Marylee Pakieser, MSN, RN, CS

Good morning. My name is Marylee Pakieser. I have been a registered nurse for 29 years and I am also the president of the Michigan Nurses Association.

I recently returned from Washington, D.C., where I listened to nurses from around the country tell their frustrations and concerns about the nursing professions. During the House of Delegate meetings for the American Nurses Association and its labor arm, the United American Nurses, I heard stories shared from military nurses, private sector nurses, staff nurses, public health nurses - the list goes on and on.

My trips around Michigan, from the UP to Detroit to the southwestern areas, mirror that experience. Though the degrees of the problem differ, they all point to the same thing: we are facing a nursing shortage of epic proportions. And we are just seeing the tip of the iceberg.

You've no doubt heard horror stories from California about the nursing shortage such as patients calling 911 because no one would answer their call bells. We don't have the extreme situation that Californians face, but don't be fooled into thinking that Michigan doesn't face a nursing shortage. You would be surprised to find out how large some of the vacancy situations are in Michigan. In early 2001, Battle Creek Health System reported a 9.6% vacancy rate.¹ Last fall, Sparrow Hospital had 40 open positions and Ingham was not much better with 1/10th of their RN staff positions open.² Even the Petoskey area reported a 5% general nursing vacancy.³

Far more alarming, however, are the anecdotal accounts coming from the Detroit area. MNA has been told of times recently when the Detroit Medical Center had 154 open positions and the University of Michigan was looking for RNs to fill approximately 200 open positions.

Why the shortage? Do you know the actual average earnings of a full-time nurse in the United States? $46,782. If you adjust that figure to match the purchasing power of the dollar, it's $23,369. Even more incredible, based on the dollar's worth, the salary for an RN has only increased $203 between 1992 and 2000.⁴ That's a $25.37 raise per year for a job that requires analytical and critical thinking skills while performing physical labor at the same time. It's certainly something to think about.

You've no doubt heard testimony about the working conditions nurses face today in hospitals, especially mandatory overtime. Don't be fooled by this term, either. Sometimes it's called "extra assigned shifts" or "hospital requested shifts" or any variety of terms. Mandatory overtime is oftentimes used by hospitals as a staffing solution when there are not enough nurses to handle the patient load. But think this through. The hospital is putting nurses back on floors that have already worked their scheduled shift and oftentimes are exhausted. Think about the last time you put in a full day in Lansing and then had to drive home to your district. Were you at your best? Should you have been driving? What if there had been a heart patient, newly back from open heart surgery, relying on you to be the one to save them if their monitor went off?

A 12-hour shift is very common for nurses. Now think about 4 hours added on to that. 6 hours. 8 hours. Very little time off your feet and a bag of chips for your meal. It's not a good thought, is it? It's reality, though, for a lot of nurses.

The American Nurses Credentialing Center surveys hospitals seeking recognition for having excellence in nursing practice and work environments friendly to nursing. These selected hospitals, which petition the ANCC, are granted the status of being a Magnet Hospital. Sad to say, there are no Magnet Hospitals currently in Michigan. We need to have one or more Magnet Hospitals in our state to use as models for nursing excellence. I've read that these Magnet Hospitals don't experience problems with the nursing shortage and mandatory overtime. Could it be a coincidence that where nurses are treated as professional caregivers, the problems that many hospitals face don't exist? Something to think about!

We are the backbone of the healthcare system and we know that a future without nursing will truly be a disaster. We usually solve our own problems, but this one is too big for us alone. As Dr. Peter Buerhaus, a well-known nurse researcher of the shortage, has stated, this is a social problem as well. We need assistance from our government, our communities, our educators. We need you to work with us before we face a world without nurses.

Did you know that the average age of a nursing instructor is 56.5? We cannot educate new nurses if we have a shortage of adequately prepared instructors. To teach the analytical skills needed for good nursing requires educators who can matriculate at a university level, and these are in short supply. Consequently, we need more scholarship money for masters and doctorate programs.

We want the best and the brightest recruits to enter and to stay in nursing. But to do that, respect for our profession has to skyrocket. We are a separate and independent profession from medicine and the other health care disciplines. You can't just lump us into the "not doctors" category and expect us to be here down the road. The tide has to turn now. We need our work environments to be conducive to quality patient care. Our profession must begin receiving the respect it deserves. You've had doctors stand before sub-committee members in the past two months and tell you that they're worried about the nursing shortage. If the doctors are worried and the nurses are worried, then it's time for the legislators to get worried and stay worried until together we can figure out some practical answers to meeting this crisis.

Let me close by just offering a few suggestions:

1. We need one or more Magnet hospitals in Michigan;
2. I mentioned earlier in my testimony the needs for Masters and doctorate scholarship money to provide for more nurse educators;
3. We need your support for legislation that benefits nurses, including banning the use of mandatory overtime as a means of staffing.

I encourage you to turn to MNA for expert advice on the issues facing nurses. We have nurses in every area of nursing practice - researchers, clinicians, educators, administrators - that can accurately provide information to help you in your legislative efforts. We know that to make significant change, nurses and legislators must communicate and join forces. We are committed to making that happen.

On a personal level, there is one thing that you could do immediately. I've heard it said, time and again, "You're so smart, why aren't you a doctor instead of settling for being a nurse?" Not only does this hurt the nurse who receives this back-handed compliment, but it hurts the nursing profession. I urge you to look inside your own perception of nurses. If you share this view, even a little, I encourage you to spend some time with nurses. Go to where they work. Talk to them about their education. Find out what they do on a daily basis. Understand their needs. If you'll do that, you'll play an integral part in the social solution for correcting the nursing shortage.

I appreciate your time and your interest. Thank you.

Footnotes:

1. Christenson, Trace. "Nursing a Demand," Battle Creek Enquirer, January 16, 2001.

2. Noga, Cari. "Nurse Shortage Not Severe in TC," Traverse City Record-Eagle, 1/28/01, http://www.record-eagle.com/2001/jan/28nursh/htm.

3. Ibid.

4. National Sample Survey of Registered Nurses - Preliminary Findings, February 2001. US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing. Rockville, MD 28057.

5. Testimony of Sue Meeker, Head of Nursing, St. Clair Community College, to the House Health Policy Sub-Committee, Lapeer, Michigan, June 1, 2001.

Attachments:
1) Testimony of Denise Geolot, PhD, RN, Director of the Division of Nursing, Bureau of Health Professions, Health Resources and Services Administration, to the Sub-Committee on Oversight of Government Management, Restructuring and the District of Columbia, Committee on Government Affairs, US Senate, June 27, 2001.


2) Testimony of Ann O'Sullivan, MSN, RN, President of the Illinois Nurses Association, speaking on behalf of the American Nurses Association, to the Sub-Committee on Oversight of Government Management, Restructuring and the District of Columbia, Committee on Government Affairs, US Senate, June 27, 2001.


3) Testimony of Janet Heinrich, PhD, RN, Associate Director, Health Education and Human Services Division, US General Accounting Office, to the Sub-Committee on Oversight of Government Management, Restructuring and the District of Columbia, Committee on Government Affairs, US Senate, June 27, 2001.

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