Heidi Taylor, Ph.D., R.N.
Interim Dean and Associate Professor, College of Nursing and Health Sciences, West Texas A&M University
As a nursing education administrator married to a health care finance man, I look forward to reading HFMA's journal when it arrives. Over the years, I have been disappointed by how little attention nursing issues get in journals focused on the financial health of health care organizations. Your cover story in the October 2007 issue by Lutz and Root ("Nurses, Consumer Satisfaction and Pay for Performance") was a welcome read. The authors accurately describe the complex issues impacting the nursing shortage, with one minor exception.
To suggest that nursing education models have not changed much in 50 years is inaccurate. As a nursing education professional who evaluates baccalaureate and graduate nursing programs across the country for accreditation purposes, I can say with confidence that innovative models of nursing education abound. Many nursing programs have incorporated curricula that offer accelerated learning for persons who hold degrees in other disciplines, on-line programs, clinical simulation instruction to ease the burden on our clinical agency partners, and many other examples too numerous to list.
I strongly urge the professions in hospital management and administration to embrace the concept that nursing care IS the primary business of hospitals. Most services offered in a hospital could be done on an out-patient basis were it not that patients need to be nursed by well-educated professionals. My real dismay is that the HCAHPS patient satisfaction survey is used so heavily to evaluate nursing care.
Patients have a great awareness of the “comfort” care they receive from a variety of health workers, not all of whom are nurses. But patient satisfaction of comfort care is only a part of the quality nursing care story. Patients usually never know when nurses catch errors on medical orders, assess subtle changes in status that require swift intervention – and then intervene, coordinate members of a multi-disciplinary team to assure efficient care, advocate for patients when physicians argue over courses of treatment, figure out ingenious ways to administer multiple medications, ordered by multiple physicians, that are incompatible with one another. Oh, and in the meantime, answer call lights, educate patients, manage pain, listen carefully, keep the area quiet…and do all of these things for 8-15 patients at a time.
There is no simple solution to the nursing shortage and the quality care problem. But if you asked most nurses what they need to feel more satisfied with their work, my guess is that you would get a fairly consistent answer: “I need time to care for my patients in the ways they deserve to be cared for.” The moral distress experienced by nurses when they go home every day knowing they couldn’t do everything they wanted to do for their patients causes severe burn out, very quickly. It is no wonder that 50% of nurses leave their first job after two years.
