the truth to be."

He did, however, point to a climate in which consumers are increasingly distressed about the quality of health care. Because of their concern, Altman predicted that nurses once again will be in demand. (See related article on nursing shortage, page 32.) He estimated that by the year 2000, hospital profit margins will rise by 3.5 percent, which is considerably less than the 10 percent suggested by other economists.

Altman also expressed his concerns about the future of health care. "Let's not forget about two issues that we really need to worry about. One is that as we start banging around on managed care and socialized data, there is the real possibility that health care costs are going to start growing again," he said. "And second, we're very close to having 50 million Americans without health insurance. While we can pat ourselves on the back for being more efficient, we need to worry about this problem."

During the second day of the conference, Chris Kovner, PhD, RN, FAAN, associate professor at New York University, and David Ward, PhD, assistant professor at Medical University of South Carolina also looked at the uninsured, RN demand and managed care.

"I tend to fall into the trap in thinking that insurance is a magic cure-all, and that if in fact we insured everybody, all are problems would go away," Ward said. "Access to health services has to do with a lot of other factors. You can live in an area and have the best insurance in the world, but if there are no providers in that area, it doesn't do you any good."

He reported that while estimates of the cost of financing the uninsured vary, many place it roughly at $20 to $40 billion per year. Coming up with enough money to cover the cost will be a tough challenge, Ward said. One finance method involves increasing the federal excise tax on cigarettes by $0.75, but that would only generate about $10 billion a year.

Kovner reviewed the findings of the U.S. Department of Health and Human Services 1996 National Sample Survey of Registered Nurses (See the Jan/Feb issue of The American Nurse). She also raised some important workforce issues.

"How much government regulation do we want in our lives as professional nurses?" Kovner said. For example, she questioned whether RNs want continued government involvement in licensing, and in determining who the workforce should be in nursing homes.

Employer-employee relations and competition with other health providers also will be two big issues, Kovner said. RNs may want to consider taking back some tasks that have been designated as "non-nursing" tasks. Some of them are nursing, and they give nurses a chance to spend time with their patients, she said.

The conference was supported by the pharmaceutical company GlaxoWellcome through the American Nurses Foundation.