The Call-In: The Nursing Industry
LULU GARCIA-NAVARRO, HOST:
Now it's time for the Call-In. Last week, we put nurses on call. Depending on where you live, nurses can be in short supply with potentially big consequences for patient care. What does it mean for the nursing industry, and how is the job changing? Well, we heard from a lot of you.
Here's Ed Stern of Falls Church, Va., Gina DeMarco of Colorado Springs, Jennifer Steele of Milwaukee, and Christopher Todd of Big Pine Key, Fla.
ED STERN: I think nursing has changed. It's evolved. It's not just fluffing pillows and passing medications.
GINA DEMARCO: It's physically demanding. It's stressful. The hours are long. There's days it's rewarding, but I would say I second guess what I'm doing.
JENNIFER STEELE: This has been the most challenging and rewarding work. Nursing is not what I do; it is who I am.
CHRISTOPHER TODD: There's always been a nursing shortage. And it's only going to get worse because the average age of a nurse is getting up there.
GARCIA-NAVARRO: Twenty years ago, the nursing industry was in danger of a serious shortage, but that's changed more recently.
PETER BUERHAUS: The good news is we have had a surge of people coming into nursing over the past 10 years such that we believe we'll be able to avoid a large massive shortage of registered nurses that would cause access to care difficulties and delay care.
GARCIA-NAVARRO: Peter Buerhaus is a professor of nursing and a healthcare economist at Montana State University. He says around the country, though, there could be regional shortages in the near future.
BUERHAUS: I get a little bit worried around both coasts. New England, particularly, there's a large number of nurses who are going to be retiring in the New England region but not as many new replacement nurses coming in. The West Coast could also be a troublespot. We just don't see the growth there as we do in the middle part of the country. So I'm a little bit worried about future shortages developing there.
GARCIA-NAVARRO: I'd like to focus on nurse practitioners because we're hearing a lot more about them. Explain what they are and why they're becoming a more important part of the workforce.
BUERHAUS: Nurse practitioners are nurses who have gone back to graduate school for advanced education. They choose a specialty. It could be primary care, or it could be caring for individuals in the emergency room or in acute-care settings. And what's happening is that when we are looking at projections of physician shortages, we're seeing that nurse practitioners can fill many of those medical roles that are opening up.
So NPs are growing very rapidly. They also are more likely to be working in rural areas of the country where we have some of the biggest shortages of primary care physicians. So there's a lot of good reasons to be backing that sort of initiative in the nursing workforce. It's helping out quite importantly.
GARCIA-NAVARRO: So you've mentioned this expanding world of opportunity for nurses. But might it also not be the case - and we heard this from some of our callers that they feel overworked, overstretched - that they're being asked to do much more than they might have been previously? And that has been a burden.
BUERHAUS: Yeah. What we've seen, I think, over the past 10 years, is a significant push to improve quality and safety in our hospitals particularly. Oftentimes, though, this means that a nurse will come to work complying with so many regulations, so many check-off forms to note that they did a particular procedure in accordance with the qualifications that are important. Hospitals are under pressure to document that because this is how they're going to get paid. So it it shifts down on to nurses, and it's taking them away from the essence of establishing a relationship with a patient.
GARCIA-NAVARRO: And is there another issue, as well? We're seeing, as you mentioned, younger nurses coming into the workforce, but they don't have the institutional knowledge. They don't have the experience, quite frankly. Is that a problem when you see senior-level nurses retiring?
BUERHAUS: It's a great question, and it does concern me. It's not that these nurses are not qualified or unprepared. But what concerns me about this, Lulu, is at the same time we have younger people coming in to replace the exiting baby-boom RNs, we're going to have a surge of older people qualifying for Medicare. Many of them will be hospitalized. And they're coming in to institutions with multiple chronic conditions - heart disease, stroke, cancer, diabetes. They're complicated patients. A lot is going on. And they're coming in just as the newer, less experienced nurses are coming in to take care of them.
GARCIA-NAVARRO: That was Peter Buerhaus, a nursing professor at Montana State University.
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ASHLEE DOVER: Hey, Monica.
MONICA COFFEY: Hi, Ashlee.
DOVER: I am a nurse for about two years. So I'm a baby.
COFFEY: Well, congratulations.
DOVER: Thank you.
COFFEY: I'm Monica. And I've been a nurse for 41 years, which is probably older than you are (laughter).
GARCIA-NAVARRO: We brought two nurses together to share their experiences in nursing. Ashlee Dover is 24. Monica Coffey is 65. She remembers having a strong mentor when she got started decades ago.
COFFEY: I had a head nurse, Alice McGee (ph). Her office was on the floor. If things got busy, she came and helped pass meds. She gave lunches. And not only did she help me become a better nurse, she helped me to become a better human being. Now I think young nurses are not supported when they are starting out. They come into nursing with far less clinical background than I did as a new grad.
GARCIA-NAVARRO: Ashlee, does that sound right?
DOVER: Yes. That is absolutely correct. Most of the time, it's just me, a bunch of other new nurses and maybe one or two senior nurses if I'm lucky enough that week to work with them. When you have 6 patients each - all of us - there's really no time to really say, hey, how are you doing mentally, emotionally? What's nursing like for you right now? It's more of - do you need help passing meds, or cleaning up this patient? Can I help you like this?
GARCIA-NAVARRO: Ashlee, do you have any advice that you'd like to ask Monica?
DOVER: How did you mentally and emotionally make it through as a young nurse and, like, keep yourself emotionally, mentally put together for your patients and your family?
COFFEY: Well, I had other interests - an avid reader, hiker. But the thing about nursing is that, every day, I always felt like I was getting to do good work. I feel like the ethics of nursing sustain me. And even when it's hard, even when it's discouraging, I always feel like I'm getting to do the best I can do as a human being.
GARCIA-NAVARRO: Does that resonate, Ashlee?
DOVER: That completely resonates because I didn't go into nursing to try to save lives or anything like that. I went to - I went into nursing to provide care, a shoulder, a listening ear to people in their times where they felt like nobody was listening or they didn't know what was going on. And that's my motivating factor is to be there for them. And sometimes it's hard. You know, you've got six patients to take care of, and three of them require head-to-toe, like, complete care. And you just wonder, like, I don't want to hurt them. I want to be there for them.
GARCIA-NAVARRO: So listening to this, it's obviously really stressful and also very rewarding. And I just want you both to briefly talk to the patients right now. What do you want them to know?
COFFEY: You go first, Ashlee.
DOVER: OK. I am so privileged to be a part of your care. And I am so absolutely thankful that you let me into your life during these darkest moments. And I want you to know even if I'm late or if I haven't checked on you in over an hour or two hours, I have not forgotten about you. Your care and everything about you means so much to me. And I promise to give you the best care possible.
COFFEY: That's a beautiful sentiment and well stated. I would speak to the patients in this country and say, please, get informed about the issues surrounding health care. Think about improving and maintaining access to health care for all Americans.
GARCIA-NAVARRO: That was Ashlee Dover of Nashville, Tenn., and Monica Coffey of Ellsworth, Maine.
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GARCIA-NAVARRO: And next week on the Call-In - it's been a year since the women's march movement brought huge numbers of demonstrators to the streets across the country. Did you participate last year or did you skip it? What have you done since then? Call in at 202-216-9217. Be sure to include your full name, where you're from and your phone number. And we may use it on the air. That's 202-216-9217.
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