Turning Around the Negative '90s

Recovery, restoration, and renewal! These are the words Leah Curtin and I first thought about when we envisioned what this decade of health care and nursing would be like. The entire nation and world is now aware of facing the future with threats against humanity never before imagined. Bioterrorism, nuclear biological warfare, potential plagues of unthought-of dimensions, unsafe water and air, a public health nightmare, and where have all the nurses gone? Recent national surveys indicate that by the year 2020 we will be 29% short of nurses needed for health care. We now have a 6% shortage of nurses, with the worst per capita ratio being Nevada. As we envision 2020, it is most evident that we need a strategic plan to transform the nursing workforce through significant changes in nursing practice and education.

It is projected that just over 450,000 new nurses will graduate from collegiate nursing education programs between 2001 and 2010. That's a gap of more than 850,000 nurses. Nurses are frustrated with lack of support from management and insufficient pay for their services. They also are tired of doing non-nursing activities, but still feel proud to be a nurse and most would recommend nursing as a profession. Everyone-the American Hospital Association, the American Organization of Nursing Executives, the American Academy of Nursing, the National League for Nursing, and even JACHO-recommend that job responsibilities, processes, and procedures be redesigned. The impending shortage of faculty to teach future nurses is even more severe because many faculty members will be retiring and there are few to take their place. Partnerships between service and education are essential if we are to create a better tomorrow for the future of nursing.

But the real essence of the health care crisis is turning around the negative nineties, and who better to lead us in this most timely issue of Nursing Administration Quarterly than Leah Curtin, RN, ScD(h), FAAN, editor and publisher of Curtin Calls and Clinical Management Systems, Cincinnati, Ohio. Leah needs no introduction-she speaks around the country with great charisma and ethical knowledge about the issues confronting the profession. She is always there at the forefront of meetings and graciously contributes to whatever cause we find a need for. Leah has been a dear friend and colleague for more than 25 years, and we enjoy stimulating, thought-provoking discourse and writing.

There was a great deal of negativism in the last nursing shortage of the 1970s with DRGs (Da Revenue is Gone) being a driving force. Nurse-physician relations were so negative that the National Joint Practice Commission between the ANA and AMA initiated the movement of collaborative practice. Some nurse leaders created truly professional practice environments, which were recognized in the original Magnet hospital study by the AAN. And now the Magnet hospital recognition is one way to turn around the negative '90s.

But does every hospital or health care setting have to be a Magnet-recognized facility? I think not. Many simply cannot afford the costs and have excellent nursing practice environments. Nurse leaders have to have strong voices in planning and policy-making and gaining control of nursing practice with setting limits on what nurses would and would not do. The most significant factor is for the nurse leaders to be strong nurse advocates and to represent the needs of nurses in an articulate fashion with a caring philosophy that pervades the practice environment. Nurses have to be empowered to direct their practice environments to give quality patient care.

Radical solutions are needed to avert a major health care crisis. Who will care for the sick, injured, and well school children, senior citizens, new mothers and babies, the dying-all people from all walks of life-if there are no nurses?

Although nurses are running away from their jobs and retiring early or simply choosing not to work as registered nurses, schools of nursing are partnering with health care providers to overhaul the system of nursing education and practice. Some historians would refer to the former teaching head nurse positions, but with nurse managers in a crisis situation, partially do to the demise of so many graduate programs in nursing administration, teaching is the least on the manager's financial bottom line mind.

Can the present education system teach nursing students to meet the needs of consumers as well as the constantly changing health care system? Are nurse educators capable of implementing the practice role of the professional nurse? Do they know enough about administration and management to articulate to students the real world of nursing practice? How is leadership taught so that neophyte nurses learn how to communicate and delegate to unlicensed personnel-because you know we will have more rather than less. Do those in service settings create environments conducive to the professional practice of nursing so that today's young professionals can translate the ideals of education into the real world of practice? Are nurse leaders in both education and service seeking the same goals of excellence in patient care?

Turning around the negative '90s will take a renewal of the world of nursing's commitment to nursing and the public we serve. We have too many vested subinterest groups. Come on now-more than 100 separate nursing organizations, each with their own agenda. We have met the enemy and it is us. Yes, I have used this phrase before, but it is also relevant today. Compromise, collaboration in nursing, and a clear vision for the future are necessary if nursing care systems and education are to meet their responsibility to work together for a healthier tomorrow for nursing and its role in society.

The profession of nursing must be clearly understood by society for its unique contribution to health care and we are on the way to doing this. The public is beginning to view us as an intellectually challenging, economically advantageous, and evolving career option with a global presence. That is why we see so many second and third career entries into nursing. By 2020 nurses will be the professionals of choice for managing/advocating each family in health care matters. Nursing is becoming an evidence-based practice discipline with research data to prove the differences nurses make. We are innovative and entrepreneurial in improving nursing care to ensure quality, cost effective outcomes. This spirit will eventually enable nurse practitioners as the provider of choice to admit patients to home care and nursing homes for nursing care. It is so ludicrous that the gatekeepers do not allow this today when a physician in these settings almost never sees patients. Nurse leaders are continuing with greater strength and numbers, to be present at the table when health care policy issues are discussed and decisions are made that affect the mainstream of nursing resources. Yes the negative '90s can be turned around, but it will take a nursing unification and effort by all nurses, regardless of education background and unique differences. The health care of our nation needs every nurse responding to the diverse needs of every American for a better and healthier tomorrow.