And, You Think Yours is a Long Commute!

I suppose because it is something out of the ordinary, I am fascinated with the idea of nurses traveling long distances to their jobs. And, I mean long distance to the extent that air travel is required. I first read about this new (to me) work/living arrangement about three years ago, although it had been a lifestyle for many nurses for several years before that.

I am not referring to travel nurses in the traditional sense. Not those who travel to and live in various cities for work assignments that last from four to 52 weeks, but those who have established permanent homes in one state and who, every week or so, fly by commercial airliner to jobs in another state. Known as sleepover commuters, they’ve chosen to trade two-hour daily car commutes, in some cases, for two-hour flights approximately every eight days.

This seems to be most prevalent among nurses working in California. The high cost of real estate in California has been the impetus for nurses to look outside the state for more affordable housing. Many have found they can purchase a home in Nevada, for instance, for one-third the cost of a comparable one in some areas of California.

The lower cost of living enjoyed in states bordering California unfortunately matches up with lower wages in those states. It is that factor that has put nurses in the air, flying to higher paying jobs in metropolitan cities in the Golden State.

In the city where they are employed, RNs often share no-frills apartments with other long distance commuters or bunk with family or friends. They work about eight days at a stretch and then fly to their homes for a similar stretch of time off. Their salaries are substantial, often augmented by overtime and on-call pay.

As might be expected, this unconventional lifestyle is most popular with RNs who are empty nesters or childless. Some report that they are spending about $4,000 more annually than when they lived near the hospitals that employ them but feel they will come out ahead in the long run based on the high-salary/lower-cost-of-living comparison and their real estate investments. Many also feel their quality of life is better away from the rat race of urban living.

Not that it’s all about the money, but I’d be curious to know how the downturn in our economy, along with the struggles of the airline industry, have affected the commuters’ bottom line.

I’ve never known a nurse who is or has been a sleepover commuter. If you fall into that category, I would like to hear your tale. Share the positives and negatives of that lifestyle, what you liked best about it and what was the most difficult aspect of it. I (and, I’m sure other readers) am eager to hear all about it.

New Legislation Tackles the Nursing Shortage

We’ve all done it. Some issue that has caused us to fret, fuss and fume for awhile, results in the frustration bubbling to the surface and, then, whoosh!, it all spews out like a geyser. That happened to me recently when, after being hit with statistic after statistic supporting the reality of the nursing shortage, I realized that hardly anyone outside the medical realm was talking about it. The public should be really concerned about this, I thought. Why aren’t all health care consumers as outraged (and worried) as I am?

I arbitrarily decided it was due to a lack of publicity that focused on the problem. The public isn't complaining because the public doesn’t know about it. I was particularly up in arms over the fact that public policy gurus and our government haven’t put a plan in place to infuse the nursing workforce with new talent. I continue to believe that the media could do more and that Washington should do what they should’ve been doing for more than a decade—appropriating funds to beef up our nursing programs, increase wages for nursing educators and promote nursing as a career in order to attract more instructors and students.

But, as so often happens, as soon as I spouted off about something needing to be done—and posting it on the Internet—I learned that there has been some recent legislative action aimed at the nurse shortage problem. I’m not in total agreement with some of it, but I at least know that the legislature is aware that there’s a problem. I had been wondering.

The Nurses Bill (HR 5924), passed in early August, authorizes 20,000 visas per year to bring foreign-trained nurses into the U.S. The nationwide shortage of nurses currently stands at upwards of 115,000 and, according to information supporting this bill, is projected to be a shortage of one million by 2020. That number is double the largest projection I have heretofore heard. And, I thought I was tense when I heard the number would be 500,000!

There is a good bit of controversy concerning the utilization of foreign nurses. The objections include the (perceived) lack in quality of education and skills those nurses bring with them and that their leaving their home countries puts that country in a situation of having its own shortage.

More encouraging is the portion of the bill that authorizes grants to U.S. nursing schools to increase their enrollment and create new training programs. The amount of money directed to these grants, however, is unknown to me, so I’m not yet certain just how excited I should be.

I am also pleased to learn that the governor of Michigan has addressed the nurse shortage on a regional level. Last week she signed into law a bill that directs $1.5 million to partnerships between 10 hospitals and 10 colleges of nursing for the express purpose of increasing the numbers of nurse educators. As in many areas of the country, Michigan’s nursing schools have long wait lists due to inadequate numbers of nursing faculty. The funds will be specifically used to put nurses without degrees into accelerated degree programs as a means of expanding the force of clinical nursing instructors. It is projected that the program will produce 42,000 nursing graduates over a period of five years.

I am still of the opinion that enough is not being done on a federal level. But, something is being done and I suppose I should be grateful for small advances.

Are positive steps being taken in your state that would help put my mind at ease? If so, please report what’s going on there.

Why is the Public Unaware of the Nursing Shortage?

The nursing shortage began a decade ago and, although statistics reveal an improvement in the situation recently, the projected deficit in the numbers of nurses needed and the actual numbers practicing will be 285,000 by 2020. That deficit represents a shortage three times larger than any in the U.S. in the last 50 years. Without trying too hard, we can visualize the next 12 years as a speeding locomotive and see 2020 bearing down on us with alarming rapidity. It is just plain scary, to put it simply. But, it quickly gets worse. Just five years later, in 2025, the projected shortage will have nearly doubled to 500,000. Even experts in health care economics, who have their fingers on the pulse of this problem, admit that the impact of such a shortage is difficult to comprehend. Yet I, an admitted news junkie, have heard or read almost nothing about this health care exigency in the mainstream media.

The authors of a recent study associated with the National Survey of the Public about Nursing expressed concern about the apparent apathy regarding the shortage expressed by our government. That despite the nursing shortage having been identified 10 years ago, there remains no national commitment to ensure adequate numbers of nurses to cope with the expected stress on our health care system due to the aging baby boomer population. I’ve mentioned it in this blog before, but in an interview with Peter Buerhaus, Ph.D., RN in 2006 he said that to solve the shortage, Congress needs to appropriate to the effort $1 billion, "which is nothing." Considering that the U.S. spends $10 billion each month on the war in Iraq, according to the Congressional Budget Office, a measly billion to protect the health of this country’s citizens does almost seem like nothing.

What is it going to take to get our government on board to do its part to fix this problem? This is going to be a national disaster in 10 short years, maybe sooner, if action isn’t taken now. Why isn’t the fire being put out now while it is still smoldering instead of waiting until it’s a raging inferno? And, why isn’t the catastrophic enormity of this problem and the calamity that is likely to result from it being splashed all over television and newspapers?

It’s a tall order, but do any of you have answers—or opinions?

Puzzling: Nurses Admired by the Public but Fewer are Entering the Profession

The nursing profession has long been highly regarded by the general public, as evidenced by the results of polls through the years which continue to show that, where respected and trusted professions are concerned, only teaching surpasses nursing in the public’s estimation. The public’s admiration for nurses, however, has not translated into higher numbers of individuals willing to enter the profession. A way must be found to parlay the high regard factor into a boost in the size of the nursing workforce.

It is also vital for the profession to figure out a way to attract a younger demographic. Every time I read or hear about the age of the nursing workforce I am astonished. In 2007 the average age of working nurses was 43.7. It is estimated that by 2012 half of us will be 50 or older. How in the world did this happen? Yes, I know about the lack of instructors and, as a result, the long wait lists for nursing school admission but, without a shred of any data to back me up, I would’ve thought there’d be more young blood coming in to at least balance out the gray-haired set.

Skewing that assumption on my part is the fact that students entering nursing school are no longer the fresh-faced 18-year-olds that were in the majority a few decades ago. Career changes are bringing older students into nursing programs and that does little to affect the average age in a positive way.

Most young people rarely have the opportunity to see hospital nurses in action. They may have an idea, in general terms, of what a nurse does but nothing concrete. So, while the idea of nursing may have some appeal to them in the abstract, most never go beyond that point to investigate the possibilities a nursing career might hold for them. Often their exposure to the profession is limited to what they see on TV in medical dramas, which, according to a recent study, does not affect their opinions of nursing negatively.

I believe in the positive power of TV because I am a product of the influence of TV medical dramas. I was a teenager—and obviously impressionable—when Dr. Kildare and Dr. Ben Casey came on the scene. Now it seems a bit shallow to admit but my watching those shows is the extent of my investigation into choosing a suitable career for myself. I sat in front of the TV every week, watched the drama unfold and said, "Well, that looks exciting. I guess I’ll be a nurse." Lucky for me, it turned out to be a good fit.

"As we move to the future, we must consider strategies that engage the public to move beyond high regard for nursing and into careers. Efforts to expand the capacity of nursing education programs and continued efforts aimed at increasing public awareness of the career advancement and salary opportunities in nursing are all important."

The statement above comes from a conclusion garnered from results of the Survey of the American Public about Nursing (Buerhaus, et.al. 2007). I would’ve liked some specific ideas for action spelled out and I’d also like to know what efforts to increase public awareness are now underway that, according to the ‘committee,’ need to be continued. I’d also like someone to explain to me how, if indeed public awareness increases interest and more people choose a nursing career, they will be educated. Let’s say increased interest occurs and the numbers of nursing school applications swell. Great! But, wouldn’t we still be burdened with the problems of not enough faculty, not enough clinical opportunities and long wait lists? How does increasing interest, therefore, solve anything? It seems like that old chicken and egg dilemma to me. It makes my head spin.

Would you recommend a nursing career to young people? Why? Why not?

Choose Your Words Carefully

"Here’s your pain medication, Mr. Smith." Change the patient’s name and that is a phrase I’ve spoken countless times in my nursing career. Most of us have, I’m sure. It never occurred to me that those words might affect the patient negatively. Quite the contrary—I thought, with that statement, that I was delivering good news. Wrong. Studies have shown that patients in a stressful situation will often misinterpret simple figures of speech or focus solely on any word with a negative connotation—in the case of my statement, the word pain. Ideally, I should have said, "Here’s some medicine to help you get comfortable, Mr. Smith."

I have always made an effort to put myself in my patient’s place but I have to admit that I have not given much consideration to the possibility that a patient would misconstrue the meaning of, or react negatively to, such simple statements that are so commonly used in the medical arena.

In his recent article on word choices (AJN, March 2008) Paul W. Schenk, PsyD, cited the example of a five-year-old who, prior to a blood draw, was told she would feel a stick. The child did not know that the word stick was a term that described a needle prick. She later told her mother that she thought she was going to be hit with a stick.

There are so many possibilities for misinterpretations that it would be difficult for any one nurse to foresee every one of them, but Dr. Schenck recommends a few specific steps that can help sidestep the problem of causing unintended negative responses by our patients.

For one, choose affirmative phrasing that eliminates don’t and emphasizes do. Rather than, "Don’t tense your arm muscle," say, "Let your arm be very limp." This is simply stating what you’d like the patient to do instead of what you don’t want him to do, which often elicits a response that is exactly opposite the desired action.

I am surprised to learn that within the often heard and spoken statement, "Just try to breathe normally," three words—just, try and normally—are considered language traps.

Briefly, just is a limiting word. It can be interpreted to mean just do this one thing (relegating to insignificant status other personal health-affecting actions the patient needs to take). To some patients, the importance of any instruction given them can be minimized when preceded by just. Also, using just as the lead word in a health-related instruction might indicate to the patient that the thing they’ve been instructed to do should be easy. When the patient finds it is not easy, anxiety can result. Ideally, just should be omitted from the beginning of such sentences.

The word try as a prelude to an instruction may convey to the patient that he is not expected to succeed, so try is another word to eliminate as a lead-in. "Try to take this medication at the same time every day," would be better stated as, "It is important to take this medication at the same time every day."

Asking a patient to breathe normally is another language trap to avoid. Physical functions, such as breathing, that are controlled by the autonomic nervous system will be altered if conscious attention is drawn to them. Requesting the patient to breathe normally guarantees that he will be unable to do so. Accurate measurement of a physical function requires avoiding talking about the function.

Dr. Schenck affirms that, as with any undesirable habit, persistence is required to break bad linguistic habits and learn, instead, habits that improve better communication. A good first step is to focus on training your ear to pick up on language traps. He recommends utilizing TV sitcoms, because they are generally rife with things you shouldn’t say and you can listen without having to respond. That accomplished, he suggests choosing one language trap and working on it for awhile before moving on to another.

Dr. Schenck’s article contains several good tips and other information for improving communication that I haven’t touched upon here. There is much to be learned by seeking out the March issue of the AJN and reading the entire piece. The skills he details would be similarly helpful in communicating with our families, friends and coworkers.

I’m going to start my bad habit transformation by concentrating on replacing don’t with do. What language change are you working on first?