We're running out of nurses. By 2012, the profession is expected to add another million members, and we're not even close to accommodating it. Meanwhile, the average nurse is 50, and the wave of retirements is supposed to hit soon. What to do?
Nursing's actually a good paying, dignified job -- starting salaries average $56,000. It's a real bright spot in an economy where job growth is mostly in low-skill, low-paid work. Problem is, we have massive training bottlenecks for nursing, and are filling the holes largely through importation of nurses from developing countries. That'll cut costs some, but it's not particularly great for our economy, nor for quality of care. In the latest issue of TAP, Joan Fitzgerald argues for a bit of foresight and national planning here:
The main reason so many nurses have left the profession is deteriorating working conditions. Cost cutting and managed care have resulted in stagnant wages, short staffing, decline in mentoring of new nurses, higher patient loads, mandatory overtime, and use of “floating” nurses who aren't familiar with cases or protocols and may not specialize in the area in which they are placed. As Gordon Lafer points out in Labor Studies Journal, “The health care industry has created its own Catch-22: as working conditions worsen, more nurses opt out of the profession, creating shortages on hospital floors and resulting in even greater speedups, stress, safety worries, and similar conditions that drive additional nurses out of the industry.” So, improving the work environment could go a long way toward bringing back nurses who left the field and retaining those still there.
Nursing also suffers from a training bottleneck. In 2005, fully 150,000 qualified applicants were turned down at U.S. schools of nursing (both associate and baccalaureate degrees) due to insufficient faculty and classroom or lab space, or lack of clinical sites. The problem is mainly low pay for teachers of nursing, combined with the fact that nurse-training programs are often money losers for community colleges and universities, so too few slots are offered. Few nurses are attracted to teaching because the pay is much lower than that of practicing nurses. Master's level faculty average $55,712 annually -- about the same as an associate degree RN in clinical practice and substantially less than a nurse-practitioner with a master's degree who makes $72,480 a year.
But instead of investing in addressing these problems to make this profession more available to Americans, we are importing immigrant nurses from the Philippines, India, Nigeria, and elsewhere. Although there are no government statistics on the number of immigrant nurses working in the United States, in 2005 about 23,000 foreign-educated nurses took the nursing licensure exam. While investing token amounts for educating U.S. nurses, the Bush administration and the hospital lobby are promoting the Brownback Amendment, which would remove all caps on hiring foreign nurses. And the administration added 50,000 new green cards for immigrant nurses. Rather than investing in it, the policy response has been to outsource nursing education.
Ultimately, the solution to the nursing shortage requires federal regulation of working conditions and federal subsidy of nurse training. While every nurse union and professional organization supports legislation to set nurse-patient staffing ratios and eliminate mandatory overtime, opposition by the American Hospital Association and the Republican Congress have blocked its enactment.
It's just dumb policy-making.
