Not Enough Nurses

The pollsters from Gallup take the nation’s pulse every year by asking Americans to rate the perceived honesty and ethics of people in various professions. No surprise then that the most recent results, delivered just after the last election cycle, ranked lobbyists, lawyers, and congressmen in the lowest third of the ethics heap, territory long dominated by telemarketers and car salesmen. The steep drop in home values and the Dow seems to have fueled a similar plunge in esteem for bankers.

Yet enjoying a kind of halo effect at the highest position on the honesty scale is a group of health care professionals whose ethics are rated as “high” or “very high” by 84 percent of respondents. In fact, in the decade since pollsters added nurses to the list of rated professions, they’ve earned first place every year but one, when firefighters were included right after 9/11. We trust nurses more than pharmacists (who were rated “high” or “very high” by 70 percent of respondents) and even physicians (64 percent).

This is good news to John Welsh, a freshly minted graduate of the University of Minnesota School of Nursing, which celebrates its centennial anniversary this year. “I think people recognize that nurses are advocates who can really determine the tone of your health care experience,” says Welsh, 43. “They’re the people who are there when the doctor has left and the questions come to your head.” The public’s high regard for his new profession confirms he made the right decision leaving his first career as a journalist. Finding a nursing job also helped, especially in a contracting market no one predicted when he began his training almost three years ago, when a long-standing nationwide shortage of nurses seemed to guarantee the profession was “recession-proof.”

Of course, not much is recession-proof anymore. Hospitals across the Twin Cities have shed more than 1,000 workers in the last year, many of them nurses. Yet this reversal comes at the same time health care reformers are looking to nurses as the cure to much of what ails our system—the players perhaps best equipped to contain costs, cut down on medical errors, smooth the transition to electronic records, shore up doctor shortages in primary care, and manage the chronic conditions of the coming wave of baby boomers that could swamp our current resources.

While patients know the care and comfort provided by good nurses can be priceless, recent studies have tried to estimate their real economic value. For instance, an American Medical Association study found that programs that paired Medicare patients with nurses for monthly one-on-one meetings improved patients’ health and cut down on costly hospital visits. Another study published in the journal Medical Care calculated that adding some 133,000 nurses to acute care hospital settings could save nearly 6,000 lives every year and amount to more than $6 billion in medical savings. Against these findings, it may be no wonder that a recent survey found that 9 out of 10 Americans want lawmakers to be sure nurses are included in any plans to reform health care—nurses’ long-term health could be critical to our own.

While nurses may earn more popularity points than others in the medical world, they haven’t always gotten the props they deserve. “For a long time, nurses were viewed as handmaidens of the physician,” says Sandra Edwardson, a professor at the U of M’s School of Nursing and director of the Doctor of Nursing Practice program. (That’s right— doctor of nursing.) Yet the shift from helpmate to highly trained practitioner got an early start in Minnesota when Dr. Richard Olding Beard persuaded the state legislature and the university to create a nursing school on campus, starting with just eight students in 1909. The school is now the nation’s longest continuously running university-based nursing school, and it’s the largest graduate program at the U of M. It operates eight Centers for Excellence and offers five degree programs on two campuses.

The school’s steady expansion has been fueled, in part, by a nurse shortage that began more than a decade ago. Though many previously trained nurses have since returned to the field and helped raise ranks by more than half since 1990, they’ve been graying right along with the rest of us. An estimated 40 percent of employed RNs are now older than 50, and surveys suggest half hope to retire in the next 10 years. With not nearly enough new nurses to take their place and a troublingly high rate of turnover (one in five new nurses will quit within the first year, according to a recent report), one government estimate claims the nation’s health care system could be short as many as one million registered nurses by 2020.

While the number of new nurses may be dwindling, the niches they now fill in health care have multiplied, with specialties in such fields as midwifery and geriatrics, anesthesia and health care informatics. The professional paths people take to nursing are also diverse, says School of Nursing dean Connie Delaney. “I have a bachelor’s degree in mathematics and nursing, and a PhD in educational administration and computers,” says Delaney, “so one of the beauties of this profession is its unprecedented capacity to marry nursing to so many specialties and interests outside of health care.”

But the public’s perception of the possibilities in nursing hasn’t kept pace. Jobs Rated Almanac ranked registered nurse 143 out of 250 professions for job desirability, factoring in such things as stress, salary, perks, and future prospects. Nurse ranked just behind forklift operator and two spots ahead of fashion model—a job with an even more infamous burnout rate. Hospital dramas in which nurses are only supporting players, and never the stars, have even been blamed for creating the notion that nursing is a noble profession that no one really notices. (Not to mention those ugly uniforms . . . ) Fueling fears about where the next crop of new nurses is likely to come from, one recent study found that only 5 percent of high school students surveyed said they’d consider becoming a nurse.

Doug Flashinski admits he was not in that 5 percent when he was in high school. Not only would his friends have given him a hard time for being interested in a “girl job,” but enthusiastic recommendations from his mother—who returned to nursing after raising her five kids—only steeled his resistance. “You don’t necessarily want to do everything your mom tells you to,” says Flashinski, 29, who majored in psychology instead.

However, a day he spent in high school shadowing a nurse anesthetist stayed with him. “Just seeing how closely you’re working with families—and then literally holding someone’s life in your hands during the operation,” he says, helped him get over the razzing his friends gave him when he applied to the U’s master’s in nursing program. He graduated in December, along with more than 30 other classmates with previous degrees in everything from French to fisheries. Though these have not been the traditional paths into health care, second-career nurses are now considered critical to solving the nursing shortage. A recent report from the Robert Wood Johnson Foundation found that nurses who come from unrelated fields tend to be older and more motivated than first-degree nurses, and better able to cope with stress.

Helping new nurses deal with a steep early learning curve has become another new strategy for attracting and retaining nurses—and a good economic move, since replacing a nurse who can’t cut it is estimated to cost between $30,000 and $50,000. As a result, some hospitals are experimenting with nursing residency programs, based on the same mentoring model physicians undergo at the beginning of their careers. And here in Minnesota, legislators held a hearing last year to consider a bill that would limit the number of patients a nurse could care for in a hospital unit. (One study found that each additional patient added to a nurse’s four-patient load increased a surgical patient’s risk of dying by 7 percent.)

Emma Beecher knows there will be challenges ahead as she begins her new career in a Twin Cities hospital, but right now she’s enjoying the flush of seeing the letters “RN” on her name badge. “I feel like I finally found the job for me,” says Beecher, 30, who graduated from Macalester College with a bachelor’s degree in studio arts and tried everything from massage therapy to bartending before earning her master’s in nursing in December. While she once thought of nursing as “just too traditional,” researching the new roles ahead for nurses assured her that her passion for public health wouldn’t have to limit her to a hospital setting or even 9-to-5 hours. “There are so many needs, so many ways I know I can help, that I wake up every day grateful to be a member of this profession,” says Beecher.

She also has a career marketing tip that might steer more young people to nursing: “Everyone thinks the uniforms are terrible,” she says. “But the truth is, they’re unbelievably comfortable.”