NEWS

Reinvestment Act May Provide Relief for Nursing Shortage

Jean McCann

The Nursing Reinvestment Act sailed through the U.S. House and Senate in a single afternoon in July and was signed by the president a week and a half later. Several nursing organizations applauded the measure, which supporters hope will help correct the nursing shortage—a problem that is expected to worsen drastically in the next two decades.

The statistics are grim: The American Hospital Association estimates that there are 126,000 nursing positions vacant at hospitals throughout the country. A study in the Journal of the American Medical Association projected that by 2020 there will be a 20% shortage in the number of nurses needed in the health care system, which translates into a shortage of more than 400,000 nurses. And the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recently reported that the nursing shortage has had a substantial impact on the health and safety of patients.

There is less information available about oncology nursing specifically, but a survey in Nursing Economics last fall gave some insight: 59% to 65% of oncology nurses and doctors perceived staffing as inadequate, and nearly 80% of nurses reported great difficulty in retaining experienced staff. The survey also noted that there is a lack of qualified applicants to fill positions that require specialized skills.

While the nursing groups are, as a whole, delighted that the president signed the reinvestment act, their next lobbying targets are the congressional appropriations committees, which must provide the funding to support the measure. "We want to make sure the funds get included in the 2003 federal budget," said Bridget Culhane, R.N., M.N., executive director of the Oncology Nursing Society. A coalition of nursing groups, which includes ONS, called Americans for Nursing Shortage Relief, is lobbying for a total of $250 million to establish and implement the programs outlined in the act.

"The bill doesn’t include anything in particular for specialty nursing, but the bill does include scholarship money for nurses to further their education for master’s degrees, for instance, which will help nurses specialize in any specialty they choose," including oncology, Culhane said.

When nurses graduate, they can go into any field they choose, but they don’t have "majors" in specialties like oncology, or residencies, as physicians do, she said. She added that the institution that hires them provides on-the-job training.

Several factors will contribute to a continued shortage in oncology nursing, said Lawrence Einhorn, M.D., distinguished professor of medicine at the Indiana University School of Medicine, and former president of the American Society of Clinical Oncology. He noted that the number of people with cancer is expected to rise as the population ages and that as economic conditions prompt hospitals to downsize, the nursing staff is often an early target.



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Dr. Lawrence Einhorn

 
But perhaps most critical is the fact that fewer people are going into nursing, and many of those who are are going into administrative positions or other areas of nursing. The JCAHO, for example, reported that there are 21,000 fewer nursing students in school now than there were in 1995.

"Many of the major medical institutions are training nurses to go into administrative posts, like working for insurance companies, rather than going into patient care," Einhorn said. "And although doctors like to think they can do everything, a lot of cancer care is done by nurses."

Linda Workman, Ph.D., R.N., professor of oncology nursing at the Francis Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, said that other specialties, such as emergency medicine or intensive care, may be more appealing to younger nursing students. She said that older students or those who have had a family member suffer from cancer are more likely to choose oncology as a specialty.

Inpatient nursing, with its greater stress and often longer hours, has been hit harder than outpatient nursing. The ONS suggested that the changing health care system is partly to blame. In a position statement on the impact of the nursing shortage on the quality of cancer care, the organization noted that in the 1990s, hospitals closed beds and more patients were treated in outpatient settings. "RNs were laid off in large numbers, hospitals hired ancillary workers, and nursing schools reduced faculty and admitted fewer students," according to the statement. "If present trends continue," the organization concluded, "demand for nurses rapidly will outpace the available number of nursing positions for many years to come."

Shifting workload has also aggravated the seriousness of the problem. Einhorn suggested that patients are receiving less quality care from both doctors and nurses. Nursing is short-staffed, and "physicians also have less time to spend with patients because of mountains of paperwork."

Emil J. Freireich, M.D., professor of medicine at the University of Texas M. D. Anderson Cancer Center, Houston, noted that at his institution, which receives considerable financial support from federal, state, and outside sources, special teams perform tasks such as transporting patients and preparing medications, so nurses can concentrate on patient care at the bedside.

However, at many smaller institutions, nurses have a long list of responsibilities that can keep them from focusing on patient care as their primary duty. "If you don’t have enough nurses, you tend to replace them with other personnel that may not be as well-trained," Freireich said.

Yet even M. D. Anderson has a nursing shortage. John Crossley, R.N., Ph.D., director of nursing there, said inpatient care is about 50 nurses short, and, to a lesser degree, outpatient care has too few nurses as well.

Several organizations are trying to quantify just how the nursing shortage has affected cancer care in the country as a whole. ASCO, for instance, is now in the midst of a large-scale study of the quality of cancer care. The first part of the report is expected to be ready by next spring, said Paul Bunn, M.D., ASCO president and director of the comprehensive cancer center at the University of Colorado in Denver.

In this 18-month study conducted by Harvard University and the Rand Corporation, researchers will review patients’ records to determine the level of care given to each patient, including the amount of time nurses spend with patients. Patient surveys about their care are also being conducted.

Bunn said that the organization is also considering doing some workload surveys that will include medical, pediatric, radiation, and surgical oncology as well as oncology nursing, and that it hopes to partner with other organizations to accomplish this.

But beyond quantifying the effect of the nursing shortage, ONS is trying to raise public awareness of the problem, both among legislators and consumers, said Gail Mallory, Ph.D., R.N., director of research for ONS. The organization has a program called job shadowing, in which student nurses spend time with oncology nurses during their normal workday and, it is hoped, have their interest piqued in the specialty.

Also, some oncology nurses are going into high schools and even middle schools to attract interest in nursing. Mallory reported that ONS now has 30,000 members—the highest number yet—to help promote their specialty.

The federal government is doing its part to stimulate interest in the nursing field as well. The Nursing Reinvestment Act will provide scholarships to students who agree to work in critical nursing shortage areas after graduation, give grants to health care facilities to develop best practices in nursing administration, establish career ladder grants to encourage nurses to further their education, and create public service announcements to promote professional nursing.



             
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