There's a lot of anger out there. Doctors are unhappy with Medicare reimbursement, managed care and malpractice lawsuits. Acute-care hospitals are mad at specialty hospitals. Employers are mad at insurers. Insurers are mad at hospitals. And patients are mad at insurers and employers.
But nobody is angrier, it seems, than nurses. They say they are underpaid compared with the demands of their work, the object of maltreatment by alpha-male doctors in the hospital setting and the recipient of much of patients' ire for poor-quality care and service. More importantly, they say, their opportunities for advancement have been stifled by administrations not willing to look to career advancement for their RNs. These are often cited-justifiably, in many cases-as the causes of the nurse shortage.
This year has witnessed an unprecedented level of activity on the nursing front, from congressional approval of a Nurse Reinvestment Act and California's unveiling of the first mandatory nurse-staffing ratios to big union contract wins and the Joint Commission on Accreditation of Healthcare Organizations backing nurse career advancement.
But nurses are still angry. They want better pay and working conditions now; they don't think the new federal law will do anything to promote that; and they want doctors to know right now that nurses are healthcare practitioners too. Some are even mad that Modern Healthcare's recent 100 Most Powerful People in Healthcare list had only three nurses on it (Aug. 26, p. 6).
So what is going to be done with all this outrage? Here are some ideas:
First of all, nurse organizations should get behind the Nurse Reinvestment Act, specifically backing the still-needed congressional approval of $137 million for its first year. This law is an important first step toward improving nursing quantity and quality. It includes scholarships, training grants, help for nursing faculty, grants to improve career ladder programs and a "best practices" program to improve nursing quality. A panacea? Hardly. But a starting point? Yes.
Next, nurses should stop looking to governments to solve the nursing crisis. Mandatory nurse-to-patient ratios aren't the solution. Although there have been studies of the relationship between quality of care and nurse staffing, nobody has shown that a set ratio of nurses is needed to achieve good outcomes. Other factors, such as patient acuity and quality of physicians, come into play. Also, government is good at passing mandates and poor at paying for them. We don't know how much California's nurse staffing law will cost, but Kaiser Permanente, which already had committed to a 1-to-4 nurse-patient ratio last year, will spend $150 million to $200 million alone to reach its goals at its 27 California hospitals. Who will pay the cost for other hospitals?
Instead, we all should look at the nursing crisis for what it is: healthcare's self-inflicted wound. Everyone bears a part of the blame. While hospitals are working overtime to keep doctors happy, nurses, who provide much of the front-line care, have often been ignored. Nurses ought to have a career path open to them, a way of advancing through training, experience and skill. They ought to be recognized for the increasingly sophisticated care they provide.
The other side of that argument, of course, is that nurses ought to be better trained and prepared if they are to provide such complex care. A four-year bachelor's degree should be standard for anyone called a registered nurse. Now fewer than one in three nurses have such a degree. When even more advanced training is available, take it.
Finally, nurses ought to channel their anger away from the picket lines and Capitol steps and toward pushing their own hospitals to give them a ladder to climb.