How and When Will More Nursing School Applicants be Accommodated?

Once again, a painful truth hurts more because it has become personal. What now? It’s the shortage of places in nursing programs for qualified applicants. My friend, Sue, has been a middle school teacher for over 20 years. About 8 years ago she was diagnosed with a life threatening medical condition that required vigorous and debilitating treatments. The treatments did their job and Sue is now hale and hardy.

Her two-year up close and personal experience on the receiving end of medical magic got Sue thinking that maybe she’d like working in the medical field. Back in the classroom, however, she was consumed by the myriad responsibilities that go along with teaching, putting the idea of changing careers on the back burner. Then, a series of administration changes at her school brought about a decidedly unpleasant atmosphere at work that made the decision to switch to nursing an easy one.

Sue has two master’s degrees but not much in the way of a science background, so while still working full-time, she took on a heavy science curriculum in night classes at her local university, acquiring the prerequisites she’d need before applying to nursing school. Sue is nothing if not conscientious, so studying occupied the bulk of her time away from teaching and she earned A grades in almost every class, with a high B or two along the way.

Of course, Sue made a plan. She identified nursing programs that were a good fit for her and began the application process. This was to be her last year of teaching; she’d use the summer to relocate and be ready to start nursing school in the fall. She is single, self-supporting financially, with no immediate family to depend upon should she find herself in a bind. Planning ahead for medical coverage while in school was vital, so that was a big (and limiting) factor in her decision to apply to certain schools in certain states.

In an email last week Sue shared the news that she was not accepted into her first-choice program. There were 450 applicants for 45 openings. I’d be willing to bet that plenty of the 405 applicants left out in the cold, so to speak, are equally as highly qualified as Sue.

I’m sure that in many ways Sue’s story is no different than that of others who are traveling the same path, hoping for a chance to have a nursing career. But, knowing her as I do, I want what she wants and, for once, I’d like something to be easy for her; for all the puzzle pieces to fall into place without her having to jump through hoops and needing to change plans at the last minute. She has fallback plans and she’ll pursue them but how nice it would’ve been to have everything settled early on.

And, the 400-plus left to do no more than dream of being a nurse at a time when this country is desperate for their talents—well, that’s just sad.

New Administration Conducts Summit Addressing Health Reform

Things might be looking up for the nursing profession, thanks to the new administration in Washington. On March 5, 2009, American Nurses Association (ANA) president, Rebecca M. Patton, RN, MSN, CNOR was among 100-plus invitees in attendance at the first White House Forum on Health Reform.

Health care professionals, lawmakers and other stakeholders were brought together at the forum to express specific concerns and to highlight issues each considers of paramount importance.

The following issues were included on the ANA’s agenda:

 The need for a nursing workforce investment plan to combat the nursing shortage.
 Full utilization of advanced practice nurses as a cost-effective method to promote wellness, coordinate care and manage chronic illness.
 Promoting recognition that safe staffing is essential by the reintroduction of legislation that holds hospitals accountable for unit by unit staffing plans, based on each unit’s unique needs and developed with input from the nursing staff.
 The need for more public reporting to give transparency to clinical measures and health outcomes of providers.
 Separating the cost of nursing care from that of room and board. Nursing care should be set apart and billed for separately.

Speaking at the summit’s closing session, President Obama validated the need for nurses and nurse educators and the essential role nurses play in the health care system.

Patton told ADVANCE for Nurses, “To me, it looks like we at least have a president who gets it.”

Thank goodness! Nothing as big as solving our health care woes can be accomplished overnight and the president has asked us to be patient on many fronts. I’ll try, but my frustration often precludes patience. I am simply eager—perhaps even desperate—to see significant progress in educating greater numbers of nurses and for a greater general recognition of and appreciation for the crucial and weighty contributions nurses make to the health of our country’s populace.

It appears the Obama administration is on the right track to effect positive change for the nursing profession and I, for one, am not hoping to see our president fail.

Back Injuries Affect Nurse Workforce Numbers, Patient Safety, Health Care Costs

Are there nurses out there somewhere who’ve managed to avoid a back injury over the course of their career? I know that during my nursing education proper body mechanics and safe methods for lifting/moving almost anybody and anything were stressed over and over. Our instructors kept a close eye on us and we were summarily called to task if we were seen putting our musculoskeletal systems at risk.

Despite the rigorous reinforcement of the fundamentals of lifting, however, sometimes a situation of an urgent nature will present itself. The sort of situation that calls for action, where there’s no time to pause a moment to consider one’s ideal positioning or to put a lift apparatus into use. Such a situation was the genesis of my back injury. I was luckier than most. My herniated disc responded well to anti-inflammatory drugs and exercise therapy. I was asymptomatic the majority of the time with a flare-up occurring perhaps once every couple years. Down the road, several years after I left clinical nursing, the disc ruptured and required a laminectomy—with an excellent result, I’m happy to report.

My RN friend, Joan, has not been so fortunate. She suffered a work related back injury and had the first of four surgeries when she was only 24. For most of the ensuing 28 years she has had to deal with persistent back pain. She phoned me one day several years ago and told me to open the newspaper to the obituary page. “Do you see the obit for Jane Doe [a nod to HIPPA]?” she asked. “Yes, I see it,” I replied. At this point I must explain that Joan is quite comedic, something that is not always easy to convey via the written word, where inflections can’t be heard and interpreted.

“Well, she’s the patient I was lifting when I damaged my disc. I’ll bet she has had a better and more pain free 16 years than I’ve had!,” she said in mock indignation. I pointed out that while it might be true that Mrs. Doe had had perhaps several pain-free years, at least Joan was still among the living. “There are days when I don’t consider that a good thing,” she said.

In the state of Texas, an activist representative, Senfronia Thompson, has authored and introduced into legislation a bill aimed at reducing workplace injuries for nurses and other health care workers. The bill requires hospitals to have safe lift policies, such as providing lifting equipment and providing training to employees to avoid debilitating back and other musculoskeletal injuries.

Data collected in 2007 shows that health care workers nationwide suffered 66,060 work-related musculoskeletal injuries. These workers missed 43,000 days of work that year, the third most of any occupation sector.

That nursing is significantly made up of an aging work force that is burdened with caring for an increasingly obese patient population, nurses are at increased risk for incurring a musculoskeletal injury. Reducing these injuries is safer for the patient and will serve to keep nurses at the bedside. The financial ramifications of injury reduction are huge. An analysis of 723 such injuries at University of California hospitals in 2003 estimates the injuries cost the University system between $8 and $11 million.

Kudos to Rep. Thompson for taking action on the issue of protecting health care workers. If they haven’t already, other states should follow suit.

What is your state or hospital doing to prevent such injuries?

Shortage of Faculty Exacerbates the General Nursing Shortfall

I would be willing to say that discussions of the nursing shortage have been overdone if there were evidence of progress in solving the problem or if I weren’t so concerned that there won’t be a nurse to care for me when I need one. Problems always seem more monumental when one is affected personally and that’s where I find myself. My health is good—for now. I have the dubious distinction, however, of being a member of the oldest Baby Boomer class, so who knows how much longer I’ll enjoy my healthy status before things begin to fall apart.

The truth is, the problem of not enough nurses is growing, not shrinking, so how can we not talk about it at every turn. Ignoring the reality of the shortage merely exacerbates an already critical situation. I am a nurse who does not work in a clinical setting. Rather, I write about nurses and nursing. I am not alleviating the shortage by clocking in at a hospital every workday but I certainly can do my part to keep the subject at the forefront, if only in my small realm, by writing about it—often.

When the shortage is addressed, the focus tends to be on clinical nurses. Not much attention has been directed upon another vital group of nurses—nursing faculty. Thousands of qualified nursing school applicants are turned away every year due a lack of faculty and clinical facilities.

A number of factors are at play in the problem of inadequate numbers of faculty. University programs stress Ph.D. credentials for their faculty. While certainly desirable, attaining a Ph.D. is a time consuming and expensive endeavor that ultimately leads to an academic position that pays significantly less than that of a clinical nurse. The state of Maryland reports that the disparity in compensation there is about $30,000. The average salary for a clinical nurse with an advanced degree is $80,000, while a nursing faculty member earns about $50,000. Most of us don’t work only because we have a love for our profession. That love goes hand in hand with a paycheck and $30,000 is a dramatic gap. Frankly, given those numbers, I’m surprised anyone is teaching.

In a phone interview many months ago with Diana Mason, Ph.D., RN, editor-in-chief of the American Journal of Nursing, she stated that universities need to make concessions for increasing the salaries of nursing faculty as has been done for medical school faculty.

There are many more facets to the nurse faculty shortage—it isn’t all about the money. But, money talks and increasing funding for faculty says, “We recognize the need for adequate numbers of faculty, we value quality faculty, we honor the importance of your work and you should be compensated accordingly.” In light of the astronomically massive bailouts recently handed to the banking and auto industries, is it too much to ask that a tiny fraction of that amount of money (which would still be a lot of money) be directed to faculty at our colleges of nursing? I think not.

This frustrates me. What are your views on the subject?

Nurses Play Critical Role in Identifying Victims of Human Trafficking

In the same way health care personnel have been educated to look for and report suspected cases of child abuse and domestic abuse, attention is now being focused on recognizing signs that a patient may be a victim of human trafficking.

A rather obscure problem, you say? No. A rarely talked about situation, perhaps, but not rare. Worldwide, human trafficking ranks as the third largest business behind illegal drug sales and gunrunning. But, surely not much of a problem in the United States? Wrong again. It is estimated that 15,000 to 20,000 human trafficking victims enter the U.S. every year. Those numbers are not firm and may, in fact, be low estimates due to the secretive, dangerous and criminal nature of the business.

While most people associate trafficking with sex-related businesses, such as massage parlors, victims may also be working in other low-level positions such as housekeepers, nannies, nail salon workers or janitors.

Most trafficking victims are women and children who are lured by false promises of money and jobs. Before long their passports are taken, they are forced to work long hours, given little to eat and often threatened, beaten and/or sexually abused on a daily basis.

In 2008 the American Nurses Association passed a resolution to educate nurses as to how to identify trafficking victims and refer them to support and legal services.

Detection is not easy. Traffickers usually prevent their victims from seeking medical care but if they do present, nurses can play a key role in identifying the victims. Assessment skills can enable nurses to pick up on clues that indicate a patient is being trafficked.

As an example, an Eastern European woman presents in the ED in late-term pregnancy, having received no prenatal care and showing signs of physical abuse. She is accompanied by a much older male who speaks for her. These are red flags that could indicate a trafficking situation.

Victims of labor trafficking may present with repetitive motion injuries as a result of excessive hours of forced labor. Trafficked farm laborers may have skin damaged by long hours of exposure to the sun. Couple those indicators with signs of physical abuse—a broken jaw, evidence of old untreated fractures—and trafficking should be considered a possibility.

It is incumbent upon the nurse to provide to victims the advocacy, support and care they need. If a nurse believes he/she has identified a victim of trafficking, a safe environment must be secured for that victim, the staff and him/herself. Notify hospital security to be on scene, or call 911 for local law enforcement support. The victim should be placed in a shelter or other safe environment as soon as possible. When that has been accomplished, various social services agencies should be called in to handle the myriad aspects of the situation.

Human trafficking is a disturbing reality that was nowhere on our radar screens a decade ago. While the problem seems to be most prevalent on the East Coast, particularly on Long Island and in the Atlantic City area, there have been documented cases across the country. This is yet another situation where nurses can be considered first responders in a way that can end suffering on a level most of us can’t fathom. I urge you to become informed and keep your antenna up.

If you have had an experience with victims of this heinous criminal practice, please share your story. To learn more about how you can recognize and deal with this problem, go to the link below.

A tool kit for healthcare providers is available at www.acf.hhs.gov/trafficking.