Blog
Dec 22, 2009
In 2009, health care reform was the most widely discussed issue in the United States because it affects every single American in every corner of the country. Whatever shape final legislation in Washington might take, we can expect greater numbers of Americans seeking primary and preventative care and, regardless of reform, greater numbers of older Americans seeking care as the baby boom generation matures. Combine these factors with technological and other transformations in health care delivery and it becomes clear that nurses and the nature of the nurse workforce have never been more important.
The U.S. will face a shortage of as many as half a million nurses by 2015; there are roughly 140,000 unfilled nursing positions in hospitals and nursing homes combined; half of all nurses are planning to retire in the next 15-20 years just as a nation of baby boomers will put unprecedented demands on the nation’s health care system. And scores of studies demonstrate that when it comes to hospital patients, the more nurses on staff, the better the health outcomes and the lower the mortality rates—a fact that affects every American family.
But numbers are only part of the story. We know the importance of a nurse workforce with the skills required by a reformed health care system to serve the Americans who will be using it in ever greater numbers. Nurses occupy an increasingly central role on care delivery teams and they can and should have a more prominent role in the delivery of primary and chronic care management. There is abundant evidence that advanced practice nurses provide high quality—and highly affordable—care in areas where no regulatory barriers limiting their practice.
As the health care workers who spend the most time providing medical care, nurses must also have more advanced education and skills. This is why we devote so much attention to ways of expanding nurse education to create a pipeline of new nurses—and nurse educators. Faculty shortages, limited clinical sites and even classroom space resulted in nearly 100,000 applicants being turned away from nursing schools last year—qualified applicants who want to devote their careers to caring and advocating for patients. While there are innovative solutions to the education crunch being implemented around the country, expanding education will most certainly require increased funding. We have worked hard to make this happen.
We believe that every American deserves a highly skilled nurse when and where nursing skills are needed. A richly skilled, effectively integrated nursing workforce—with enough professionals to meet the need—is essential to delivering high-quality health care. We will continue to act as an information resource on health care reform. The Center is collaborating with our AARP colleagues to advance the roles of nurses in increasing access to primary care, transition care and chronic care management in a reformed health care delivery system.
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Dec 21, 2009
By Brenda Cleary, CCNA Director
As I look back on a very busy year with so many high points, one that especially bears mentioning was the opportunity to serve as the representative from the U.S. at an international policy and research roundtable in Sydney, Australia, in early September. Now I actually got to Sidney by default due to the misfortune of an esteemed colleague, Dr. Marla Salmon, Dean of Nursing at the University of Washington, who suffered a shoulder injury which prevented her from making the trip.
I joined nursing and health care leaders from Australia, Canada, and the UK, including the Chief Nurse of the Commonwealth of Australia and President of the International Council of Nurses, Rosemary Bryant; the Chief Nurse of Canada, Sandra McDonald- Rencz; and representatives of the UK Commission on the Future of Nursing and Midwifery, Commissioner Anne Marie Rafferty and Commission Support Office Joint Lead Jane Salvage. The visit was fully funded by the Worldwide Universities Network, a global research collaboration between 16 universities. Jill White, dean of the University of Sydney’s faculty of nursing and midwifery, hosted the four-day event to explore and develop health policy education and research priorities and strategies. For more information, go to http://www.nursing.usyd.edu.au/news_events/news/roundtable.shtml.
The group concluded that nurses and midwives need to build closer alliances with health care consumers and community groups, which is very consistent with our efforts at the Center to Champion Nursing in America. And they should "plot a course of action" that will serve as a catalyst to champion the need for higher quality, innovative healthcare services.
The group plans to further develop its international nursing policy network at a meeting in 2010. Among other things, it hopes to discuss the UK Commission’s report, due out in March and also follow the work of the Initiative on the Future of Nursing in the U.S.
What did I learn? I learned that a 4-5 day trip to Australia challenges human endurance (but it was so worth it). I learned what it was like to serve as the Chief Nurse of a national health system from colleagues at the roundtable. And I was reminded that nurses share much in common around the globe. Finally, I convinced myself that I could climb the Sydney Harbour Bridge. See the flag on top in the picture—I was there, thanks to arrangements made by my Australian friends and meeting hosts!!
Dec 18, 2009
By Marjorie Beth Henderson, RN, BSN, CHPN
Delicate and frail, the ninety-year-old woman lay quietly in the hospital bed, her shallow breathing barely discernible. Silvery hair framed her kind face where velvety wrinkles had been caressed by many-a-grandchild, and remnants of laugh-lines marked the corners of her mouth.
Shadows of evening had already fallen, and except for soft strains of a favorite song, “Blessed Assurance” playing from the CD, the room was silent. Death seemed imminent, and I tried not to look at the clock. Praying that this dear lady’s family would arrive in time, I gently placed her frail hand in mine. “Miss Elly, I’m still here. I’m going to stay with you until your family comes.”
Her eyelids flickered. I refused to look at the clock. Leaning forward, I caressed her fragile hand. My thoughts were filled with gratitude for Miss Elly’s life and for what she had brought to the world and also were filled with images of the loved ones she would leave behind.
In these moments, I want the world to stop. I try to forget that beyond this room I have other patients in the Hospice House, knowing my co-workers will take care of them. I pray that peace will prevail over pain and surpass all fear and unanswered questions. Nothing is more important than this one precious life and the passing that is taking place. Other pressing nursing duties fall away and priorities re-set themselves.
Without exception, the Hospice nurses I know view their work as not just a job, but a calling. While at work, these nurses place their personal worlds of problems and cares on hold to focus on patients who have six months to live—or six hours. They zero-in on families who face multiple responsibilities and the inevitable void that the absence of this loved one will bring. Along with other members of an interdisciplinary team, Hospice nurses strive to help patients and families “put the pieces together” as their world seems to be falling apart. Patients and families are encouraged to continue meaningful daily living, assisted to complete necessary tasks at hand, and offered support as they ride the emotional roller coaster of acceptance, denial, and life review that can stir up both treasured memories and bitter regrets.
A Hospice nurse’s role is tailored to each patient’s needs—for no family situation is the same and each patient is unique as well. The commonality is that we are all human beings. We are born . . . we live . . . we die. For Hospice patients, death is a process and end-of-life care becomes a major determinant in what their quality of life will be.
One must understand that this “dying process” is on an uncertain timeline that falls into the realm of “living”. In other words, we live until we die.
As a Hospice nurse, my goal is to truly help each of my patients “live until they die” - - to provide compassionate care that promotes the highest quality of life possible until that last breath is taken. May the passing of each person be with dignity, in the circumstances of their choice. And if at all possible—may there be at least one caring person present to hold their hand.
Marjorie Beth Henderson, RN, BSN, CHPN, is on staff at Hospice House, Florence, SC
Editor's note: November was National Hospice/Palliative Care Month, but we wanted to share this compelling account of a day in the life of a hospice nurse.
Dec 11, 2009
Here at the Center to Champion Nursing in America (CCNA), we discuss solutions to the nationwide nursing shortage in terms of "issue areas": skills for the future, education capacity, recruitment and retention, practice and access to care, and leadership. Of special interest to CCNA and AARP is the retention of older nurses in the workforce in ways that are rewarding and meaningful. This residency program at Massachusetts General offers new opportunities to deepen their expertise and redirect their careers. Retooling nurses in geriatric and palliative care also helps meet a fast growing societal need. A very important and timely twofer, as they say, or in other words, an innovative initiative that tackles more than one issue.
With a grant from the U.S. Department of Health and Human Services, Edward Coakley, MS, MEd, MA, RN, created and now directs a six-month residency program for staff nurses aged 45 and older who wish to improve their skills in order to deliver the best possible care to the health system’s geriatric patients. Not only does the RN residency program increase the quality of patient care, it does so by inviting older nurses to contribute their wisdom and experience, a strategy which has proven invaluable to health care institutions and the communities they serve.
The video features two nurses whose experience totals more than four decades and both have committed to extending their careers as a result of the residency program because it empowers them as professionals to not only provide better care, but to champion the needs of their older patients. Coakley and his colleagues agree that geriatric patients often receive unnecessary and disruptive care when what they most need is a patient and family centered plan of care that helps them understand and manage various treatment options in later life.
As strong patient and family advocates and champions, nurses are well positioned to offer that kind of care, and older nurses, with updated skills and a lifetime of experience, are proving to be some of the best providers of the palliative care this growing group of patients needs.
We are pleased to have documented this breakthrough program and showcase it as a model that retains older nurses in the workforce while expanding geriatric care capacity. We enjoyed filming the dedicated nursing professionals in this four minute video, and we hope you’ll take the time to watch it here. Also, we encourage you to view our other videos of nurses addressing access, quality and affordability of health care for all Americans.
Please share these video links with your friends, family, and colleagues.
