I’ve always thought it to be an odd feature of the American healthcare system that nurses play such a subordinate role to doctors. These caregivers spend much more time with patients than physicians do, and they’re generally viewed as more trustworthy. Yet it’s the doctors who rake in the big salaries and exert the most influence on your diagnosis and treatment protocols.
For geezers like me, this power disparity is particularly galling when you consider the cluelessness most general practitioners display when faced with elderly patients suffering from multiple chronic conditions. It’s no coincidence, it seems to me, that in-home healthcare is so popular among the senior set. Most of that care is delivered by nurses.
That’s why we might want to pay some attention to the nation’s looming nursing shortage.
As Susan Gubar reports in the New York Times, healthcare facilities in a handful of states are already suffering from a dearth of nurses, and that trend is likely to accelerate in the next decade. The American Association of Colleges of Nursing estimates that as many as 1 million of the 3.8 million registered nurses will leave the workforce by 2030.
It’s not like there’s no interest in the profession; nursing schools are inundated with qualified applicants. But budget cuts and a lack of teachers holding the required advanced nursing degrees (who can earn substantially more outside of academia) have limited the number of available courses. In 2018, Gubar notes, these institutions turned away some 75,000 candidates.
With that academic pipeline reduced to a trickle and retirements shrinking nursing staffs, workload has expanded — with predictable consequences. Gubar recounts a friend’s experience at an Indiana hospital coping with staff and budget cuts. Rushed to the emergency room with a bowel blockage, she was forced to spend the night there because administrators had closed an entire floor due to a lack of nursing staff. When she’d finally settled into a room, she found herself waiting for 45 minutes before a nurse answered her call button. Apologizing, the nurse explained she’d been assigned two extra patients and was also expected to staff another part of the clinic.
Gubar, an ovarian cancer survivor, is no stranger to these conditions. During an appointment for a blood draw, she encountered a particularly frustrated nurse who noted that hospital administrators were unwilling to replace a departing receptionist. She and her colleagues would be required to fill the role — along with their other duties. “It’s gone from the human touch to ‘get it done and get it billed,’” she said.
More recently, Gubar was shocked to learn that her longtime oncology nurse was quitting. The workload and culture had simply become too much for her and her colleagues, one of whom told her, “I’d rather be a greeter at Walmart than work under these conditions.”
What makes this occupational crisis so tragic is that there’s plenty of evidence suggesting that effective nursing care can extend the health span of the elderly. A November 2019 New York University study, published in The Gerontologist, reviewed 27 years of research on a nurse-led eldercare program and found it significantly improved older adult care.
The program, Nurses Improving Care for Healthsystem Elders (NICHE), serves 580 acute-care hospitals and nursing homes in the United States, Canada, Singapore, and Bermuda. Those facilities, researchers found, were able to improve their quality of care in a number of areas, including patient safety and length of hospital stays. And, by implementing a “geriatric resource nurse model” that helped nurses assume leadership roles, the program also enhanced workplace culture.
“The evidence on the NICHE program is promising, though more research examining patient outcomes and the impact on healthcare professionals is needed to better help healthcare organizations to meet their goals and improve outcomes for older adults,” lead study author Allison Squires, PhD, RN, said in a statement.
Meanwhile, we may need to hear more from physicians like Haider Warraich, MD. The Duke University Medical Center cardiologist, writing in STAT News, lamented the absence of nurses at a 2019 conference focusing on patient distrust of doctors. “The consequence of such an omission is underscored by what happens when nurses and doctors collaborate,” he notes. Such collaboration improves both patient outcomes and job satisfaction. And it might just be the key to saving the healthcare system.
“If we are to reshape medical care and how it is perceived,” he adds, “the power dynamics between physicians and nurses need to be evened out.”