When Kristyn Gresham worked as a volunteer for the La Leche League, the breast-feeding-awareness organization, people frequently would remark that she would “be a great nurse.”
“I liked the idea,” Gresham recalled. “It’s a field in which you can help people feel better every day.”
Some friends warned the Morton Grove resident about “being worked too much” and “seeing sicker patients in shorter times.” Such talk didn’t deter Gresham from earning a nursing degree from Oakton Community College in mid-2001. She has worked as a surgical nurse at Rush North Shore Medical Center in Skokie since graduation.
In many ways, Gresham’s career path is exactly one that nursing recruiters hope more and more individuals follow to reverse a labor shortage that figures to reach full crisis mode by 2010. But her career path differs from most in one detail: Gresham is 42.
“I know my age is pretty close to the average age of nurses,” said Gresham, who is mother to three children, aged 14 through 22. “We need more young people in the profession.”
The average age of registered nurses is 45, according to research published by nursing scholars earlier this year. In fact, 30 percent of RNs are 50 or older, while a mere 9 percent are younger than 30. Nearly 95 percent of nearly 2.7 million RNs in the United States are women.
There is a serious problem forming in these statistics, which nursing schools and related organizations are recognizing and intently studying. Employment of registered nurses is expected to grow by 20 percent to 35 percent each year between now and 2010, mostly because of an aging population and technological advances that allow more medical conditions to be treated. But many 40-, 50- and 60-something nurses will be leaving the profession for reasons ranging from simple age-related retirement to more complex work-life balance issues.
Based on projections from the U.S. Bureau of Labor Statistics, 1 million new nurses will be needed by 2010. That’s a tall and potentially impossible order. Eleven percent of nursing positions at American hospitals already stand unfilled.
“There is no one solution,” said Eleanor Sullivan a registered nurse and former president of a nursing honor society, Sigma Theta Tau International, who has taught doctoral classes on the future of nursing. “But one thing nurses need to do is make themselves and the profession more visible. We are the invisible majority of health care.”
The nursing shortage figures to intensify between 2010 and 2030 if no turnaround measures are in place. One group of patients would be most affected.
“America will face a health-care crisis beginning in 2010: Not enough nursing-care providers to care for the people who need it most, our senior citizens,” wrote a special task force commissioned in 2000 by the Nursing Institute at the University of Illinois at Chicago and led by former U.S. Labor Secretary Lynn Martin, now an adviser at the Deloitte & Touche accounting firm.
“Technology is not the answer. Technology cannot produce or replace the human beings needed to provide health care to our aging population. It cannot change beds, dispense medicine or bathe and dress people. There simply will not be enough people to provide the touch, the smile and the skill to care for the elderly,” the report states.
The UIC task force pointed out that the U.S. population of adults between 18 and 64 is expected to decrease 6 percent between 2010 and 2030, while Americans 65 and older will increase as much as 20 percent. A pivotal number is the 85-and-older population, which will increase by more than 4 million in the next three decades; 20 percent to 50 percent of these individuals will require basic nursing care or assistance with daily living.
It calculates to a fast dwindling ratio of potential caregivers to people who will need care. Just how to stop the decline is the paramount question for nursing leaders, who believe all of us should be aware and concerned about finding the right answers.
“The largest percent of labor dollars spent on health care goes to nurses,” said Noreen M. Sugrue, a senior research associate at the University of Illinois at Chicago College of Nursing. “Legislators are always looking for a way to cut those costs without considering its effect on nursing care.”
Sugrue said that a typical full-time nurse will earn about $40,000 to $45,000 per year but added that a nurse’s buying power hasn’t changed much in the last 10 years. Yet she, like others, said money is not the top issue for cracking the approaching labor crisis.
“The work environment needs attention,” she said. “Some nurses might work 8 to 10 [consecutive] days without time off. At the end of their shifts, they can’t and won’t just walk off the floor if there is not enough staff coming to replace them. Think about how that affects a single mom who needs to pick up a child from day care.”
Julie Schaffner, vice president of operations and chief nurse executive at Advocate Lutheran General Hospital in Park Ridge, said, “Happy nurses lead to happy patients.”
A role in decision-making
For one thing, she said, it is critical for hospital administrators and doctors in private practice to include nurses in decision-making in matters ranging from work schedules to patient care.
“The patient’s experience is highly dependent on the nursing care they receive,” Schaffner said. “We regularly ask our patients about the nursing care, and we regularly ask our nurses about job satisfaction.”
Another wise investment is to providing training and education opportunities for nurses.
“Nurses take the responsibility of educating patients seriously,” she said. “They want to have the best tools to educate.”
Interestingly, more than a few nursing scholars identified more rigorous professional training as a possible solution to the labor shortage. Currently, nurses can become licensed after attaining a two-year diploma.
People such as Eleanor Sullivan said a four-year bachelor of science degree needs to be the new standard.
“There is not a single other health profession that requires only two years of education,” Sullivan said. “It keeps the nurse’s status low.”
Though raising the educational bar might seem only to heighten labor crisis conditions, Sullivan said, it won’t deter most nursing candidates and likely would upgrade its appeal.
“Nobody goes into nursing to get rich,” Sullivan said. “It is similar to people who become social workers or special-education teachers. It’s about making a difference.”
Enrollments increasing
A new survey by the American Association of Colleges of Nursing supports Sullivan’s argument. Enrollment in entry-level baccalaureate programs in nursing increased for the fall of 2001, the first time in six years. Enrollment is expected to rise again this fall.
Nursing deans are attributing the rise in nursing undergrads to an intensified recruitment campaign (including Internet site enhancements and more recruitment staff) and, in some cases, federal grants to increased underrepresented demographic groups in nursing (men at the top of the list).
Another factor is a “Be a nurse” television ad campaign sponsored by medical supplier Johnson & Johnson. The commercials have struck a chord with nursing candidates, Schaffner said. The success is to that firm’s credit but also shows how some image-building can help the nursing profession in the years ahead.
“We have had a health-career program with Maine East High School that highlights nursing as a profession,” Schaffner said. “But we are now starting career talks at the elementary and middle school levels. Research shows a good number of kids make up their mind about careers by 5th grade.”
It’s as much about what the kids don’t see themselves doing. And parents can be part of the negativity. The UIC task force contended that a critical benchmark for a nurse’s image is whether parents would want their daughters or sons to pursue the profession. These days, the answer too often is “no.”
A lifelong ambition
The answer hasn’t changed much, in fact, since the 1960s, when Chicago native Paula Dillon attended the University of Colorado.
“I always wanted to be a nurse,” said Dillion, 55. “I come from a family of nurses and physicians. But I talked myself out of it at the time, thinking it was bad pay for too many hours. So I got a teaching degree even though I never wanted to be a schoolteacher.”
Dillion said her father’s “lukewarm” response to her nursing dreams contributed to her decision.
Several years and many soul-searching sessions later, she moved back to Chicago, enrolled in a nursing undergraduate-degree program at Loyola University, then later earned a master’s degree in nursing at the University of Illinois. She now is director of about 400 medical surgical nurses at Rush-Presbyterian-St. Luke’s Medical Center. She has rough days–who doesn’t?–but few regrets.
“Nursing is a good and interesting career,” Dillion said. “I most enjoy all of the interaction with the nursing staff. They are dedicated and determined to do the best job.”
Dillion has some backing on her statements. The nurses at Rush recently were collectively awarded with a Magnet Award designation from the American Nurses Association. Only 51 hospitals out of a possible 5,810 have received the honor across the country.
Money’s not the answer
Like other peers, Dillion said, she hopes to see four-year undergraduate degrees become the minimum entry standard for nurses during her career. What’s more, she agrees that money is not the top issue for solving the looming nursing labor problem.
“People might go to a new hospital or medical practice for a raise or bonus,” Dillion said, “but they won’t stay for money. There has to be something more.”
The U. of I.’s Sugrue is a nursing researcher but not an RN herself.
“People need to understand nursing is not only a noble and honorable profession but essential,” Sugrue said. “I would be pleased if my [9-year-old] daughter took on the work.”
For her part, Kristyn Gresham took her youngest daughter, 14-year-old Melissa, to work on the national Take Your Daughter to Work Day in April.
“My older kids [Jim and Terri] have already decided on careers, but Melissa is still thinking about her options,” Gresham said. “I have always hoped one of my children would become a nurse. After a day at work with me, Melissa said, `Wow, this is really cool.’ That made me feel good about the future of nursing.”
