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Startling discoveries

March 14, 2007 - This week's Charleston City Paper (SC) featured a long cover story by Will Moredock headlined "Critical Condition: S.C.'s nursing shortage could use some intensive care." The article includes what is by now fairly standard information about the causes and effects of the shortage. But it is notable for its heavy reliance on expert quotes from Medical University of South Carolina (MUSC) nursing dean Gail Stuart, PhD, and for its admirably detailed look at what MUSC Hospital MICU nurse Misty Deason actually did for patients during a recent shift. The piece seems to reflect the writer's surprise at the importance of bedside nursing. Moredock says studies showing nurse staffing and education levels affect patient outcomes were "startling discoveries." He also seems to marvel at the level of accomplishment of nursing leaders like Stuart and MUSC nursing professor Winnie Hennessey, PhD, whose name appears on "more than a dozen" publications. Even so, the piece is an unusually rigorous look at how the shortage affects one state, and we thank Moredock and the Charleston City Paper.

Moredock spends a lot of time describing the care Misty Deason provides to her critical patients during a 12-hour shift, despite short-staffing. Deason checks the many patient monitors and tubes, conducts a "blood-gas diagnosis," mixes medications and gives them, helps another nurse calculate the output of a dialysis machine, makes arrangements for the transfer of a deceased patient, investigates and determines why pressors are not raising a patient's blood pressure, aspirates the air out of a ventilator pump, and of course, keeps extensive records. The piece notes that Deason, who previously had a degree in psychology, went into nursing after her son was born with a heart defect requiring operations and extensive pediatric care, and she was moved by the "skill and compassion" of his nurses.

The comprehensive piece also discusses the nursing shortage, especially as it affects South Carolina. In doing so, it turns again and again to Stuart. Her first quote captures the importance of the problem:

When you come into a hospital, doctors will see you for 10 minutes a day. ... Nurses are the ones who keep patients alive.

The piece suggests that the shortage is the result of a "perfect storm" of circumstances that have not been adequately addressed. These include the aging general and nursing populations, the increasing complexity of care, the availability of other career options for women, the reluctance of men to enter nursing, difficult relations with physicians, and "the outdated perception of nurses as hospital 'go-fers.'" The piece rightly focuses on the faculty shortage, the "primary bottleneck" for training more South Carolina nurses. It links that shortage directly to the fact that nursing faculty are paid as much as $30,000 less than clinical nurses with comparable education, according to the American Association of Colleges of Nursing.

In the piece, Stuart also pursues an issue that she has in the past, namely the economic effects of the shortage in South Carolina. She explains the economic value of the health care industry to the region, and the potential costs should companies and others decide not to invest in the area in part because of a weak health care infrastructure.

Stuart directs Moredock's attention to something that is not always regarded as part of the shortage: a shortage of BSNs. Moredock notes that "75 percent of nurses in the state have associate degrees, yet national accrediting agencies recommend that no more than 33 percent of the work force should be associate nurses. The rest should have baccalaureate degrees or more." Stuart says this means "we're going in the wrong direction."

The piece also spends some time on initiatives Stuart has launched to try to address the local shortage. It reports that the South Carolina Nursing Collaborative she organized has raised $4 million to support MUSC nursing faculty, allowing the school to double the number of BSNs it awards. Stuart has also launched an interactive online academic program that allows nursing students throughout the state to participate, including as part of the MUSC doctoral program.

One telling part of the piece is Moredock's apparent surprise at discovering how important nursing is in the clinical setting, and how formidable people like Stuart are. He writes that the shortage "has led to some startling discoveries in the way nurses affect patient outcomes and the American health care system." Then he cites research showing that higher nurse staffing levels are linked to better patient outcomes, that 24% of patient injuries and deaths are "due to low levels of nursing staff," and that units staffed by nurses with at least a BSN "had lower patient mortality." Of course, this is only "startling" if you thought that nurses were insignificant pillow fluffers, rather than highly trained science professionals. On the other hand, the writer's evident surprise may actually help the many readers with the same perspective better assimilate the new information.

Similarly, Moredock is clearly impressed with "freshly minted PhD nurse" Winnie Hennessey, who he observes teaching a course at MUSC. Hennessey, lecturing on care for the terminally ill, "discussed a dizzying array of symptoms, conditions, medications, procedures." Moredock notes that Hennessey's varied three-decade career in nursing has included cardiology, digestive disease, and surgical intensive care, that her resume "runs more than 10 pages," and that her name is "on more than a dozen journal articles and other publications." Once again, the fact that these things appear in the piece speaks volumes. It's unlikely that any article would bother including such information about a physician, or about a professor in most other fields. But again, it is just the kind of thing the public needs to hear about nursing.

Moredock lets ICU nurse Deason end the piece:

This is not a sexy job. Grey's Anatomy is sexy, but they will never do a TV show about nurses ... People think that nurses just deliver pills and give baths, but it's nothing like that. This is not a TV show. The doctors don't do everything. We have a lot of autonomy in recommending and acting in an emergency... It's a very satisfying job. ... It's always a good day if both of your patients are alive at the end of your shift.

See the article "Critical Condition: S.C.'s nursing shortage could use some intensive care" by Will Moredock from March 14, 2007 in the Charleston City Paper.

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