If you've ever been a patient in a hospital, you probably
remember a nurse who made a difference in your care. It may have
been someone who was right there to meet your every need, a model of
efficiency. It may have been someone who hugged you when tears were
cascading down your cheeks. Nursing in this country is a wonderful
combination of science and nurturing, and that's nowhere better
exemplified than in our hospitals.
There's trouble on the horizon, though.
For much of the last 100 years, if a bright young woman wanted to
enter a profession, she had two choices: nursing or education.
That's changed. These days, the student body of almost all
professional schools, including medicine, is about 50 percent women.
There's no question that society as a whole is better off to have
women contributing in every field. But with women who in the past
might have entered nursing now seeking careers in a variety of other
professional fields, less nurses are coming out of our nation's
nursing schools. And with many nurses moving into retirement or near-
retirement years, the nursing profession as a group is rapidly
aging. The average nurse in this country is 42 years old, and it's
an average that is rising constantly.
This growing labor crunch is exacerbated by the fact that the
pool of nurses is distributed in a different manner than it used to
be. Last year for the first time, more nurses worked outside of
hospitals than inside. The reason has to do with quality-of-life
issues, which in today's world are often as important as money in
attracting and retaining employees.
Hospital nursing is very difficult work. Hospitals by nature are
seven-day-a-week, 24-hour-a-day operations, requiring nursing
coverage around the clock. Hospital nursing also usually includes
fair amounts of overtime, adding to unpredictability in nurses'
Because managed care restrictions send marginally ill people home
to recover, the patients who remain in hospitals have a much higher
degree of acuity than in the past, making caregiving more arduous.
Patients are not only more ill, but sometimes more informed,
demanding and suspicious. Patients and their families have been
encouraged by media to be wary of care, which often gets translated
into significant demands on nursing time and attention.
Nurses get substantial demands from another direction, too.
Physicians, themselves pressed by the exigencies of a changing
health care environment, sometimes are quite exacting with their
In the end, we have a vicious circle. Because the work is hard
and demanding, and fewer nurses are being produced, the pool of
nurses is shrinking. That makes the job even more frustrating and
less satisfying. And round and round we go.
For all these reasons, many nurses choose not to even get on the
merry-go-round, while others are jumping off. Hospital nurses are
seeking and accepting opportunities to work in physician offices,
surgery centers and insurance offices. Away from a hospital setting,
nursing schedules are more predictable and work pressures are less.
Given the growing crisis, what are some solutions?
Pay is probably part of the issue. Nurses in this country start
at a salary of about $26,000, give or take a few thousand according
to the community, the size of the hospital and the unit in which
they'll be working. …