RN Speaks Out for Her Profession
The following testimony was delivered Friday, July2,
2001 to the House Subcommittee on Apropriate Supply
and Utilization of Michigan's Health Care Workforce
of the Standing Committee on Health Policy.
Elaine Van Doren, Ph.D., RN
Coordinator & Instructor
Kalamazoo Area, RN Studies Program
University of Michigan, School of Nursing
Testimony regarding nursing shortage
I have been a practicing nurse for over 30 years in
this State. During this time, I had come to believe
that I had seen it all as far as nursing shortages
and the ways in which people respond to them. However,
the past several years have surprised even me. I am
increasingly concerned about the health and safety
of both those who are seeking care from our health
care organizations and the staff providing that care.
Today, I would like to talk with you about those concerns,
based on my own direct observations and from the many
conversations I have had with students.
First, let me tell you that my students come from all
over West Michigan; from as far away as Benton Harbor,
Albion, Grand Rapids and Sturgis and all points in
between. These men and women are already RNs, they
have Associate Degrees in nursing from a variety of
community colleges. They come to the RN Studies Program
so that they may meet the requirements for a BSN, the
Bachelor of Science degree in Nursing. Nurses obtain
their BSNs to develop greater skill in applying the
nursing process for their clients and/or to expand
their career opportunities. The majority of my students
are also employed full time and provide direct service
to clients as staff nurses in acute care, outpatient
and long term facilities. Most are married and have
children; some are single parents. Given all these
characteristics, it should not be surprising for me
to tell you that I find my students to be some of the
most dedicated, hard working professionals I have ever
met. Unfortunately, over the last several years, I
also find them to be increasingly more discouraged
and frustrated. Like other American nurses, they are
very dissatisfied with their work settings.
There are 3 issues I would like to address:
- The routine use of mandatory overtime is a major
problem in too many acute care settings. One Tuesday
night a student called me in tears to tell me she
couldn't attend class the next day because she had
been mandated to stay at work for 4 more hours after
working her usual 12 hour shift. She still would
have come to class, but was also told that she had
to work the 7 am to 7 pm shift that next day due
to a opening in the schedule. Please note that the
nurse had approximately 7 hours in between shifts
and the last day was the 3rd day in a row she had
worked 12 hours. Extending a shift, rapid turnaround
for shifts and last minute changes in scheduling
are common occurrences.
- Ethical conflicts are increasing for today's staff
nurse as a result of such scheduling and staffing
problems. Each year as part of a course, my students
complete an ethical analysis. Five years ago, most
of the situations presented related to clinical
issues such as assisted suicide and stopping treatment.
In the last several years, the students' present
conflicts such as being threatened with patient
abandonment if they refuse to work, ill prepared
nursing assistants, lack of control over nursing
personnel and inadequate staffing issues.
- In general, nursing is hard work with limited
monetary rewards. Nursing salaries have not kept
pace with the rate of inflation, potential salary
growth is limited, and retirement benefits are usually
inadequate. Additionally, health care employers
after laying off nurses in the 80's, cut benefits
in the 90's. Ten years ago, many students had full
tuition coverage, now most are significantly limited
either by hours or total dollars.
I have tried to provide just a few examples of the
issues faced by staff nurses in our area. As you
and I know, these situations are the result of complex
factors within the health care system. While the
causes may be complex, the results are becoming
more understandable. In a major study by Needleman
and Buerhaus from Harvard, consistent relationships
were found between nurse staffing variables and
negative patient outcomes.
Nurses and the Public need your support and commitment
in:
- Increasing funding for education at the associate
degree and baccalaureate level.
- Opposing mandatory overtime as a scheduling choice
- Supporting salaries and benefits that not only
will attract but retain nurses.
- Encouraging the involvement of direct care nurses
in staffing decisions.
Thank you
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