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Nurses take action to address shortage

and Karen Allen

Nurses are disappearing before our very eyes. The nursing shortage is one of the most pressing health care issues for our community, state and nation.

An unprecedented gathering of nurses from all corners of our region will kick off the New Year and come together as problem solvers to address some of the tougher questions: How can this shortage be addressed at the local level? Who will lead the charge to strengthen the RN work force? Who will have the courage to act in the best interests of the valley?

If you or a family member recently visited a clinic or hospital, you were probably struck with a stark realization—Registered Nurses are in short supply. Nearly one half of Oregon's registered nurses are 50 years of age or older and the proportion of older nurses has doubled in the past 20 years. According to the Oregon Center for Nursing, by the year 2025, 41 percent of Oregon's currently licensed RN's are expected to retire. Other nurses are leaving for different reasons. Some feel forced to leave the workplace because they can no longer deliver the caliber of care in which they believe. The requirement that operations remain "in the black" often translates to delivering lesser-quality care than professional nurses know is justified. Many nurses feel overworked and understaffed. Ideals taught in schools of nursing are replaced by the harsher realities of the job, in which long hours and inadequate RN/patient ratios often prevail. Often, good nurses leave to find less stressful, better paying jobs.

Even with these challenges, we are witnessing a significant increase in applications to schools of nursing. And while this helps to increase the number of graduates, we are still falling woefully behind. The 2006 data from Oregon State Board of Registered Nursing shows that we have increased the number of graduates from RN education programs by 76 percent since 2001. However, in our state, two to three times more fully-qualified applicants apply to schools of nursing than can be accepted into these programs; across the country, more than 30,000 qualified students were turned away from baccalaureate programs of nursing. (American Association of Colleges of Nursing, 2006).

If we do not act, it will get worse. Nursing faculty are leaving their jobs here and elsewhere. According to the Oregon Center for Nursing, by 2010, an estimated 65 full-time equivalent nursing faculty positions in Oregon will be vacated due to retirements and by 2015, Oregon will have need for more than 90 additional nursing positions. Some nurse faculty members are attracted to hospital and clinic jobs where salaries are higher. Some elect to move to states where better salaries exist. In most schools of nursing, faculty are required to hold masters and doctoral degrees, yet many are paid lower salaries than nurses with less education working in hospitals and clinics. A final challenge in building capacity in nursing schools is the need to find supportive hospitals which will welcome more students in a teaching environment. Such "learning labs" require extra time and attention from staff.

Here in Oregon and across the country, additional state funding must be secured and sustained if we hope to increase nursing school enrollments. In Maryland, the state legislature joined with local businesses and hospitals to raise over $50M dollars to double nursing student enrollments to 1900 undergraduates per year. Part of the initiative called for recruiting 400 additional nurse educators and paying them higher salaries to retain them. Hospital leaders willingly participated in this statewide nursing education effort because producing a steady pipeline of new nurses is now guaranteed. Those graduates will be put to good use staffing hospitals and clinics. Leaders acknowledged relief because they see an end in sight to a time when they will no longer need to rely on importing costly traveler nurses to use as staff. Extraordinary innovations — too numerous to mention here — are being crafted in our community, but more need to be designed and on a grander, more comprehensive scale.

The road to a stronger, healthier Oregon RN workforce is long. There are many questions to address along the way: how to find opportunities for applicants to our nursing schools, how to improve nursing work conditions, how to empower nurses and motivate them to stay on the job and in our state, and how to recruit and retain sufficient nurse educators to keep the pipeline producing. How do we assure that our legislators, hospitals and healthcare organizations will support these efforts through appropriate and sustained funding? These are some of the important questions to be raised at the upcoming Nursing World Cafés, being held at the Medford Red Lion Inn on January 9 and 15, 8 a.m.—noon. Sponsored by the Gordon Elwood Foundation and the Jefferson Regional Health Alliance, this will prove to be an event worth watching.

Jan Heineken, RN, Ph.D., is associate dean for Oregon Health and Science University's southern region, Ashland/Klamath Falls. Karen Allen, RN, MSN, BC, is associate drector for patient and nursing services at the Veterans Affairs Southern Oregon Rehabilitation Center and Clinics in White City.