Betsy White: The coming nurse shortage: a national health crisis

Sometimes it's necessary to prove the obvious.

A recent study published by researchers from the Nursing School in the Journal of the American Medical Association found that surgical patients taken care of by nurses with larger work loads are much more likely to die from complications. With each additional patient a nurse must care for, the likelihood of dying within 30 days of admission increases by 7 percent. An average patient load of eight, when compared to a load of four, is associated with a 31 percent increase in mortality risk.

In looking at over 232,000 patients and 10,000 staff nurses from 168 hospitals in Pennsylvania, the study also found that hospitals with higher patient-to-nurse ratios end up with large numbers of nurses who are burnt out and dissatisfied with their jobs. And as nurses become emotionally exhausted, they quit.

It seems evident that a nurse taking care of more patients has less time and mental capacity to devote to each individual. Still, patient loads of eight or more are common on many medical and surgical units in hospitals across the country.

What is it about nursing that makes it such a mentally, emotionally and physically demanding profession? Clinically, nurses are the eyes, ears, noses, hands and integrating forces of health care. In hospitals, they provide an ongoing surveillance system to detect subtle changes in patients' conditions and intervene to prevent further deterioration. They are the voices of patients and must navigate through a confusing and disjointed health system to provide the individuals under their watch with the highest quality of care.

And they do not get credit for all that they do. Take for example, a morning bath. To an outsider, this may be seen as a simple activity of cleansing. To the nurse, it is a prime opportunity for assessment and intervention, all done within a routine five-minute morning interaction.

What is the patient's functional status? If he needs assistance with bathing, why does he and are we making him overly-dependent by giving him more than he needs? What is his mental status and has it changed recently? Why? What does his skin look like? Is he at risk for developing a debilitating pressure ulcer? How are his wounds? Is he coping well with his hospitalization?

A nurse's ability to assess, intervene and educate -- in other words, to nurse -- diminishes dramatically when forced to take on the responsibility of caring for more patients. Even those with the sharpest minds, top clinical expertise and best management skills find themselves pressured in our current systems of care.

We are living in a precarious time for health care. Managed care-related cutbacks over the last decade have resulted in dangerously low numbers of nurses to serve the needs of our growing population. Hospitals are now attempting to fill the void through the use of financial incentives and other benefit packages, but there are simply not enough nurses in training to replace those that have left. The nursing population is aging -- the average age is 45 -- and schools are struggling to boost their enrollments in the midst of low interest among youths in the profession.

A key barrier to recruiting the best and brightest high school students into bachelors degree nursing programs is the primitive image of nursing that still remains in today's society. Despite its evolution over the last several decades into an autonomous career and rigorous academic discipline, nursing has yet to achieve the intellectual, financial and social prestige of peer professions, including medicine. For many, nurses are still stereotyped as women in starched white uniforms and caps who assist physicians and empty bedpans all day.

Ask any Penn Nursing student to count off the endless times he or she has been told by others to become a doctor instead of a nurse. Ask about the criticism he or she has received for paying tuition to an Ivy League university to study nursing. Then try to figure out why these talented students must consistently answer such questions.

Better yet, ask to hear some stories of patients whose lives have been touched by your fellow student. We need the brightest youth to choose nursing and we need you to help us overcome deterring stereotypical images of the profession. So learn what nurses really do.

After all, we'll be taking care of you some day.

Betsy White is a Nursing senior from Mahwah, N.J., and president of Student Nurses at Penn.

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