Nurses are educated - not born

So the research studies have been completed and reviewed . . . and recalculated and reviewed again. The facts remain the same. By 2020 (that's just 9 years from now!), Idaho will lack about 30 percent of the nurses we need. Fortunately, there is no lack of interest in nursing as a career. In fact, nearly half (900 out of the 2300 applicants in 2009-2010) were turned away (Idaho Nursing Overview, 2011). Applicants were not turned away due to lack of qualifications; rather, they were not accepted due to shortage of nursing faculty. Consider the following facts: 1. Educators with advanced practice (graduate) certificates earn only 61% of the average wages for their equivalents that practice in other settings. 2. Nurse educators with master's degrees earn only 67% of those working in other health care settings (in fact, the average annual salary in Idaho for an experienced nursing faculty member prepared with a master's degree in nursing is less than $45,000 - this same nurse may be able to earn as much as $20-30,000 more working in the local hospital). 3. More than a 1/4 of Idaho nursing instructors plan to retire in the next five years. 4. 20% of Idaho's nursing faculty possess bachelor's or associate degrees, creating a large pool of workers who could benefit from increased credentials - however, instate access to graduate level nursing education in Idaho is greatly limited (Idaho Nursing Overview 2011 & Governor's Task Force on Nursing).
Per the Governor's Task Force on Nursing, "without sufficient numbers of qualified faculty, Idaho schools not only lack the ability to increase student enrollments, they are challenged even to maintain current levles of student enrollment . . . salaries paid to nurses in many settings exceed salaries paid to faculty . . . (consequently), nursing faculty leave academic positions for employment in local healthcare facilities".
Therefore, two very distinct components must be taken into action: 1. salary adjustments for current faculty to achieve equity with industry, and 2. additional monies for each new nursing faculty position necessary to increase student enrollments.
It is our responsibility as consumers, health care professionals, and Idahoans to let our voices be heard on the importance of higher education and equity between salaries.

So you say there's a nursing shortage?

Sometimes it's difficult to imagine there's an actual nursing shortage in our area when I hear new nursing graduates state, "I'm still looking for a job". However, there are many factors that contribute to this phenomenon. Increasing costs of health care and the state of financial distress within our nation has caused our medical facilities to tighten their budgets. Like any business, they are being asked to work more with less. This strategy is resulting in increased patient:nurse ratios, increased use of overtime shifts for "high volume" hours, using travel nurses to fulfill short-term vacancies, in addition to nurse burn out. In critical care areas such as Critical Care Units, Pediatric or Neonatal Intensive Care Units, or the Emergency Department, vacancies are being offered to experienced nurses due to the complexity and cost of training new graduates. If we as nurses continue to suppress our voices, accept these budget-conscious strategies, and act merely as "task-masters", someone else (most likely somewhat who is not familiar with the roles and responsibilties of a registered nurse) will be making decisions for us. An interesting research fact reported in the book Policy & Politics in Nursing and Healthcare (2012) states, "an increase in workforce (to reach adequate staffing levels) would reduce hospital stays by 3.6 million days and thus generate additional productivity value of $231 million annually and $6.1 billion in annual medical savings" (Mason, Leavitt, & Chaffee). It's time to let our voices be heard.

Through My Eyes

As I interviewed neighbors, friends, and professionals about their views and opinions about nursing, I realized that unless you have followed a nurse around for the day - perceptions vary greatly. Therefore, my first blog post is a brief glimpse of what I see through my own eyes as an Emergency Department nurse.
* You might think I'm just looking at the monitor to write down your pulse rate or blood pressure - but did you know I'm also interpreting your heart rhythm. In fact, just yesterday I caught a slight elevation in an ST segment which signaled a lack of oxygen to the heart before complete arterial blockage occurred.
* Did you know when I answered your call light to help you off the bed pan, I also assessed for any skin breakdown/bed sores before any infection can set in?
* It was your registered nurse that advocated and suggested a different pain medication when the regimen you were receiving wasn't relieving your pain.
* You might think I'm just playing and having fun with the little girl next door as we prepare to place stitches in a laceration to her head. In fact, I'm assessing her developmental level and creating a plan of care that will fit her coping needs the best so this experience is less traumatic.
* I remember taking care of an elderly woman who had fallen in the middle of the night - she had broken her hip and layed on the floor for almost 2 days until her neighbors found her. She was so appreciative of the cares we provided. Yes, I was the one that gave her the bed bath - not because no one else could - but because it was my chance to assess her skin, evaluate her ability to care for herself after surgery, and to help return a bit of her dignity as I washed her body and hair.
* Did you know that before I came into your room to offer education on home care after an asthma exacerbation that I was performing CPR and advanced cardiac life support on a 32 year old female who had intentionally overdosed on narcotics and alcohol?
* In a matter of one hour I might be prioritizing care for the following 5 patients: rehydrating a pregnant mom suffering from persistent vomiting with intravenous fluids, managing 3 different intravenous drips to help maintain a critical blood pressure of a 74 year old male with sepsis, monitoring the oxygenation and respiratory status of a 36 year old female after repetitive nebulizer treatments to decrease an asthma exacerbation, triaging a probable forearm fracture of a 16 year old football player and ordering xrays and pain medication from a protocol selection list, and evaluating the mental stability and safety of a homeless male waiting for an available bed in the community to detox from alcohol . . . and the waiting room is full.
* Yesterday I heard the crack in a new mom's voice when she arrived with her colicky 4 week old baby - exhausted from lack of sleep, scared of not knowing what was wrong with her baby, and stressed about her looming hospital bill. It was me - the registered nurse - that took the extra 15 minutes to assess her support network, emphasize the importance of "parent time outs", educate about colick, and give her a supportive hug.
* I might look tired today because I'm working an extra 4 hours to my 12 hour shift because our staffing is limited - but that won't stop me from taking the extra 5 minutes to ask you that one question I have asked many, "Is there anything else I can do for you?"
* Did you know that before I give you any medication - I have the knowledge and education to know it's use, action, duration, side effects, contraindications, and parameters to monitor?
* In order to give you the safest care, I obtain routine recertification for my CPR, Advanced Cardiac Life Support, Pediatric Life Support, Trauma Nurse Core Certification and Emergency Nurse Pediatric Certification?
* Yes, there are many tasks I perform (IVs, catheters, wound care, medication administration, lab draws, splints, etc). But did you know I am also educated in assessment? When I listen to your lungs I might suspect pneumonia. When I listen to your heart I might hear a subtle extra heart beat telling me you might have an enlarged heart. When I push on your tummy I might elicit a response that leads me to suspect appendicitis. When I have you get changed into a gown I'm watching your strength in movement, looking for skin breakdown, observing for unusual markings or bruising, looking at your skin color, observing for dehydration, anemia, or jaundice.
* Yes - I do have the virtues so many people attach to nurses (caring, compassionate, honest, comforting). However, I'm also an educated professional.
* And yes, Daddy . . . I can even change bedpans.