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June 12, 2005 -- Today the Milwaukee Journal-Sentinel ran a fairly good piece by Joel Dresang about how a partnership of public and private Wisconsin entities plans to use a federal grant to address the critical nursing faculty shortage, which is an important element of the overall nursing shortage. The piece provides a good description of the project, and it highlights some important aspects of the faculty shortage. It might have included some perspective as to potential drawbacks to efforts to address the nursing shortage by aggressive streamlining of nursing education, rather than dealing with the factors that are actually driving the shortage, including poor working conditions and a widespread lack of clinical resources and real respect.

The article, "Seeking cure for nurse shortage," reports that the University of Wisconsin System and a "partnership of educators, job developers and employers" plan to use a recent $1.3 million grant from the federal Department of Labor, along with funds from local partners, to increase the number of nursing faculty in the state. The piece notes that a lack of faculty is a key barrier to training the nurses needed to ease the overall shortage, since 29,000 qualified nursing applicants were reportedly turned away from nursing schools last year, and the waiting list for nursing slots at Wisconsin's "technical colleges" has 3,000 names. The Wisconsin program was one of only a dozen nationwide to receive such grants. According to a Labor official quoted in the article, the government was impressed with the Wisconsin program's ideas for "accelerating" nurse education programs. Among the specific project details are plans to "streamline" coursework, offer scholarships, "arrange schedules" so that working nurses without BSN degrees can get their masters in nursing in two or three years instead of four or five, and arrangements with employers to allow nurses to teach while they continue to practice, "allowing them to continue to earn the higher pay associated with [clinical] nursing." The piece includes brief quotes from a local nursing dean and nurse executive praising the grant plans. It also provides some helpful details as to the scope of the shortage in Wisconsin, noting the 3.8% decline in the state's working nurses from 2001 to 2004, even as projections indicate that that number must expand quickly over the next decade in order to meet demand. The piece also notes that the aging U.S. population plays a role in the shortage, both in the increasing need for care, and in the fact that much of the nursing workforce itself is nearing retirement age.

The article stresses that adding nursing faculty is not a "cure-all" for the shortage, then notes that training nurses is expensive because of the need for extensive institutional and technological resources. However, it does not really say what might be needed to address the overall shortage beyond educational resources. It does include a quote from the director of the Center for Workplace Studies at SUNY-Albany. She praises the Wisconsin project, noting that she (in the reporter's words) "liked to see that the health care executives and educators were working together to create options to retain nurses in the work force and give them incentive to develop new nurses." The piece does not explain how any of the elements of the Wisconsin plan would do anything to "retain nurses in the work force," as opposed to simply making it easier for them to enter the work force.

The piece commendably highlights the importance of the faculty shortage, and some elements of the plan, notably the scholarships and the measures to help practicing nurses integrate clinical and educational work, seem promising. The piece also provides relevant data on the scope of the shortage, and it includes quotes from knowledgeable nurses (which may seem like a given, but in some pieces is not).

The article might have included some additional perspective on the use of "streamlining" and "accelerating" nurses' educational programs as a primary tool to address the nursing shortage. To the extent such plans mean that serious health professionals will receive significantly less training than has previously been required, they may raise patient safety concerns, especially given the increasing complexity of care and higher average patient acuity. Moreover, it's hard to see how such an approach addresses the key immediate causes of the shortage, which include short staffing, poor working conditions, and a lack of clinical resources. Indeed, while we don't doubt some programs can be streamlined without sacrificing quality, some might argue that a reduction in the amount of formal education nurses receive is the last thing a profession needs when it is struggling with a widespread lack of respect and empowerment, and that the profession's long term wellbeing actually depends on strengthening its educational requirements. In addition, while the piece notes that the overall shortage is about more than the faculty shortage, it may suggest to some readers that the rest of it is pretty much the need for other educational resources (besides faculty) and to some extent a natural result of the aging population. In fact, all the training incentives in the world won't help much if the basic reality of clinical practice remains untenable for too many nurses, and there is a continuing exodus from the bedside. In other words, it's fine to address the symptoms of the nursing crisis, as long as it's not a substitute for addressing the causes.

We thank Mr. Dresang and the Journal-Sentinel for covering these important issues.

See the article "Seeking cure for nurse shortage: Partnership to bolster instructor ranks to get more students trained" by Joel Dresang in the June 12, 2005 edition (June 11 web edition) of the Milwaukee Journal-Sentinel.

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