Are Nursing Shortages Causing Deaths?

[Guest guest]

Are Nursing Shortages Causing Deaths?

A nonprofit group's report says more immigrant nurses and training

programs are needed to ease patient suffering

by Moira Herbst September 6, 2007, 4:26PM EST

The U.S. is facing a severe nursing shortage, and it's causing

increased death and illness for American patients, says a report

released on Sept. 5 by the National Foundation for American Policy

(NFAP), a free market-oriented nonprofit group. As baby boomers are

aging and require more care, the U.S. could face a shortage of one

million nurses by 2020, according to the U.S. Department of Health and

Human Services.

Relieving patient suffering amid the growing crisis will require both

investment in U.S. nursing training and boosting the numbers of

immigrant nurses admitted to the country, says the NFAP study.

Nursing Applicants Turned Away

" It's simple: Not enough nurses means bad patient outcomes, " says

Stuart , executive director of NFAP. " Nurses make a great

difference in preventing infection, illness, and death, and public

policy needs to ensure there are enough of them. "

The NFAP study, entitled " Deadly Consequences: The Hidden Impact of

America's Nursing Shortage, " is in part a review of the medical

literature on the shortage and in part a set of policy proposals. NFAP

cites a number of studies, including one by the Journal of the

American Medical Association (JAMA) on surgery patients, which found

that increasing a nurse's workload from four to eight patients could

be accompanied by a 31% increase in patient mortality. The study

concluded that " substantial decreases in mortality rates could result

from increasing registered nurse staffing, especially for patients who

develop complications. "

The NFAP report focuses on two policy recommendations: increasing

nursing faculty and school infrastructure and relaxing immigration

quotas to bring in more foreign nurses. First, NFAP calls for

increasing both private and public sector funding for U.S. nursing

training programs. U.S. nursing schools do not have enough capacity to

accommodate students applying for training programs. Most nursing

schools have two- to three-year waiting lists, and turn away more than

100,000 applicants each year.

" Stagnating Wages " and Other Problems

In other words, the emerging nursing shortage stems in part from a

shortage of nursing teachers. Because nursing programs attract fewer

private-sector dollars and sponsorships than other subject areas like

information technology, universities have either scaled back the size

of their programs or have allowed faculty pay to stagnate. That's why

many RNs decide not pursue a masters or PhD in nursing to become

educators, opting instead for higher-paying jobs in business, public

health, or health-care administration.

Trained as an RN, Teri Ross-Ferguson of Rochester, Mich., pursued a

B.A. in Health Care Administration as well as an MBA. She is now a

self-employed health-care consultant. " I feel like I made the right

choice, " says Ross-Ferguson in an e-mail. " It's unfortunate that there

are not incentive programs out there to attract nursing educators. I

believe this would solve the real problem of lack of nurses in this

country, " she adds.

But even if nursing schools expand capacity, the industry will need to

find ways to retain nurses by making the job more attractive. " You can

spit out as many nurses you want, but if working conditions in

hospitals don't change, it won't do any good, " says Glasson,

president of the Nurse Alliance of the Service Employees International

Union, who worked as an RN for 25 years. " Stagnating wages, mandatory

overtime, and short staffing problems are chronic. "

Immigration Controversy

NFAP's second policy recommendation—relaxing immigration limits to

bring in more foreign nurses—is more controversial. NFAP advocates

increasing the U.S.'s annual green card quota to accept more than the

140,000 each year the current law permits. Some experts and nurses'

advocates say that drawing an increasing number of nurses from abroad

is a quick fix that drains resources from other countries and fails to

solve the problem in the U.S.

" Relaxing immigration restrictions for nurses, which effectively takes

the nurse staffing crisis in the U.S. and outsources it to developing

countries that can ill-afford to give up their nurses, is not the

answer, " says Cheryl , RN and president of United American

Nurses, a labor union representing 115,000 RNs.

, along with other experts and nurse advocates, argue that a

better way to boost staffing is to pay nurses more while improving

working conditions (BusinessWeek.com, 8/28/07). There is an untapped

pool of 500,000 people in the U.S. with Registered Nurse (RN)

certification who are not employed as nurses, enough to fill all the

nursing vacancies in the U.S. twice over. Nurse advocates argue that

many of those workers are moving to other jobs or sitting on the

sidelines because hospitals offer nurses low wages and poor working

conditions.

But given the current structure of the U.S. health-care system—a

network of for-profit companies intermingled with large-scale

government programs—it's unclear that nurses stand to earn

considerably more. " Limits on wages arise from reimbursements from

insurance companies and Medicare, " says NFAP's . " If hospitals

did spend money to bid up nurses' salaries, they'd have a significant

cash problem, or they'd probably cut something somewhere else. "

Herbst is a reporter for BusinessWeek.com in New York.

http://www.businessweek.com/bwdaily/dnflash/content/sep2007/db2007095_010041.htm