According to the ANA ( American Nurses Association ), the average age of an RN in the US in 2004 was 46.8 years of age and the percentage of RNs under 40 was 26.6 percent. That means quite simply that fewer women are chosing to become RNs. Men still make up a small percentage of that population less than 10 percent.
Although one would never guess it from watching medicals shows on TV, RNs do the bulk of patient care in both hospital and outpatient setting. MDs do not give you your shots, change your dressings, administer your chemotherapy, engage in substantive health care teaching, or minister to your emotional needs. One part of the health care crisis that needs to be seriously contemplated is who will be caring for your when you are ill and whether they will be able to do an adequate job.
I am not going to bore you with gleaming statistics. I would rather offer a personal perspective on why the nursing shortage continues and what incentives can be offered to curtail it.
In 1961, when my mother graduated nursing school at the ripe old age of 21 women's options in the workplace were limited. You became an RN, a secretary or a teacher, if you could afford any kind of schooling. My grandmotehr openly admits it never occurred to her to suggest university because they were working class and even very smart working class girls did not go to university. In those days, you worked until you got married, quit your job and had children and then dropped back into nursing when the kids were older. My mother was a bit of a maverick and decided while she was still married to go get a BA part time.
By the time my parents were divorced, she secured a job as an instructor. She later got an MA "on the sly" because the college she worked at offered an extra 500$ a year for MA prepared instrcutors. She did it on the sly because she was worried her boss might feel threatened and make it even harder than it already was.
Flash forward to 1996, when I went into nursing after bouncing around the job market with a useless set of degrees. I resisted the idea because when I was growing up people always asked me if I was going to be a nurse like my mother. What happened in the mean time was simple and complicated: women discovered they could do more than become teachers, secretaries and RNs. I should piont out that I was a shitty, unmotivated, student and had I not been encouraged by some teachers who saw something I did not I probably would have never graduated highschool. Teachers are the great unsung and much maligned heroes of our society and I would hate for anybody to think I was in any way shape or form demeaning teachers. We blame teachers for everything and give them little credit.
Young women can make more money doing so many other things, that nursing has become less and less attractive. Why would anybody sign up for shifts, weekends, holidays and stress at every turn when the average MBA graduates today and can command well in excess of what a seasoned RN can earn? In essence, opportunities for women other fields have resulted in a huge net loss for attracting new RNs. I am not keen on going back to the "good old days" I would have been a very disturbed and disfunctional June Cleaver model.
Since money drives our health care system, RNs are being asked to do more complex treatments and care on with a greater patient load. RNs are becoming burned out much quicker and no longer see nursing as career for
life. In some institutions, there is "forced" overtime, RNs are routinely asked to "float" to patient care areas where they have no to little experience. They are faced with benefit cuts like workers in other sectors and often subjected to draconian management styles. When they "blow the whistle" on unsafe practises, they are often ostracized.
In the old days, patients were not expected to speak up for themselves, MDs knew best and they had a God like authority that nobody questioned. While RNs see themselves as being "patient advocates", they often find themselves in direct conflict with patients and families. I am a supervisor and I am often called into mini-conferences because a family member does not like the "attitude" of the RN. Sometimes when I ask for specifics, they are able to give me concrete examples that I can address, but frequently they are pisse doff because they did not get a pillow or a soda quickly enough. I have had families tell me they will sue me and "have my job" and while there are legitimate reasons why I could be fired, the fact is that people are often frustruated by bad communication and questions about care the MD did not answer and take it our on the RNs who deliver the care.
RNs tend to be portrayed in the media as either placid angels, sluts, or crazed bitches who enjoy torturing people. Whenever I tell people I am an RN in a social setting I inevitably get the "bad nurse" stories.
At my particular institution, we have a good relationship with the MDs, I have disagreed openly and fervently with the plan of care and lived to tell of it. I have gone over the head of more than one MD when I was unhappy with his or her decisions, and dragged a more senior MD in without a moment's thought. I am not a very emotional person but if somebody is fucking with my patients I get pretty hot. However, surveys in many journals indicated that the relationships between MDs and RNs is not always one of mutual respect and RNs still often fear speaking up.
Ironically enough in may areas of the country, nursing schools have huge waiting lists and many applicants just give up and move on to something else. Many young women still want to become RNs but the school system is at a bit of a bottle neck.
If we don't attract and recruit RNs now in 20 years all of your RNs will be giving care from wheelcahirs and walkers so what are we to do. I am 43 and most of my colleagues who are my age joke about how our retirement plan is death and that we will be in worse shape than our patients. it is funny but in a creepy way because there is some truth to it.
RNs are also moving away from the bedside which is partially good news because there are more Nurse Practitioners and other roles for nurses that are worthy and challenging. The problem is that some institutions are using unlicensed individuals to do some treatments and medications without the proper training and it is done so under the supervision of an RN.
How do we attract more RNs? The answers are not easy. We need more nursing schools but we also need qualified instructors to teach in them.
While I believe I am paid a fair wage, pay varies among institutions and regions. I think if nursing was a male dominated profession the starting wages and top out wages would be much higher. I also think we need to attract more men into the profession. That will require changing some of the dominant images of nurses.
We need federal incentives. Some institutions have loan repayment programs contingent on a contract of agreed length of employment, others have sign on bonuses. However, it depends greatly on the institution.
RNs need to be unionized so they can negotiate to eliminate bad managment practices.
I long to see realistic portrayals of RNs in the mass media but I suspect that in itself is a long battle.
I would actually love to hear from my fellow Kossack RNs for innovative ideas. I am long on criticism at this piont and short on solutions. I fell into nursing by accident and I don't regret it one bit.
I am not a stereotype. Nurses are tall, short, funny, feisty, kind, chatty, quiet, weird, gay, straight, every colour and culture imaginable, we are beautiful, plain, thin, and not so thin. We bitch about our jobs and love them at the same time. We love our patients, even the ones who challenge us. In fact, I would say the very patients who made me struggle the most are also the ones who taught me the most. We are just as all American as cops and firemen. We are also fast disappearing.