ABC's 20/20 to Focus on Nurse Staffing in Hospitals
The number of nurses employed by U.S. hospitals has been increasing steadily from 859,000 in 1992 to more than 901,000 in 1997, the latest year in which statistics are available. This is occurring at a time when the number of hospital beds and hospitals has been declining.
Health care in America has undergone a tidal wave of change in the past few years. Hospitals have endured perhaps more of that change than any other segment of the field. And of all the dedicated hospital professionals providing care, nurses have had to manage and cope with that change where it matters most: maintaining the quality of care we bring to people. They have done a spectacular job.
Hospital patients and the way they receive care have also changed dramatically. Many people are being treated successfully in outpatient settings or with medication and therapy, rather than hospital stays. This means that patients in hospitals are oftentimes older and more acutely ill.
In most hospitals, the traditional staffing of nurses and nurses' aides has evolved into teams of professionals, including physicians, nurses, aides, patient care technicians, therapists, pharmacists and others. This permits nurses to concentrate on the clinical and patient monitoring tasks for which they are highly trained and skilled.
While various kinds of unlicensed aides have always been there to assist nurses, hospitals are using more of them and giving them more training in order to meet the many demands of patient care. The national agency that accredits hospitals, requires them to have written standards for the training, work and continuing education of these caregivers to ensure they are skilled and capable.
There is no question that cost containment pressures are playing a larger role in how hospitals train and deploy workers of all kinds. Federal Medicare cutbacks, state cuts in Medicaid and managed care and insurance companies are forcing some hospitals to reduce or close services. They are making it harder for hospitals to keep up with other employers in salary and benefits.
Today, some hospitals in parts of America are having difficulty recruiting experienced nurses, particularly in specialty areas such as critical care and the operating room. There simply are not enough experienced nurses out there to meet the demand. And hospitals, because they are the most difficult settings for nurse practice, have a tougher time than others recruiting nurses.
The current shortage is far less severe than previous ones. But it is of enormous concern because nursing school enrollments appear to be dropping and a significant number of nurses will be retiring over the next decade. In addition, we are seeing experienced nurses leave hospitals for less stressful, more lucrative practice opportunities.
We must come up with long-term national strategies to increase nursing school enrollment, strengthen the training of nurses and others members of the patient care team, and improve the work environment or we will face a serious shortage of nurses in all health care settings.
Government, insurers and others must understand that their economic decisions about payment have real human consequences in terms of the services available and the numbers and skills of the people who take care of patients. Hospitals are still places where care is a human experience, not a product. Hands-on care is delivered by people who do difficult jobs extremely well.