Creative educational programs seen as key
Almost two years ago, a report from the Rhode Island SHAPE Foundation made some dire predictions. Already, it said, the state’s nursing work force fell short of demand by 8 percent. By 2010, the shortfall could grow to 25 percent, and by 2020, to 55 percent.
“Rhode Island faces a crisis that will grow over time but is already at our doorstep,” it said.
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The SHAPE study helped mobilize state leaders, and in the last two years, the General Assembly has allocated $1.6 million to add faculty to the three public colleges’ nursing programs. In addition, the Community College of Rhode Island, the R.I. Department of Labor and Training and local hospitals joined forces last year to obtain a $1.8 million federal grant to help CCRI expand and improve its programs in nursing and other health care fields.
But all that is still not enough to meet the huge need for nurses – thousands of them: Not only do hospitals, nursing homes and other facilities need to replace nurses who retire or take other jobs; they also need additional nurses to deal with an aging patient population.
On May 5, dozens of industry and educational leaders gathered at the Providence Marriott to discuss what more Rhode Island can do. The event was sponsored by the SHAPE Foundation, an independent nonprofit that undertakes research about the state’s health care community.
“Today’s nursing crisis could balloon into tomorrow’s health care disaster if we don’t act quickly,” said Dayle Joseph, dean of nursing at the University of Rhode Island. “Fortunately, it’s not too late to take action. Today’s discussion is just the beginning.”
Joseph set the tone for the event by providing some data on Rhode Island’s nurse shortage. In 2004, the SHAPE study estimated, the state had the equivalent of 12,000 full-time nurses. If current trends continue, by 2010, the supply would drop to 11,200 in the best case scenario, or 10,760 at worst; meanwhile, the demand would rise to 12,550 to 14,450 FTEs.
Combine the two sets of projections, and by 2010, the shortfall would range between 10 and 25 percent. By 2020, the SHAPE researchers predicted, it would range from 35 to 55 percent.
And those numbers do not take into account the shortfall in training. Across the nation, there’s a growing demand for nurses with bachelor’s and master’s degrees, not just the minimum associate’s-level education required to become a registered nurse – which is what CCRI, the state’s largest nursing school, offers.
Two guest speakers addressed that issue and suggested ways to further expand and improve Rhode Island’s nursing programs to meet the health care industry’s changing needs.
Margaret L. McClure, executive director of nursing at New York University Medical Center, in New York City, spoke of the two major roles RNs play: as caregivers and as “integrators.”
In the latter role, they’re the only ones who deal with the “full person,” she said, connecting the services provided by various specialists. As caregivers, she said, they meet the range of patients’ needs: basic “dependency” needs, comfort, education, monitoring and therapies.
Nurses’ therapeutic role is critical, McClure said, because they are the ones who can catch possible problems and correct them before anyone is hurt.
Joseph had mentioned that technology was driving many nurses out of hospitals, and McClure said it’s because too much of the technology that nurses use isn’t intuitive or user friendly. Hospitals need to stand up for their nurses, she said.
“I’m beginning to say to anybody who will listen to me, ‘You’ve got to push back on these vendors,’ ” she said. Hospital procedures have also gotten too complicated, McClure added: “We have to take steps off everything we do,” for the sake of patient safety.
Most important, McClure added, institutions need to ensure RNs spend as much time as possible at the bedside. Studies have shown that RNs spend as much as 70 percent of their time away from patients, McClure said, and the trend is to delegate some nurses’ duties to support staff, but even routine tasks are opportunities to monitor and educate patients.
Addressing the nurse shortage directly, McClure said it’s particularly acute at the higher levels, and there’s a “tremendous, insatiable demand” for nurses with master’s degrees and even doctorates – for administration and education but also for specialized practice and to work for insurers, pharmaceutical companies, drugstores, etc.
But the educational “pipeline” isn’t producing enough nurses with bachelor’s and master’s degrees, she said. “We’re at well over 60 percent” of nursing graduates with less than a bachelor’s degree, she said, “and we’re now approaching over 70 percent.” Even if 50 percent or 70 percent of those RNs continue their education, she said, it won’t suffice. “This is an emergency, and we’re not doing enough to address it.”
Melanie C. Dreher, dean of nursing at the University of Iowa, echoed McClure’s assessment, saying that in the changing health care environment, nurses increasingly need the skills and expertise to treat “really complicated patients.”
But nursing schools haven’t caught up with all the changes in medicine, Dreher said. Nursing has changed dramatically in the 35 years she’s been a nurse educator, she said, but nursing programs haven’t changed much. “We’re amazingly conservative.”
“Now we can’t be conservative anymore,” she said, “because this is the [nursing] shortage to end all shortages. This is permanent.”
Nursing schools need to reconsider what is essential and what isn’t, she said – for example, is witnessing a birth (a standard requirement for students) really more important than dealing with a death? Similarly, given how fast medicine is changing, accumulating knowledge is less useful, Dreher argued, than being a good “lifelong learner,” knowing how to observe patients expertly, and how to listen and communicate, and being able to synthesize information. Nurses also need to know how to delegate, she said, and know how to supervise helpers.
In addition, Dreher recommended making big changes to the clinical practice part of students’ education. For example, she said, students should be paired up with individual nurses, rather than assigned to units; they should, at various times, work all shifts and not just be limited to specific days for certain times; and nursing students should be exposed to the doctors’ “grand rounds” training.
However Rhode Island tackles its nursing shortage, Dreher told the audience, “what you’re doing here is very important. This is a small state, but you are doing something very big, and it will influence the nation if you are successful.”
