October 24, 2008 -- Tonight the PBS television program "NOW" aired a fairly good half-hour report about the ongoing U.S. nursing shortage. "Nurses Needed" makes many good points, describing the critical role nurses play in bedside care and patient outcomes. It also gives a sense of some key features of the shortage, including the shortage of faculty and even a passing reference to the role of popular culture in reinforcing damaging views of nurses. Unfortunately, the report largely overlooks some major causes of the shortage, most notably short-staffing and the lack of sufficient clinical resources for nurses. The report does seem to suggest that stressful workplace conditions are driving nurses away, but it makes little effort to place that factor in the current context--nursing has always been stressful, why are we now suffering the worst shortage in modern history? Still, the report provides a good deal of useful information, and we commend producer Bill Gentile, senior correspondent Maria Inahosa, and host David Brancaccio.
The report contains some good descriptions of nursing skill and the importance of nursing to patient outcomes. Brancaccio notes early on that constant attention from a good nurse may be just as important to the survival of surgical patients as the work of the surgeon. And the piece cites the well-known 2002 Journal of the American Medical Association study linking nurse staffing to patient outcomes.
The report focuses on the experiences of several specific nurses and patients, and it shows some of what happens between them in clinical settings. At New York-Presbyterian hospital, we see some of the high tech care in the neurological ICU, as a team of nurses works to help a dancer recover after a bad fall. The dancer's family expresses great appreciation for the nurses, in fairly emotional terms. We see burn unit nurses working with infection precautions, and a kidney transplant nurse coordinates the response to a possible heart attack. The report notes that nurses actually do much of what many people think only physicians do. At another point, Brancaccio observes that pop culture products often show the work of physicians heroically, but the role of nurses in managing care and advocating for patients is overlooked.
The report notes that nurses face stress, as we see in the portrayal of the transplant nurse. The piece says that many nurses find this strain to be too much, then cuts to a nurse describing how she suffered abuse from patients. She later became a phone advice nurse. Far more should be done to address abuse of nurses--by patients, physicians and colleagues. But the stress nurses have long faced is probably not the main reason we are in the midst of a global crisis now. Factors like short-staffing are more fundamental. At another point the piece suggests that the shortage is not really about pay, but about structural and systemic problems. But it does not clearly explain what the main systemic problems are. There is a passing note that then-candidate Barack Obama supports staffing ratios, but the piece does not explain what those ratios are, or why they might be needed to address a lack of clinical resources for nursing.
The report gives significant time to New York-Presbyterian's chief nursing officer, Willie Manzano. She discusses the effects of the shortage on her very large nursing staff. We hear about the hospital's admirable nurse residency programs, which may be a critical way to reduce the high rate of hospital nurses who drop out in the first year of nursing. The report shows Frank Costello, a senior hospital nurse who teaches new nurses both in the classroom and at the bedside, and the report notes that this kind of mentoring has reduced turnover. The onscreen identifier tells viewers that Costello is a clinical nurse specialist (CNS), but this will mean little to most viewers. It would have been better if Brancaccio would have explained what CNSs are, and why it is so important that CNS positions that have been cut in the past 15 years be restored in order to strengthen nursing practice.
The segment also makes the great point that investing in nurse staffing could actually be cost-effective, despite our current economic woes, because it will save lives, preventing complications and errors. But this point is not linked back to the current state of affairs--is a failure to provide adequate resources part of the nursing crisis? Is managed care a factor? Had the report consulted a nursing union representative in addition to the nurse executive, it might have been able to give viewers a more complete picture of the situation.
The piece does consult "Dr. Mary Naylor," a professor at the University of Pennsylvania's nursing school. (It would have been helpful for the report to clarify that she is a nurse and not a physician, which viewers might otherwise assume.) Professor Naylor observes that nurses will be increasingly needed because the population is living longer with more chronic conditions, and she stresses that the shortage is part of a national health problem that requires a national solution. But again, we do not get a clear explanation of just what this problem is. The piece notes that the shortage played little role in the presidential campaign, with Obama supporting staffing ratios, limits on overtime, and more funding for professors, and his rival John McCain supporting efforts to attract nurses to rural areas. This part of the report rightly focuses on the faculty shortage, which has caused nursing schools to turn away large numbers of qualified applicants. It explains that nurses can make a lot more money as senior hospital nurses or as drug company employees, though curiously the report fails to note that a key factor in why nurses are not becoming educators in sufficient numbers has been the growth in advanced practice nursing.
Despite some problems, the report on the whole provides a valuable look at the current state of the U.S. nursing shortage.