Changing how the world thinks about nursing

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December 5, 2004 -- Today's Baltimore Sun editorial, "Good Jobs Available" recites much of the usual data relevant to the dimensions of and potential solutions to the US nursing shortage, and appears to be intended to attract potential nurses to the profession. The editorial makes a rational economic case for nursing as a job choice, but it is amazingly dry and myopic--starting with that inspirational headline. It ignores the real challenges and non-material rewards of nursing, and misses central aspects of why we have a global shortage and what it will take to fix it. Yet the editorial may appeal to potential nurses in a way that other recruiting efforts will not.

At first glance, the Sun's editorial may seem like a standard description of the current shortage, including the usual information about the current and projected shortfalls, some of the tangible positive benefits of being a nurse, and the nuts and bolts of current measures to ease the crisis. However, on closer examination, it's clear that piece completely misses the systemic health care restructuring of the 1990's that was a major factor in the short-staffing that has driven countless nurses from the profession. It reflects no awareness of the continuing battles, like the one going on in California right now, to address that issue and bring back the nurses who fled. Oh, sorry--the piece does mention one cause of the shortage being "high turnover from job stresses." Fortunately, now "better pay and incentives," legislative initiates and recruitment campaigns "have eased the crisis," though it's not going away, in part because of the continuing faculty shortage, which merits further action from the government and educational institutions. Fine. But the piece's entire description of what nursing actually entails is to note in passing that it's "the pivotal link in the U.S. health care delivery system." By contrast, the editorial is very interested in the material benefits and what it approvingly cites as a "relatively moderate amount of schooling" (never mind concerns that a "relatively moderate" amount of schooling is not enough for the increasingly complex work nurses must do to keep patients alive and functional.)

We're not sure that selling nursing as basically an ideal McJob, one with pretty good pay that doesn't require much training, is really going to attract the nurses we want caring for us when our lives are at stake, in a world of sicker patients and shorter hospital stays. The piece does not appear to be aware that nursing is not just another job with attractive material benefits, but an autonomous and highly technical profession whose members save lives every day. It also completely fails to note that nurses remain over 90% female in most nations, and that lack of understanding of or respect for nursing is a major factor in the shortage worldwide, and must be addressed if the current crisis is to be resolved. It's not going to be fixed by throwing some scholarship funds at nursing schools for a few years, though that of course is one helpful step. Paying for nurses to get graduate degrees doesn't mean they're necessarily going to teach, as long as academic salaries remain relatively low, as is the case now. Nor will training new nurses do much if the jobs they encounter when they get out remain so undersupported and understaffed that they soon leave in despair, as many veteran nurses have.

It's telling that the only time the piece manages to look up from under its green eyeshade with anything approaching real emotion is when it remarks that it's "striking that these well-regarded, well-paying jobs" are going unfilled. Well, yes, it would be striking if you knew absolutely nothing about what nursing is really like in the managed care era, and had spent no time considering whether society's enduring lack of real understanding for the profession might be a factor in its lack of resources and support. Why isn't one nurse enough for 15 patients? Would your son like to do women's work? Would your smart, ambitious daughter like to empty bedpans? On the whole, the piece appears to have been based entirely on information that could be found on a database of labor statistics. It could easily be accused of knowing the cost of everything and the value of nothing.

But then we began to wonder if there was subtle strategy in this approach. Of course, if your goal was to attract new nurses, perhaps you would not want to give an honest account of the job's problems, or how challenging it was going to be to really fix them. It's also not that hard to see why the piece might ignore the gender issues that are a major factor in nursing's status worldwide--why scare potential male nurses off by reminding them that they would be in a distinct minority? An honest discussion of the image problems might likewise discourage men and other potential candidates. (Of course, once they get out of school and start working...but never mind.)

Even so, why say nothing more about nurses' work than that it's "pivotal," omitting all discussion of how nurses save and improve lives, how they advocate for patients and teach them how to manage their conditions, how they are changing the future of care? You might do that if you feared, and not without reason, that you could not engage in such a discussion without triggering the deep-seated stereotypes about nursing that remain in almost all of our heads and that the media reinforces daily, notions that nurses are angels, handmaidens, and/or sex objects. The piece's answer: Don't even call it a profession. In fact--and this may be the most obvious indicator of the piece's strategy--don't even mention the word "nursing" until the third paragraph, after you've already laid out some of the job's benefits in the difficult current economy. If you put "nursing" right up front, or even talk much about it, many people--notably men, but also women who think they're too good for the work--will just stop reading. So emphasize that it's just a job like any other, and by many objective measures, a darn good one. Sure, it has "job stresses." So does any job. Get over it. So...out of work? Need to feed your family? You can't afford to worry about what people think, or whether you're doing something important, or even whether you have the resources to do a good job. Here. Take it and live.

Do we believe the editorial writer actually thought about all this? No. And we can't endorse a vision of the shortage that seems to miss key aspects of the nature and importance of nursing, how it got into the current mess, and how it might get out. But the piece does marshall a wealth of information to support its logical, if prosaic, arguments. It might do some good. And its approach to attracting new nurses is, to say the least, "striking."

See the Baltimore Sun's December 5, 2004 editorial.

 

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