Mary B. Killeen, PhD, RN, CNAA — Testimony

I am testifying on the nursing shortage based on my background and experience.
I live in Marion Township in Livingston County with my husband. We have been here for 11 years. I have been a registered nurse for 39 years working mainly in the inpatient side of hospitals with mothers and children. My roles have included staff nurse, childbirth educator, staff development specialist, clinical nurse specialist, department director, and research and special projects coordinator. For the past 4 years I have been an Associate Professor at the University of Michigan-Flint in the Department of Nursing teaching Issues & Trends in Nursing and Leadership and Management. In 1998, we began a graduate program with 2 tracks for Nurse Practitioners and I have taught in this program as well.

Additionally, I am an elected member of the American Nurses Association's Congress on Nursing Practice and Economics. The Congress develops policy on practice issues including the nursing workforce supply and demand.

I wish to speak to four areas of special knowledge and concern: impact of the shortage on nursing education; recruitment of disadvantaged and minority students; RN job dissatisfaction; phased in retirement for aging RNs;

1. The impact of the impending shortage on education is evident by shrinking enrollments in nursing programs nationally. A recent study (Buerhaus et. al., 2000) reported that women graduating from high school in the 1990s were 35 percent less likely to become RNs than women who graduated in the 1970s. In the Hometown Argus and Press, top graduates from Livingston Co. high schools are highlighted at the end of the school year. Their career plans are included in the brief biography. Not one of the graduates this year chose nursing as a career.

Reductions in enrollments of nursing programs within the last decade attest to this narrowing pipeline. According to a 1999 Nursing Executive Center Report, between 1993 and 1996, enrollment in associate degree programs declined 11 percent. Furthermore, between 1995 and 1998, enrollment in baccalaureate program declined 19 percent. At U of M-Flint, we have openings for 32 basic students twice a year, fall and winter, in our baccalaureate program. For the past 3 years, we have had a markedly lower applicant pool, and for the past three semesters, we have not filled all the openings. We maintain our entry standards but we are having increasing difficulty attracting qualified applicants, as are other nursing programs.

Why is this decline in enrollments happening? My nurse colleagues and I believe there is poor press and inaccurate word of mouth information at the high school and elementary school level. My colleagues at U of M-Flint recruit in school classrooms in the area and promote the positive and correct misinformation. The feedback indicates that high school students surf the net and gather information on occupations' working conditions and salaries. The RN layoffs in the nation's hospitals, resulting from cuts in the mid-nineties, and salary compression seem to be the major reason for a lack of interest today.

The public needs to hear the positive side. Nurses love their profession as a career choice and do not hesitate to tell others of the opportunities in a variety of settings and with a variety of patients and in a variety of roles. Nurses like myself climbed the career ladder and found great satisfaction. Our nursing program's Selection Committee has concluded that the common theme in entry essays is that candidates have had a positive experience with a nurse in their personal or family history, and this has influenced them to choose nursing as a career. In summary, we need more media and other efforts to support the positive image of nursing in Michigan with a special focus on elementary school children's impressions.

2. Recruitment of disadvantaged and minority students is a major problem in a profession that does not look like the people we serve. We have struggled with this issue in the Flint community. Minority students we seek include African-American and Hispanic students from Genesee County and male students. Male students constitute 5.9% of the US RN workforce. This level has not increased much in the last 10 years compared to other traditionally "female" professions. Men are a significant number now in the teaching profession. Men have not been too shy to become EMTs, nursing home administrators, Physician Assistants and other health care professionals. However, we seem to only be able to attract a handful (typically 1-3 in my classes) in nursing - mainly mature men who are switching careers to nursing. I wonder what we could do to remove the stigma for males to enter nursing? This is a special interest of mine and I ask my male students what holds other men back from nursing. They believe there is a gender stigma to nursing in our American culture. Note the movie based on this premise: Ask the Parents. This is possible to deal with once they are in the field, but it deters many males from considering nursing. We need more publicity on the strong image of males in nursing.

We have made very intense efforts to recruit and retain African-American students at UM-Flint. In the class due to graduate this December, there were five African-American students at the start of the program. Unhappily, we have had four of the five drop out or drop back in the program. The administrative assistant in the Department of Nursing who oversees enrollment points to financial hardship as primary factor. Unfortunately Financial Aid covers school expenses, and some but not many living expenses. Because of their lack of financial support, many of our minority students are forced to work many hours to sustain themselves and their families and end up dropping back or dropping out. If students are weak in their basic education, they need to study hard and take advantage of the resources we offer them. But minority students often don't have the luxury of time to use these resources. They need financial aid that helps with living expenses rather than tuition aid alone. . A recent blurb in the Livingston County Argus and Press stated 10 scholarships of $1,000 each were going from the Department of Industry & Consumer Affairs to students affiliated with Hurley Medical Center in Flint. Upon investigating, I learned these are for Nurse Anesthetist master's students. These students will be earning upwards of $100,000 upon graduation. Our top students vie for the slots in this program because of the high salaries. There is a great need for broad financial aid packages for BSN students, especially for minorities and those with families to support while they earn their degree. In summary, we need more extensive funding for basic students in baccalaureate programs, our future leaders in nursing.

3. RN job dissatisfaction: In 2001, Flint experienced a long nurses' strike at one of our hospitals - McLaren Regional Medical Center. The major issue was mandatory or "forced" overtime. Nurses were successful in negotiating more humane staffing strategies but much bitterness remains. Three years ago I conducted a nurse job satisfaction study at a major hospital in this region. The findings I believe are even more relevant in 2001. The purpose of the study was to examine work satisfaction and turnover among registered nurses and licensed practical nurses. A convenience sample of 917 nurses was used. Surveys were mailed to each full time or part time nurse's home and returned to the U of M-Flint Research office in the provided stamped envelopes. A response rate of 43% (283 RNs and 42 LPNs) was considered good. The nurses ranked their level of satisfaction and importance with 6 job components: professional status, interaction, autonomy, pay, task requirements, and organizational policies. Their level of job dissatisfaction was no better or worse than that of nurses elsewhere in the US. Their rankings of satisfaction and importance matched except for Pay (high dissatisfaction), autonomy ( moderate dissatisfaction), and task requirements (moderate dissatisfaction). Their level of turnover was high: 12%. But again, this is similar to nurses elsewhere. The theme of their comments related to pay revealed that nurses want improved pay and benefits including increased wages, improved part time benefits, increased tuition reimbursement and various incentives. The retirement program was particularly perceived as not satisfactory. It is well known that an experienced nurse reaches the ceiling of the pay structure in 5 years, 10 at the most. If this wage compression could be adjusted so that more experienced nurses are paid more, it would be very helpful in retaining numbers of RNs in the workforce in Michigan. In summary, nurse job satisfaction, especially wage compression and mandatory overtime must be addressed as part of the nursing shortage problem.

4. Phased in retirement for aging RNs: The profession is interested in creatively looking a new ways to retain the experienced RN who is retiring early due to workplace health and safety issues as well as dissatisfaction with understaffing and mandatory overtime. Recent ads in the classified section of our local paper sought RNs as real estate agents declaring in large print: RNs make great real estate agents!! ANA has long had an interest in pensions and retirements primarily as a women's issue, but also because of individual nurse's lack of portable pensions. We need to address this issue and assess whether these plans are truly portable or if there is a knowledge gap among nurses with regard to pension/financial planning. We also need to explore the nurse's openness to something like a "phased retirement" particularly as a tool for retaining the older, experienced nurse at the bedside. Are there innovative ways to phase in retirement instead of giving bonuses to recruit into the facility, using those dollars as a contribution to a pension or retirement plan if the nurse decides to work for an additional year? Other possibly strategies are a reduced work week for full pay, full salary for weekend employment, preference of shift, reduction of patient contact hours, use of education sabbatical and mentorship and preceptor roles.

In reviewing my main points, I believe future legislation in Michigan should address: 1) supporting media and other efforts to project a positive image of nursing in the recruitment of young persons to the profession; 2) providing incentives for males to enter nursing and finding financial packages for nursing students particularly minority students; 3) working with employers to improve workplace conditions and salary; and 4) funding demonstration projects that retain nurses over 50 in innovative ways.

Finally, I am a concerned citizen because this shortage will affect me and my family. I ask who will take care of me after I have given a lifetime to the nursing profession? This is a problem too big for nursing to address by itself. It is truly a social issue. Thank you for forming this task force to learn more about the problem in Michigan. I will leave my contact information so that I may be of assistance to you in the future.

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